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At the Interdisciplinary Conference on Orthopedic Value-Based Care, According to an article in Helio, Randy Fagin, MD, chief medical officer – national group of HCA Healthcare, said among the 183 hospitals in the HCA Healthcare system, about 88,000 hip and knee replacements are performed annually, not including those performed at the system’s 125 ASCs.

And according to Dr. Fagin, “Physicians who use robotics are growing faster, 36% year-over-year case growth vs. 7% for those who are not using robotics.”

However, a factor that may be disruptive to robotics is augmented reality (AR), Fagin said. “Augmented reality is, I believe, going to be disruptive to robotics, massively disruptive. It is going to come on slow.”

However, because AR is a disruptive innovation, “it’s going to hit a dynamic growth curve” followed by a logarithm rise in utilization, until such time that the utilization levels out and become commoditized, Fagin said.

“We’re going to hit a logarithmic rise in utilization of augmented reality in hip and knee replacement and it will disrupt the robotic marketplace,” he said.

An article published by Stanford University helps explain how this new technology might be used by surgeons.

Surgeons make their way down to the Neurosurgical Simulation Lab to practice an upcoming operation. Because they’re practicing on images from the actual patient, rather than a generic brain, they can map out the surgery ahead of time. “It’s a window into the brain – and a window into the brain of the particular patient we’re going to operate on,” said Anand Veeravagu, MD, an assistant professor of neurosurgery and the head of the Stanford Neurosurgical Simulation Lab.

The three-dimensional aspect of the imagery eases surgeons’ planning and improves the accuracy of the surgery, with the aim of producing safer procedures. “We can plan out how we can approach a tumor and avoid critical areas like the motor cortex or the sensory areas,” said Steinberg, professor and chair of neurosurgery. “Before, we didn’t have the ability to reconstruct it in three dimensions; we’d have to do it in our minds. This way it’s a three-dimensional rendering.”

Stanford Medicine doctors are using the VR technology for the brain and spinal cord because these organs are stable and lend themselves to imagery – unlike other body parts, which move with blood flow and breathing. But Malie Collins, MS, senior program lead for the VR program said the technology may soon be available for the rest of the body.

Surgeons typically use video feeds while they are operating, but the new VR technology adds a three-dimensional view which they can superimpose on the real-time video. “It has much, much more detail,” said Steinberg.

And Johns Hopkins neurosurgeons have performed the institution’s first augmented reality surgeries in living patients. During the first procedure on June 8, 2020, the physicians placed six screws in a patient’s spine for spinal fusion surgery to fuse three vertebrae in order to relieve the patient’s chronic, debilitating back pain. For the second surgery on June 10, surgeons removed a cancerous tumor known as a chordoma from the spine of a patient.

The technology used by the physicians for the augmented reality surgeries consisted of a headset with a see-through eye display that projects images of the patient’s internal anatomy such as bones and other tissue based on CT scans – essentially giving the surgeons X-ray vision.

“When using augmented reality in the operating room, it’s like having a GPS navigator in front of your eyes in a natural way so you don’t have to look at a separate screen to see your patient’s CT scan,” says Timothy Witham, M.D., director of the Johns Hopkins Neurosurgery Spinal Fusion Laboratory and professor of neurosurgery at the Johns Hopkins University School of Medicine.