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- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. David Homesley,
an orthopedic surgeon at Novant Health.
Dr. Homesley, it's a pleasure
to have you on the podcast today.
- Well, thanks for having me
- Now, I'm looking forward to our discussion.
I know we'll talk a lot about some
of the new technology in the orthopedic space,
especially robotics and how the technology's evolving.
But before we dive into those questions,
can you tell me a little bit more
about yourself and your background?
- Yeah, I, um, I've been in practice for about 20 years
and I trained at the, uh, Rothman Institute, did
residency and fellowship there and finished in 2003.
And, um, I've been in Charlotte since 2004, um,
where I'm, uh, the chair of the orthopedic department
of Novant Health, uh, Presbyterian Medical Center, uh,
here in Charlotte, North Carolina.
And it's a big health system that's a non-for-profit, uh,
system that, um, supplies, uh, healthcare
and services to communities in Charlotte, Winston,
and Wilmington, North Carolina.
- Well, that's amazing to hear.
And you know, it seems like a huge, uh, department
to really be overseeing.
Um, from your perspective, could you talk a little bit about
how you're using robotics
and how that's changed the field of orthopedic surgery?
What have you seen as the advantages of using robotics?
- Um, I, I think that, you know, it's an evolving field.
I, I think that it's, I think
that the technology has improved
a lot over the last 10 years
or so, where it's a lot more efficient and it's giving, uh,
or I think it can give surgeons data in the operating room
that can make choices
or decisions for the patient, um,
specifically given their anatomy and,
and what their deformity is for, um, in, in particular
for like knee replacement planning.
- Well, that's fascinating to hear,
and certainly as you mentioned, I,
I know the technology has really evolved over the, um,
the past few years, especially to get to a place
where it's very sophisticated
and I hear it, you know, it can definitely be more precise
even than it was, you know, five, 10 years ago.
From your perspective, having all that data
and information, how does it change the way you think about
patients and, and, um, the level
of care you're able to provide?
- Well, I think, I think what I like about it is that,
you know, when we do a knee replacement
and, you know, he is trying to get a good,
well-balanced knee, um, that's essentially centered
underneath the hip and above the ankle.
And I think that we have really good accurate, uh,
alignment rods and tension devices to achieve that.
But I think what the robotic surgery does is it really helps
with the, um, equating that, I guess,
idea of feel factor
and tension devices to essentially numerical data
that then you can kind of translate into not only
what you're feeling but what you're seeing on the computer
screen in real time, that then you can position
the femoral component
and the tibial component to kind of match
that patient's, um, soft tissue laxity
or their knee, uh, motion, um, by not having
to potentially take more bone
or, um, release more tissue or and accommodate for that
before, even before you starting the surgery.
- Well, that's fascinating to hear and,
and really seems like a cool, um, technology to have,
have patients, uh, really appreciated having their,
their robot as part of the surgery?
Or is that something, you know, um,
that some are a little bit nervous about?
- I think, I think a lot of them like it
because they, I think they just feel that it kind
of gives you more data
and I think they, you know, um,
maybe trust the surgery just a little bit more.
I mean, I, I I will say that, you know,
when we we're doing surgery on patients, a lot of it, a lot
of what we do is from the confidence of,
of the patient with the surgeon
and that they have a more confidence,
I feel like they're gonna do better
and then they're not questioning as much.
So I think if they, they feel like, and I do,
and I do feel the,
the robotic surgery does give you more information
to be able to make better decisions about, like I said,
with the balancing of the knee.
And I think that if you kind of explain it, explain
to the patient that way, they, they feel more comfortable,
comfortable about, um, their outcomes.
- That makes a lot of sense, you know,
and really it seems like it would be, um, a valuable tool
to have, as you mentioned in the operating room.
Um, from your perspective too, is it now, you know,
most surgeons are learning about the technology
and learning about robotics
when they're going through training.
Um, how does that really affect new surgeons coming up now,
um, and really being able
to use the technology appropriately and,
and, um, be able to include
that within the care that they're delivering?
Do you see this as eventually becoming a standard of care
or how do you see robotics, um, moving forward?
- That, that's a, a great,
and I would say tricky question, uh, to
answer in the sense that that, you know, the,
the robotic surgery doesn't really do the surgery.
I mean, you have to know how to balance a knee
because, you know, I, I think that with the, the training
that we do through courses, um, through, um,
if you're already out in practice and,
and you, you do it, I would encourage a, you know,
to either, um, definitely, uh, work with a, a lab
where you can do it on cadaver
and if you have the opportunity to scrub with a, a surgeon
that's experienced to definitely do that
because what you'll probably find is, is based off
of your exposure and your experience.
'cause you know, I've, I've been doing 'em for five years
and I've done probably, I've done over a thousand of them
and every knee's a little bit different.
But what I think, what's what I have found is, is that
with the robotic surgery,
what I have found is very consistent with it, I find is, is
that the numbers that I'm seeing in the operating room
are probably particular to me in
what I do in the operating room.
And I think if another surgeon was doing the same robotic
system, they looked at those numbers,
they may not quite be the same based off of
what their exposure is and how they like their knee.
Some docs like their knee a little bit tighter
or some like a little bit looser based off of
where their starting point is.
Um, so, so I do find there's
definitely a learning curve from there.
And so it is definitely something to where
I think in the orthopedic training, you definitely gotta
have a lot of experience, you know, with the surgeon
who doesn't do the robot to understand how
to balance the knee because there'll be some nuances
that even when you do the robotic surgery, you'll get
to the end and you'll still have
to do some little tweaking with the balancing.
I, I find though, with the robotic surgery,
I'm finding I'm doing that less
and less with the robotic surgery.
So when I get to the end and I'm trialing it, I'm not having
to do, um, recutting it
or doing soft tissue releases where sometimes
with the manual you may have to do that.
And, and also what's neat about the robotic surgery,
if if you feel like you can't, you're not gonna be able
to accommodate it with a soft tissue release
or you're not happy with something.
What's neat about the robotic surgery is that if you have
to go back and recut something, it's, it's, um,
even more accurate of recutting than having
to put the cutting black, cutting blocks back on the knee
to, to refashion the cut.
Um, so I think some, there's some advantages to the robot,
but it, but it's not the end all be all.
I mean, you, you have to understand kind of the mechanics
of the way your knee, the way you like your knee replacement
and how the numbers that you get on the robotic surgery
translate to what you do.
- That makes a lot - Of sense. That
answered the question .
- Yeah. Yeah, no, I appreciate that.
Um, and I appreciate you getting into the nu nuances of it
because certainly, you know, there's a lot
to think about there and um, as you mentioned, being able
to understand the procedure, um,
in each surgeon's a little bit different in
how they prefer things to go.
So, um, that, that's really helpful information.
Now broadening it out a little bit, when you look at, um,
yourself and in, um, the orthopedics department at Novant,
how are you thinking about growth
and adding value to the organization overall?
What do you really see as being areas where you're going
to spend most of your time on over the next year or two?
- I, I would say I, I think most of it is, is, is just
taking care of taking, uh, good care of patients.
I, I think that, um, you know, the, the, um, the thing
with the robotic surgery, I think is, it's a, it's a,
it's a really, um, neat technology
and I think that as the, the word gets out
and patients, you know, learn about it, you know,
I think it is something that that helps, um,
with, with the outcomes.
And I think it's, it's neat to stay on top of the,
the technology
but also to explain to patients too that in hip
and knee replacements we've got such good technology,
it's hard to say what the, the newest stuff
that's coming out's gonna be the best for them
because we need about 10 years of data to show that
what we've been using is, is good and,
and is better than what we're currently using now.
And I think we're getting, we have enough data now to show
that with the robotic surgery, it's definitely the same
as the traditional way of doing it.
And I think as we kind of move forward,
we're probably gonna find that I think it's, you know,
it'll be, um, if not equal, better in the sense
of consistency, consistency for patients.
So I think, I think that part's neat, neat for patients,
you know, just trying to stay, staying up
with the technology and you know, just kind of explaining
to patients what's out there because they do get a lot
of information off the internet.
And part of our job that's frustrating is it is sometimes
'cause of what comes out in the, in the internet is just to
explain it to 'em in a, you know, in a, um, in a way
that they understand that that's kind of best for them.
- I can imagine that there, you know,
sometimes it's misinformation
and sometimes the marketing hyperbole that gets in there.
Um, you know, and it can become tiring to, to continue
to explain that to patients.
But such an important lesson in, in part
of your interactions with them.
Um, you know, do you ever get patients coming in asking
about robotics or really
wanting that to be part of their care?
- Yeah, I think they do because they, they, they,
they're starting to hear about it more
and they just kind of wanna know, um, what's out there
as far as the tech technology goes.
And I think part of that is a little bit word of mouth.
Sometimes it's even, um, you know, um,
with the patients, um, being referred for from their, um,
doctors and um, you know, kind of just wanting to know kind
of what's out there to give them the best possible
outcome that they can get.
And I think, I think that one
of the neat things about working at, um, Novant is,
is they kind of all, uh, um, you know, working as a team to,
to try to make the best possible results
they can for the patient.
And you know, that kind of starts from the nurses,
the physical therapists, the anesthesiologists,
and you know, I think that gives us some really good
outcomes to where, you know, we've, we've become, um,
a partner with, uh, Carrum Health,
which is like a digital health company that kind
of looks at the top 10% of providers, you know,
based off of their outcomes.
And we've been lucky and,
and fortunate to be able to partner with them.
And so that's gathered more patients too, um, with, for, um,
hip and knee placements.
- Absolutely. That's great to hear. And you know,
you also mentioned some of the misconceptions.
Is there one common thing
that people come in thinking that just isn't true?
- I would say as far as a knee replacement goes,
they come in thinking that the knee is gonna, you know,
fix all their problems
and once we put the knee in it is gonna feel like a normal
knee and they'll never know it's a knee replacement.
And what I try to explain to patients is regardless of
how well aligned or how well balanced it is,
they'll probably always know it's an artificial knee.
'cause it just doesn't move like a normal knee, regardless
of the implant that you use.
Um, it's, you know, obviously usually better than the
arthritic knee, um, where you can, you know,
do activities on it, um, that, um, you know,
that they can't do on their arthritic knee.
Um, and so that's something they've gotta, uh, uh, try to,
I try to, uh, explain to the patient
where the hip replacement, a lot of patients, you know,
they'll forget which hips replace
and the rehab's not as hard
and other than some maybe numbness over the incision,
they'll may forget which hips replaced.
But a knee, a knee, the complexity of it's just
so much the way it moves, it's so hard to reproduce
with a knee replacement that most patients will kind
of know it's an artificial knee.
- Got it. That, that's really interesting to hear and,
and definitely, um, good to know.
Now, is there any other technology that you use and,
and really feel like is cutting edge
or on the forefront of, of, uh, where orthopedics is headed?
- I, I, I, I've, I've probably over 10 to 13
or 14 years I've been using, um, um, uh,
with some knee replacements.
I've been using uns cemented knees or pre FITT knees.
Um, I've had really good results with those.
Um, and those are, you know, when we do a knee replacement,
a lot of times we'll cement it to the, um, end of the femur
and the, the tibia.
Um, but I've been also,
but I've been doing a lot of, um,
what's called press fitt knees, where there's bone on growth
so you don't have to use cement.
Um, and I, I like that technology a a lot, um, and it,
and it's been good to me
and my patients, so I've continued to do those
and been doing, um, more
and more of those, uh, CrossFit needs.
- Well, that's awesome to hear.
Thank you for sharing that with us.
Now, before we wrap up,
I'm wondering are there any other areas where you see it
as being really primed for growth
and development in orthopedics going forward?
- I, I think, I think that, um, you know, I,
I think it's just, it's, it's something where, like I said,
with the hip and knee replacements,
our technology's really good currently where we think,
you know, hopefully they're gonna last 20 to 30 years.
So it's hard on new technology to come out to,
to jump on that bandwagon.
And I think that, you know, a lot of surgeons did
with the metal and metal
technology with the hip replacements.
'cause in the lab, you know,
it looked like it was gonna do well
and then there are patients that didn't do well with those.
Um, so I think that, you know, it's being careful
but also kind of looking at, um,
the outcomes of the patients.
And I, I think that, you know, kind of back
to the question you just asked me, the other,
the other thing I'd find, not necessarily technology,
but um, it's more, uh, too of what are the
outside modalities that we can utilize
to help the patient have a better outcome
with their physical therapy and activity level.
And so I think that's kind of a team approach
and doing things like, um, you know, peripheral nerve blocks
and regional anesthesia, um, different types of, um,
you know, uh, medications that we use, um, interop
and post-op to help the patient be able to kind
of do their physical therapy a little bit easier, um,
which can improve their outcomes.
- Fantastic. Well, Dr.
Homesley, thank you so much for joining our podcast today.
This has been really a fun and interesting conversation
and I look forward to connecting with you again soon.
- Sure. I appreciate you having me.
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