1 00:00:00,080 --> 00:00:01,679 Hi, everyone. This is Lucas Voss with the 2 00:00:01,679 --> 00:00:04,319 Becker's Healthcare podcast series. Thanks so much for 3 00:00:04,319 --> 00:00:06,980 tuning in today, and I'm very excited 4 00:00:07,359 --> 00:00:09,519 to be joined by 2 great experts today, 5 00:00:09,519 --> 00:00:12,799 doctor Keith Behrendt, chief medical development officer at 6 00:00:12,799 --> 00:00:15,345 Ortho Alliance and surgeon partner at JAS 7 00:00:15,644 --> 00:00:16,144 Orthopedics, 8 00:00:16,845 --> 00:00:19,905 and doctor Wilburrd, surgeon partner at Atlantic Orthopedic 9 00:00:20,204 --> 00:00:20,704 Specialists. 10 00:00:21,245 --> 00:00:23,164 Doctor Behrendt, doctor Boyd, thanks for being here 11 00:00:23,164 --> 00:00:24,545 today. Great to have you. 12 00:00:25,404 --> 00:00:27,619 Great to be here. Yeah. Thanks so much. 13 00:00:27,619 --> 00:00:29,779 Looking forward to it. Absolutely. This is a 14 00:00:29,779 --> 00:00:30,839 fascinating conversation. 15 00:00:31,379 --> 00:00:33,700 Before we get into the weed of things 16 00:00:33,700 --> 00:00:36,579 here, doctor Behrend, would you mind introducing yourself, 17 00:00:36,579 --> 00:00:38,979 and then we'll follow that up with doctor 18 00:00:38,979 --> 00:00:40,579 Burd. Can you talk a little bit about 19 00:00:40,579 --> 00:00:42,520 your yourself and your work? 20 00:00:43,115 --> 00:00:45,354 Sure. Thanks. So my name is Keith Behrend. 21 00:00:45,354 --> 00:00:46,975 I am a hip and knee surgeon, 22 00:00:47,354 --> 00:00:49,935 in New Albany, Ohio outside of Columbus. 23 00:00:50,314 --> 00:00:51,114 Been here, 24 00:00:51,594 --> 00:00:54,494 a little over 20 years in specialty practice. 25 00:00:54,969 --> 00:00:58,729 Did a fellowship here, with JIS Orthopedics, Adolf 26 00:00:58,729 --> 00:01:00,729 Lombardi, Tom Mallory, and and stayed on as 27 00:01:00,729 --> 00:01:01,309 a partner. 28 00:01:02,250 --> 00:01:02,729 And, 29 00:01:03,129 --> 00:01:05,709 I've been down the road of really 30 00:01:06,170 --> 00:01:07,950 jumping into the partial knee 31 00:01:08,545 --> 00:01:11,504 pool, and then the anterior hip pool, and 32 00:01:11,504 --> 00:01:13,905 then sort of my midlife crisis has been, 33 00:01:14,224 --> 00:01:17,825 that kinematic alignment with the medial sphere concept. 34 00:01:17,825 --> 00:01:20,484 And so I'm excited about the discussion today. 35 00:01:21,349 --> 00:01:22,730 Absolutely. Doctor Byrd? 36 00:01:23,109 --> 00:01:24,950 Yeah. Thank you. Yeah. My name is Will 37 00:01:24,950 --> 00:01:27,349 Byrd. I'm a joint replacement surgeon out of 38 00:01:27,349 --> 00:01:28,489 Virginia Beach, Virginia. 39 00:01:28,870 --> 00:01:30,870 Been in practice for about 5 years now 40 00:01:30,870 --> 00:01:32,730 and specialize in hip and knee replacements. 41 00:01:33,435 --> 00:01:35,594 I have a focus in outpatient surgery with 42 00:01:35,594 --> 00:01:38,635 rapid recovery protocols. And for my knee replacements, 43 00:01:38,635 --> 00:01:41,915 I'm doing a unrestricted caliper verified kinematic alignment 44 00:01:41,915 --> 00:01:43,454 through a subbasis approach. 45 00:01:44,715 --> 00:01:46,015 That sounds very complicated. 46 00:01:46,370 --> 00:01:48,049 It's a lot of words. Yeah. We'll talk 47 00:01:48,049 --> 00:01:49,329 about that in a second. And I it 48 00:01:49,329 --> 00:01:50,930 was very interesting. As I was doing some 49 00:01:50,930 --> 00:01:53,010 research and looking into these questions, writing these 50 00:01:53,010 --> 00:01:55,670 questions, I had actually heard of kinematic alignment, 51 00:01:55,730 --> 00:01:57,670 we'll call it k a, throughout the conversation 52 00:01:57,730 --> 00:02:00,225 here, because I follow, you know, athletes a 53 00:02:00,225 --> 00:02:02,965 lot and and injuries and how they recover, 54 00:02:03,025 --> 00:02:05,525 etcetera. So I had heard of kinematic alignment, 55 00:02:05,984 --> 00:02:08,564 and and it has certainly gained some popularity, 56 00:02:09,344 --> 00:02:10,405 because of its accessibility 57 00:02:11,025 --> 00:02:12,705 for a lot of different patients. Doesn't matter 58 00:02:12,705 --> 00:02:15,030 if you're high performing athlete or not, whatever 59 00:02:15,030 --> 00:02:17,289 it may be, and, certainly, the compatibility 60 00:02:17,830 --> 00:02:20,090 with, the implants on the market, etcetera. 61 00:02:20,710 --> 00:02:23,590 We'll start with, with doctor Behrend here. Can 62 00:02:23,590 --> 00:02:25,189 you walk us a little bit through what 63 00:02:25,189 --> 00:02:25,689 PACE 64 00:02:25,990 --> 00:02:26,729 and elaborate 65 00:02:27,110 --> 00:02:27,610 on 66 00:02:28,375 --> 00:02:31,335 why it's seeing sort of a popularity spike 67 00:02:31,335 --> 00:02:33,754 and why physicians are gravitating towards it? 68 00:02:34,534 --> 00:02:36,694 Sure. I I I think that's probably the 69 00:02:36,694 --> 00:02:39,034 the biggest crux of the discussion 70 00:02:39,415 --> 00:02:40,395 around KA 71 00:02:41,094 --> 00:02:43,415 worldwide, and that is, you know, what what 72 00:02:43,415 --> 00:02:46,719 is it? So kinematic alignment really goes back 73 00:02:46,719 --> 00:02:49,439 about 20 years, maybe maybe 18 years to, 74 00:02:49,680 --> 00:02:51,300 the work of Stephen Howell. 75 00:02:51,680 --> 00:02:53,759 He was working off of some concepts that 76 00:02:53,759 --> 00:02:54,959 were brought forth by, 77 00:02:55,439 --> 00:02:56,739 researcher named Eckhoff, 78 00:02:57,375 --> 00:02:59,715 looking at the cylindrical axis of the knee. 79 00:02:59,935 --> 00:03:02,254 And so fast forward now, again, almost 2 80 00:03:02,254 --> 00:03:04,495 decades, and Steve Howell, it turns out, was 81 00:03:04,495 --> 00:03:04,995 correct 82 00:03:05,375 --> 00:03:08,174 in his assumptions and and in his science 83 00:03:08,174 --> 00:03:09,155 and and clinical, 84 00:03:09,775 --> 00:03:11,715 application of the concept where, 85 00:03:12,590 --> 00:03:14,990 basically, in order to do what is real 86 00:03:14,990 --> 00:03:17,550 kinematic alignment, you can call it anything you 87 00:03:17,550 --> 00:03:20,290 want, but the only true kinematic alignment 88 00:03:20,909 --> 00:03:22,770 is resurfacing the knee 89 00:03:23,230 --> 00:03:25,409 back to its original surfaces. 90 00:03:26,485 --> 00:03:28,884 And so by definition, you have to take 91 00:03:28,884 --> 00:03:31,844 out the exact same amount of diseased bone 92 00:03:31,844 --> 00:03:32,504 and cartilage 93 00:03:32,884 --> 00:03:33,864 that you're replacing 94 00:03:34,485 --> 00:03:36,504 with metal and metal and plastic. 95 00:03:37,044 --> 00:03:38,724 The only really way to do that is 96 00:03:38,724 --> 00:03:38,868 with caliper verification. It's been proven, multiple times, 97 00:03:38,868 --> 00:03:39,810 as doctor Byrd 98 00:03:44,849 --> 00:03:47,009 And so we can talk about inverse k 99 00:03:47,009 --> 00:03:48,229 a and gap balancing 100 00:03:48,770 --> 00:03:51,169 and restricted k a and and sort of 101 00:03:51,169 --> 00:03:53,409 k a and robot this and blah blah 102 00:03:53,409 --> 00:03:53,909 blah. 103 00:03:54,534 --> 00:03:56,955 Resurfacing the knee back to its pre arthritic 104 00:03:57,014 --> 00:03:59,014 state by removing the same amount of bone 105 00:03:59,014 --> 00:04:01,034 and cartilage is being replaced by 106 00:04:01,574 --> 00:04:02,314 the implant. 107 00:04:02,614 --> 00:04:04,775 That is kinematic alignment, and it has to 108 00:04:04,775 --> 00:04:05,354 be unrestricted, 109 00:04:05,735 --> 00:04:07,254 and it has to be verified with a 110 00:04:07,254 --> 00:04:07,754 caliper. 111 00:04:08,870 --> 00:04:11,030 Yeah. And doctor Byrd, you you mentioned as 112 00:04:11,510 --> 00:04:13,590 you mentioned been talked a little bit through 113 00:04:13,590 --> 00:04:14,409 that as well. 114 00:04:15,030 --> 00:04:17,830 Why why are more physicians gravitating towards it 115 00:04:17,830 --> 00:04:18,490 right now? 116 00:04:19,029 --> 00:04:20,790 Yeah. I think that's a good question, and 117 00:04:20,790 --> 00:04:23,110 you are seeing kind of a cultural shift. 118 00:04:23,110 --> 00:04:23,610 And, 119 00:04:24,074 --> 00:04:26,895 you know, historically, we've always had this alignment 120 00:04:26,955 --> 00:04:29,215 strategy, this mechanical alignment strategy. 121 00:04:30,395 --> 00:04:32,634 And that's kind of been the dominant force 122 00:04:32,634 --> 00:04:34,175 in joint replacement. And 123 00:04:34,715 --> 00:04:35,455 that has 124 00:04:35,915 --> 00:04:39,259 been around for, you know, multitude of, reasons, 125 00:04:39,259 --> 00:04:40,800 whether it be implant longevity 126 00:04:41,419 --> 00:04:44,300 or just comfort level. But as we as 127 00:04:44,300 --> 00:04:46,379 we learn more, we learn that, you know, 128 00:04:46,379 --> 00:04:49,019 every patient has a unique alignment. There's plenty 129 00:04:49,019 --> 00:04:50,879 of literature out there showing that 130 00:04:52,375 --> 00:04:55,095 everyone has their unique alignment strategies, and they 131 00:04:55,095 --> 00:04:57,274 can be grouped into, like, 9 different phenotypes. 132 00:04:57,334 --> 00:04:59,334 Right? So not everyone falls on this plumb 133 00:04:59,334 --> 00:05:02,214 line. Mhmm. There's about only about 15% of 134 00:05:02,214 --> 00:05:04,634 patients that are truly in this mechanical alignment 135 00:05:04,694 --> 00:05:05,194 strategy. 136 00:05:05,709 --> 00:05:08,589 And so when you look into that and 137 00:05:08,589 --> 00:05:11,229 you realize, well, gosh, man, that's 85% of 138 00:05:11,229 --> 00:05:13,649 my patients that I'm incorrectly replacing. 139 00:05:14,110 --> 00:05:15,329 You start to realize, 140 00:05:15,949 --> 00:05:17,870 okay. There's gotta be some better way to 141 00:05:17,870 --> 00:05:20,014 do it. And the more we learn, the 142 00:05:20,014 --> 00:05:22,334 more you're seeing surgeons drift away from this 143 00:05:22,334 --> 00:05:24,675 MA or mechanical alignment strategy. 144 00:05:25,774 --> 00:05:27,855 Is that what most appeal to you too 145 00:05:27,855 --> 00:05:30,254 in terms of of going gravitating towards it 146 00:05:30,254 --> 00:05:31,795 and and really leveraging it? 147 00:05:32,730 --> 00:05:34,810 Yeah. I mean, there's a ton of reasons 148 00:05:34,810 --> 00:05:35,949 why I kinda gravitated 149 00:05:36,329 --> 00:05:39,449 away from MA, but yes. So it just 150 00:05:39,449 --> 00:05:41,449 makes sense. The more you sit down and 151 00:05:41,449 --> 00:05:42,990 think about what you're doing 152 00:05:43,449 --> 00:05:45,290 and how you're doing it, it just makes 153 00:05:45,290 --> 00:05:48,225 sense to give a patient specific alignment strategy 154 00:05:48,285 --> 00:05:50,545 versus kind of more of like a cookbook. 155 00:05:50,605 --> 00:05:52,525 Everyone's gonna get the same Mhmm. 156 00:05:53,245 --> 00:05:56,944 You know, standard angle fixed angle that's predetermined. 157 00:05:57,564 --> 00:06:00,410 I mean, when only 15% of those patients 158 00:06:00,410 --> 00:06:02,250 are gonna be happy or fall into that 159 00:06:02,250 --> 00:06:02,750 alignment, 160 00:06:03,050 --> 00:06:04,650 it just makes sense to give a patient 161 00:06:04,650 --> 00:06:05,710 specific alignment. 162 00:06:06,410 --> 00:06:08,730 Yeah. Doctor Baron, you I I loved your 163 00:06:08,730 --> 00:06:10,810 introduction on on sort of the how this 164 00:06:10,810 --> 00:06:13,194 emerged. Right? The sort of the historic piece 165 00:06:13,194 --> 00:06:15,194 to this, where did this come up. When 166 00:06:15,194 --> 00:06:17,194 you first started using it and after first 167 00:06:17,194 --> 00:06:19,275 starting using it, what were your what were 168 00:06:19,275 --> 00:06:21,275 your thoughts, and and why did you decide, 169 00:06:21,275 --> 00:06:22,475 okay, this is this is the way to 170 00:06:22,475 --> 00:06:24,814 go and and leveraging this more and more 171 00:06:25,060 --> 00:06:27,160 in terms of the appeal to certainly 172 00:06:27,779 --> 00:06:29,720 the doctor itself, but also the patients? 173 00:06:30,819 --> 00:06:32,579 So I I had the opportunity to work 174 00:06:32,579 --> 00:06:35,699 with Steve Howell, again, almost 2 decades ago, 175 00:06:35,699 --> 00:06:36,199 and 176 00:06:36,500 --> 00:06:38,805 he and I really diverged in our in 177 00:06:38,805 --> 00:06:41,525 our principles of knee replacement. I I continue 178 00:06:41,525 --> 00:06:43,845 to believe in mechanical alignment regardless of the 179 00:06:43,845 --> 00:06:44,985 technology used, 180 00:06:45,764 --> 00:06:48,004 and we had really good results. And we 181 00:06:48,004 --> 00:06:50,004 looked at a very large series. It was 182 00:06:50,004 --> 00:06:51,545 published in a a very reputable 183 00:06:52,199 --> 00:06:52,699 journal, 184 00:06:53,160 --> 00:06:55,899 and what really stood out to me was 185 00:06:56,199 --> 00:06:57,959 there were a certain percentage of patients that 186 00:06:57,959 --> 00:07:00,379 are dissatisfied. And you can call it 20%, 187 00:07:00,439 --> 00:07:02,279 which is what everyone argues. It might be 188 00:07:02,279 --> 00:07:03,259 8%, whatever, 189 00:07:03,720 --> 00:07:06,279 but not everyone's really happy. And even those 190 00:07:06,279 --> 00:07:07,814 that are happy are the yeah, buts. 191 00:07:08,455 --> 00:07:10,774 Are you better? Yeah, but. How's your knee? 192 00:07:10,774 --> 00:07:11,915 Well, it's good, but 193 00:07:12,375 --> 00:07:13,514 the yeah, buts, 194 00:07:13,975 --> 00:07:16,555 are a huge percentage of our patients, especially 195 00:07:16,694 --> 00:07:18,535 those that come in complaining of the knee 196 00:07:18,535 --> 00:07:21,495 feeling tight Yeah. Or the high activity level 197 00:07:21,495 --> 00:07:24,870 patient who's not able to comfortably return to 198 00:07:24,870 --> 00:07:26,250 those high activity levels. 199 00:07:26,550 --> 00:07:28,730 And so I was just watching the literature, 200 00:07:29,509 --> 00:07:31,750 watching the science, trying to figure out what 201 00:07:31,750 --> 00:07:33,589 can I do to improve the situation? I 202 00:07:33,589 --> 00:07:35,509 I really believe that partial knee replacement is 203 00:07:35,509 --> 00:07:37,814 very helpful in that space for the right 204 00:07:37,814 --> 00:07:38,314 candidates. 205 00:07:39,095 --> 00:07:41,514 Obviously, anterior hip was incredibly impactful 206 00:07:42,214 --> 00:07:43,995 in patients, but that's hip replacement. 207 00:07:44,774 --> 00:07:46,314 And so I I decided 208 00:07:46,774 --> 00:07:48,855 to go all in. And so Friday, I 209 00:07:48,855 --> 00:07:50,314 did mechanical alignment. 210 00:07:50,800 --> 00:07:53,199 And starting on Monday, I did kinematic alignment 211 00:07:53,199 --> 00:07:56,000 with a medial sphere knee on every patient 212 00:07:56,000 --> 00:07:57,939 regardless of if they had a knee before, 213 00:07:58,240 --> 00:08:01,120 regardless of deformity, regardless of, you know, any 214 00:08:01,120 --> 00:08:03,379 of the other demographics of the patient. 215 00:08:03,904 --> 00:08:07,264 And I immediately noticed that patients were no 216 00:08:07,264 --> 00:08:09,365 longer complaining of the knee feeling tight. 217 00:08:09,824 --> 00:08:11,345 I am not suggesting that I have a 218 00:08:11,345 --> 00:08:14,865 100% satisfaction or a 100% survivorship or anything 219 00:08:14,865 --> 00:08:17,444 like that. What I did notice immediately 220 00:08:18,000 --> 00:08:19,839 was the patients did not complain of the 221 00:08:19,839 --> 00:08:20,899 knee feeling tight. 222 00:08:21,279 --> 00:08:23,360 And we started to watch those early outcomes, 223 00:08:23,360 --> 00:08:25,139 and we saw the rate of manipulation 224 00:08:25,519 --> 00:08:26,180 for stiffness 225 00:08:26,720 --> 00:08:30,079 went down in my hands by almost 6 226 00:08:30,079 --> 00:08:30,579 fold. 227 00:08:31,134 --> 00:08:34,355 And so early recovery was significantly better. 228 00:08:34,735 --> 00:08:37,475 The pain relief was significantly faster. 229 00:08:38,174 --> 00:08:40,835 We've published on this, in peer reviewed literature. 230 00:08:41,215 --> 00:08:41,955 And so 231 00:08:42,414 --> 00:08:44,815 it was a it was a blind leap 232 00:08:44,815 --> 00:08:45,554 for me, 233 00:08:46,149 --> 00:08:48,570 and then we quickly started seeing those results, 234 00:08:48,950 --> 00:08:51,669 benefiting the patients early. And now we've got 235 00:08:51,669 --> 00:08:53,750 2 plus year data on our series, and 236 00:08:53,750 --> 00:08:55,209 it shows the same thing. 237 00:08:55,509 --> 00:08:58,330 Less complaints of tightness, better range of motion, 238 00:08:58,389 --> 00:08:59,129 less manipulation, 239 00:08:59,669 --> 00:09:00,730 higher knee scores, 240 00:09:01,105 --> 00:09:02,004 and most importantly, 241 00:09:02,625 --> 00:09:05,264 higher forgotten joint scores, which is really the 242 00:09:05,264 --> 00:09:06,945 the gold standard of of what we should 243 00:09:06,945 --> 00:09:07,605 be measuring, 244 00:09:07,904 --> 00:09:10,804 knees by. So I jumped in full tilt, 245 00:09:11,504 --> 00:09:13,585 and then started looking quickly at the early 246 00:09:13,585 --> 00:09:15,664 results and now the midterm results, and I've 247 00:09:15,664 --> 00:09:16,919 been super happy with it. 248 00:09:17,639 --> 00:09:19,959 Yeah. I'm gonna be the yeah, but here. 249 00:09:19,959 --> 00:09:21,240 Right? I love that term. I think that 250 00:09:21,240 --> 00:09:22,759 was a good that was a great one. 251 00:09:22,759 --> 00:09:24,759 I'm gonna be a yeah, but here if 252 00:09:24,759 --> 00:09:27,240 I'm the if I'm a I'm a physician. 253 00:09:27,879 --> 00:09:28,700 Doctor Byrd, 254 00:09:29,240 --> 00:09:31,544 what what should I be looking towards 255 00:09:32,085 --> 00:09:33,524 if I want to if I'm not doing 256 00:09:33,524 --> 00:09:35,284 it right now and I want to start 257 00:09:35,284 --> 00:09:36,725 doing it, what do I need to look 258 00:09:36,725 --> 00:09:38,245 into? What do I need to do if 259 00:09:38,245 --> 00:09:40,184 I want to start implementing KA? 260 00:09:40,965 --> 00:09:42,904 Yeah. That's a great question. I 261 00:09:43,370 --> 00:09:45,850 I did not jump whole hog like doctor 262 00:09:45,850 --> 00:09:47,370 Barron. You know, I was early in my 263 00:09:47,370 --> 00:09:47,870 practice. 264 00:09:48,329 --> 00:09:51,370 Doctor Barron's had a, you know, storybook career. 265 00:09:51,370 --> 00:09:53,289 He's got a great reputation out there. And 266 00:09:53,289 --> 00:09:56,089 so I was building mine, and I didn't 267 00:09:56,089 --> 00:09:56,552 want to, 268 00:09:57,735 --> 00:10:00,134 just jump all in. As I wanted to 269 00:10:00,134 --> 00:10:03,815 kinda dip my toe, see how patients did, 270 00:10:03,815 --> 00:10:04,295 and kind of, 271 00:10:05,735 --> 00:10:07,415 build up from there. And I would say 272 00:10:07,415 --> 00:10:09,335 that was about 3 years ago, and at 273 00:10:09,335 --> 00:10:11,335 this point, I'm all in. I do, 274 00:10:12,240 --> 00:10:13,460 unrestricted on everybody. 275 00:10:14,159 --> 00:10:16,259 But the way to get going is, 276 00:10:16,720 --> 00:10:18,019 you know, be thoughtful. 277 00:10:18,399 --> 00:10:19,379 Do your research. 278 00:10:20,080 --> 00:10:22,000 You know, it's all about homework. Right? Do 279 00:10:22,000 --> 00:10:24,740 your reading. There are thousands of 280 00:10:25,595 --> 00:10:28,315 ViewMedi videos out there. Definitely start with doctor, 281 00:10:28,555 --> 00:10:31,434 Steven Howe's videos, and they're just a master 282 00:10:31,434 --> 00:10:33,514 class in how to get going on KA 283 00:10:33,514 --> 00:10:34,014 knees. 284 00:10:34,394 --> 00:10:35,695 And if you really 285 00:10:36,154 --> 00:10:38,475 pick the appropriate patients and stick to the 286 00:10:38,475 --> 00:10:38,975 recipe, 287 00:10:39,350 --> 00:10:40,170 It's remarkable 288 00:10:40,629 --> 00:10:43,370 how well these these, cases turn out. 289 00:10:43,830 --> 00:10:46,389 And then, of course, go watch somebody do 290 00:10:46,389 --> 00:10:46,629 it. 291 00:10:47,269 --> 00:10:49,509 I actually traveled up to New Albany and 292 00:10:49,509 --> 00:10:51,290 watched doctor Baron do one. And, 293 00:10:51,830 --> 00:10:54,315 this was prior to me doing my first 294 00:10:54,315 --> 00:10:55,914 case, and so it was just you know, 295 00:10:55,914 --> 00:10:58,154 I've read a lot, was intrigued by the 296 00:10:58,154 --> 00:10:58,975 whole philosophy. 297 00:10:59,434 --> 00:11:00,794 And I went up and watched him, and 298 00:11:00,794 --> 00:11:02,475 it was like, woah. It was like a 299 00:11:02,475 --> 00:11:04,074 light bulb went off. I was like, wait. 300 00:11:04,074 --> 00:11:04,574 That 301 00:11:04,954 --> 00:11:06,110 that's k a? 302 00:11:07,210 --> 00:11:09,769 It's it's pretty cool, actually. You know? There's 303 00:11:09,769 --> 00:11:10,409 there's kind of, 304 00:11:11,370 --> 00:11:13,289 you know, like doctor Barron says, like, what 305 00:11:13,289 --> 00:11:16,009 is it? And so when you actually see 306 00:11:16,009 --> 00:11:19,044 it being done, it simplifies the whole process, 307 00:11:19,044 --> 00:11:20,804 and that's the beauty of it. It's not 308 00:11:20,804 --> 00:11:24,105 a complicated process. It's a simplified process, actually. 309 00:11:24,884 --> 00:11:26,664 And by going and watching, 310 00:11:27,125 --> 00:11:29,365 you can take that home to your own, 311 00:11:30,004 --> 00:11:33,000 hospital and really get going. And, you know, 312 00:11:33,000 --> 00:11:35,559 it's just not, as daunting as it might 313 00:11:35,559 --> 00:11:36,620 seem at first. 314 00:11:37,559 --> 00:11:39,399 Doctor Barrington for you here. I'm I'm assuming 315 00:11:39,399 --> 00:11:40,919 you would encourage folks to to do the 316 00:11:40,919 --> 00:11:43,240 same thing and and just see one for 317 00:11:43,240 --> 00:11:45,639 themselves, see how they work, etcetera. What what's 318 00:11:45,639 --> 00:11:48,254 your take on on what practices should do 319 00:11:48,254 --> 00:11:50,195 and and what physicians should look at? 320 00:11:50,975 --> 00:11:52,975 I agree with doctor Berg completely, and I 321 00:11:52,975 --> 00:11:55,075 think one of the important things is 322 00:11:55,695 --> 00:11:59,134 something that that I've come more accustomed to 323 00:11:59,134 --> 00:12:01,235 saying to surgeons who ask about it. 324 00:12:01,980 --> 00:12:04,240 When you start out, consider restricting 325 00:12:05,419 --> 00:12:07,740 who you do the procedure on. But when 326 00:12:07,740 --> 00:12:11,100 you do the procedure, don't restrict how you 327 00:12:11,100 --> 00:12:11,759 do it. 328 00:12:12,220 --> 00:12:15,600 Meaning, there are restricted alignment principles. There's inverse 329 00:12:15,659 --> 00:12:18,304 principles, all this. Those are not kinematic alignment. 330 00:12:18,524 --> 00:12:20,945 Kinematic alignment is exactly what we've defined. 331 00:12:21,964 --> 00:12:23,964 If you are not comfortable doing it, then 332 00:12:23,964 --> 00:12:25,804 restrict who you do it on and use 333 00:12:25,804 --> 00:12:27,824 your standard technique on those patients, 334 00:12:28,125 --> 00:12:30,365 and you will become more comfortable both with 335 00:12:30,365 --> 00:12:31,105 the technique 336 00:12:31,610 --> 00:12:33,389 and sort of with the degree of difficulty 337 00:12:33,449 --> 00:12:35,789 by which you you deploy that technique. 338 00:12:36,730 --> 00:12:39,049 I as was mentioned, I jumped all in 339 00:12:39,049 --> 00:12:41,289 on in one day, but you you don't 340 00:12:41,289 --> 00:12:42,809 have to. I mean, you certainly know how 341 00:12:42,809 --> 00:12:44,169 to do a knee replacement the way that 342 00:12:44,169 --> 00:12:45,075 you've always done it. 343 00:12:45,634 --> 00:12:47,235 So take some of those patients, and then 344 00:12:47,235 --> 00:12:50,035 watch them, and compare them to the outcomes 345 00:12:50,035 --> 00:12:52,274 that you're seeing today. And you may think 346 00:12:52,274 --> 00:12:54,754 you've got wonderful outcomes, and and most surgeons 347 00:12:54,754 --> 00:12:57,894 do. Most patients do phenomenal with this operation. 348 00:12:58,580 --> 00:13:00,500 But compare them in your own hands, in 349 00:13:00,500 --> 00:13:01,879 your own clinic to 350 00:13:02,340 --> 00:13:03,240 true KA 351 00:13:03,860 --> 00:13:04,919 caliper verified 352 00:13:05,700 --> 00:13:07,639 medial spherical knees, 353 00:13:08,019 --> 00:13:10,100 and you're gonna see a difference. The high 354 00:13:10,100 --> 00:13:12,945 activity level's different, The patient's complaints or the 355 00:13:12,945 --> 00:13:14,485 patient's yeah, buts are different. 356 00:13:14,865 --> 00:13:17,264 And so, again, if you're not comfortable doing 357 00:13:17,264 --> 00:13:18,004 it in everyone, 358 00:13:18,785 --> 00:13:20,865 restrict who you do it in, but don't 359 00:13:20,865 --> 00:13:22,245 restrict how you do it. 360 00:13:23,264 --> 00:13:24,164 Yeah. Absolutely. 361 00:13:24,620 --> 00:13:26,139 And and seeing it again, like you mentioned, 362 00:13:26,139 --> 00:13:27,579 I think that that's that's really a key 363 00:13:27,579 --> 00:13:29,500 that both of you identified. That's that makes 364 00:13:29,500 --> 00:13:30,860 a lot of sense to be able to 365 00:13:30,860 --> 00:13:32,699 see the procedure and and see how it 366 00:13:32,699 --> 00:13:34,699 works and and see how how the patient 367 00:13:34,699 --> 00:13:36,159 benefits at the end of the day. 368 00:13:36,593 --> 00:13:38,799 Doc doctor Barron, with with so much experience 369 00:13:38,940 --> 00:13:40,995 in in the field itself and and certainly 370 00:13:40,995 --> 00:13:43,014 so much exposure to what's going on 371 00:13:43,554 --> 00:13:44,615 in the world itself, 372 00:13:45,235 --> 00:13:47,014 where are you seeing this go? 373 00:13:47,394 --> 00:13:49,154 As a lot of folks are talking about 374 00:13:49,154 --> 00:13:49,654 automation, 375 00:13:50,195 --> 00:13:51,875 of course, AI is a is a big 376 00:13:51,875 --> 00:13:53,980 talking point for everything. Is this going to 377 00:13:53,980 --> 00:13:56,059 come into play for k a, and and 378 00:13:56,059 --> 00:13:57,440 how are you seeing that develop? 379 00:13:58,460 --> 00:14:00,139 You know, I I'm I'm not sure yet. 380 00:14:00,139 --> 00:14:01,120 I I think that 381 00:14:01,580 --> 00:14:02,399 there is 382 00:14:03,500 --> 00:14:06,000 with everything, we're we're throwing AI. 383 00:14:06,620 --> 00:14:08,139 As long as you use that term, then 384 00:14:08,139 --> 00:14:09,040 it's gonna be successful, is what it 385 00:14:10,204 --> 00:14:10,704 seems. 386 00:14:11,324 --> 00:14:13,424 Certainly on LinkedIn, that's what I see. 387 00:14:14,445 --> 00:14:16,445 The, I I don't know. I mean, I 388 00:14:16,445 --> 00:14:18,924 think that there's an argument that is made, 389 00:14:18,924 --> 00:14:20,845 and and I just hosted a podcast where 390 00:14:20,845 --> 00:14:21,745 there was a discussion, 391 00:14:22,524 --> 00:14:23,664 about alignment 392 00:14:24,539 --> 00:14:26,700 strategies. And there's an argument to be made 393 00:14:26,700 --> 00:14:28,480 that, oh, we don't know the target. 394 00:14:28,860 --> 00:14:31,339 In AI, you know, we get enough big 395 00:14:31,339 --> 00:14:33,019 data and get AI to figure it out 396 00:14:33,019 --> 00:14:34,539 for us, and it'll tell us where the 397 00:14:34,539 --> 00:14:35,679 target should be. 398 00:14:36,059 --> 00:14:38,639 That that's kind of an interesting philosophy 399 00:14:39,259 --> 00:14:41,355 when we already know where the target should 400 00:14:41,355 --> 00:14:43,615 be. It's where the patient's knee was 401 00:14:44,074 --> 00:14:46,654 Mhmm. With the exception of some other deformity 402 00:14:46,714 --> 00:14:48,654 or some other condition that's changing 403 00:14:49,195 --> 00:14:50,975 the knee other than arthritis. 404 00:14:51,595 --> 00:14:52,334 And so 405 00:14:52,700 --> 00:14:55,179 I kinda feel like, yeah, maybe we'll have 406 00:14:55,179 --> 00:14:57,679 some increased benefit from technology. 407 00:14:58,700 --> 00:15:01,039 If you feel more comfortable using a robot 408 00:15:01,179 --> 00:15:01,679 or, 409 00:15:02,460 --> 00:15:03,440 augmented reality, 410 00:15:04,460 --> 00:15:06,620 and and certainly all of that's available with 411 00:15:06,620 --> 00:15:08,000 almost any of the manufacturers, 412 00:15:09,154 --> 00:15:12,355 The principle of this operation is even simpler 413 00:15:12,355 --> 00:15:14,834 than that. It's using a a caliper from 414 00:15:14,834 --> 00:15:17,794 Home Depot and measuring the cuts and making 415 00:15:17,794 --> 00:15:19,314 sure you put back the same amount that 416 00:15:19,314 --> 00:15:20,294 you're taking out, 417 00:15:20,720 --> 00:15:22,720 and the results are improved. Now can we 418 00:15:22,720 --> 00:15:24,820 can we improve them even more? Probably. 419 00:15:25,600 --> 00:15:28,000 Do we have a a incredibly unique implant 420 00:15:28,000 --> 00:15:29,759 that we're using now with the with the 421 00:15:29,759 --> 00:15:32,720 sphere that's specifically designed for this technique and 422 00:15:32,720 --> 00:15:34,820 this and this idea? Yes. 423 00:15:35,264 --> 00:15:37,125 And so these sort of incremental, 424 00:15:38,465 --> 00:15:40,245 additive, accretive changes, 425 00:15:41,504 --> 00:15:43,184 maybe AI is in there somewhere in the 426 00:15:43,184 --> 00:15:43,684 future. 427 00:15:44,305 --> 00:15:46,225 I don't see it as being probably anywhere 428 00:15:46,225 --> 00:15:48,725 in in the remainder of my career, maybe 429 00:15:48,865 --> 00:15:50,404 doctor Byrd's career, but 430 00:15:51,159 --> 00:15:53,080 I think that it's it's pretty darn good 431 00:15:53,080 --> 00:15:54,279 the way it is, and I don't know 432 00:15:54,279 --> 00:15:55,500 that AI is gonna 433 00:15:55,879 --> 00:15:57,480 make it much better than just doing it 434 00:15:57,480 --> 00:15:59,100 the way that it's supposed to be done. 435 00:15:59,799 --> 00:16:01,399 Yeah. Doctor Byrd, same for you here. Where 436 00:16:01,399 --> 00:16:02,600 where are you at on on some of 437 00:16:02,600 --> 00:16:04,964 this technology that's emerging, and how is it 438 00:16:04,964 --> 00:16:05,718 influencing or how do you think it's going 439 00:16:05,718 --> 00:16:06,392 to influence your your work or work in 440 00:16:06,392 --> 00:16:07,756 general? Yeah. You know, I I completely agree 441 00:16:07,756 --> 00:16:08,245 with doctor Baer, and I think I think 442 00:16:08,245 --> 00:16:10,565 the AI and robotics is very interesting, and 443 00:16:10,565 --> 00:16:11,065 it's 444 00:16:19,179 --> 00:16:21,259 pretty fun. It's a fun toy. It's a 445 00:16:21,259 --> 00:16:24,139 cool tool, but as an added value, I 446 00:16:24,139 --> 00:16:25,440 don't see it right now. 447 00:16:26,300 --> 00:16:29,259 Basically, what kinematic alignment is is just a 448 00:16:29,259 --> 00:16:31,279 true resurfacing of the bone. 449 00:16:32,379 --> 00:16:35,535 And you can achieve that without the use 450 00:16:35,535 --> 00:16:37,934 of technology. And it's funny. I saw this 451 00:16:37,934 --> 00:16:39,934 question come across. And when I was first 452 00:16:39,934 --> 00:16:42,735 learning k a, you know, someone was trying 453 00:16:42,735 --> 00:16:43,934 to convince me. I was like, oh, but 454 00:16:43,934 --> 00:16:45,455 you need a robot to do it. And 455 00:16:45,615 --> 00:16:47,715 Mhmm. You need this. You need that. And 456 00:16:47,855 --> 00:16:49,740 it it couldn't be more 457 00:16:50,279 --> 00:16:53,240 opposite. Right? So it's it's just get your 458 00:16:53,240 --> 00:16:55,799 caliper from Home Depot, probably aisle 14 or 459 00:16:55,879 --> 00:16:59,179 I'm not sure. But, 16, actually. 16. 16. 460 00:16:59,399 --> 00:17:01,159 And it's you know, I think and I 461 00:17:01,159 --> 00:17:02,839 think doctor Howell and, they 462 00:17:03,534 --> 00:17:05,474 there's literature out there to, 463 00:17:06,174 --> 00:17:08,575 demonstrate that the caliper is more accurate than 464 00:17:08,575 --> 00:17:11,454 the robots. And and the standard error that's 465 00:17:11,454 --> 00:17:13,295 built into the robots is higher than what 466 00:17:13,295 --> 00:17:14,994 you can actually measure with a caliper. 467 00:17:15,375 --> 00:17:17,375 And so if you verify every cut that 468 00:17:17,375 --> 00:17:18,994 you're doing, you can more accurate 469 00:17:19,380 --> 00:17:21,240 accurately resurface the bone, 470 00:17:21,539 --> 00:17:23,940 and you don't need the distraction of the 471 00:17:23,940 --> 00:17:24,759 of the 472 00:17:25,299 --> 00:17:25,799 technology. 473 00:17:26,259 --> 00:17:27,940 And, you know, I don't know. I hope 474 00:17:27,940 --> 00:17:28,759 by the time, 475 00:17:29,299 --> 00:17:31,859 I retire in 25, 30 years from now, 476 00:17:31,859 --> 00:17:34,134 I'm doing something different than now because how 477 00:17:34,375 --> 00:17:35,674 I mean Mhmm. 478 00:17:35,974 --> 00:17:37,335 How boring would that be if I'm doing 479 00:17:37,335 --> 00:17:39,734 the same thing? Right? Like, because from a 480 00:17:39,734 --> 00:17:42,214 scientific standpoint, we're gonna have some innovation, and 481 00:17:42,214 --> 00:17:43,894 I'm I'm just not quite sure what it 482 00:17:43,894 --> 00:17:46,214 is. But at the current state of the 483 00:17:46,214 --> 00:17:48,579 art, I cannot see how technology is gonna 484 00:17:48,579 --> 00:17:50,359 be an added value for this technique. 485 00:17:51,140 --> 00:17:53,859 Yeah. And, again, everybody, you know, now need 486 00:17:53,859 --> 00:17:56,019 to stop by at Home Depot to grab 487 00:17:56,019 --> 00:17:57,779 the the helper. I think that's a that's 488 00:17:57,940 --> 00:17:59,539 that should be that should be the move 489 00:17:59,539 --> 00:18:00,599 after this episode. 490 00:18:01,144 --> 00:18:03,005 But also, as we talked in the beginning, 491 00:18:03,065 --> 00:18:05,384 a lot of folks don't know or didn't 492 00:18:05,384 --> 00:18:08,505 know what kinematic alignment was. I recommend you 493 00:18:08,505 --> 00:18:10,744 have to listen because now I know certainly 494 00:18:10,744 --> 00:18:12,904 a lot more about the technique, and and 495 00:18:12,904 --> 00:18:14,940 that was it's very interesting in terms of 496 00:18:14,940 --> 00:18:16,380 how this is going to develop and how 497 00:18:16,380 --> 00:18:17,599 it's impacting patients. 498 00:18:18,059 --> 00:18:19,980 Doctor Barron, doctor Byrd, thank you so much 499 00:18:19,980 --> 00:18:21,759 for your time. This is very interesting. 500 00:18:22,460 --> 00:18:23,980 Yeah. Thank you. I had a great time. 501 00:18:23,980 --> 00:18:26,320 Thank you. Thank you. It's a great conversation. 502 00:18:26,380 --> 00:18:27,599 We appreciate you guys 503 00:18:28,244 --> 00:18:28,744 listening 504 00:18:29,285 --> 00:18:30,744 and hearing about KAA. 505 00:18:31,605 --> 00:18:32,105 Absolutely. 506 00:18:32,484 --> 00:18:34,164 Thank you again for joining us, and I'd 507 00:18:34,164 --> 00:18:36,005 also like to thank Medacta as well for 508 00:18:36,005 --> 00:18:38,398 sponsoring this episode. You can also tune in 509 00:18:38,398 --> 00:18:40,638 to more podcasts from Becker's Health Care by 510 00:18:40,638 --> 00:18:42,658 visiting our podcast page at beckershospitalreview.com.