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Bill Klaproth: If you're suffering from knee pain and just the thought of going up and down stairs makes you cringe and you're facing a knee replacement surgery, there is good news and something I know you're going to want to learn about. When it comes to robotic knee replacement, there is a new option for the North Bay. So let's learn about the VELYS robotic-assisted surgical solution with Dr. Jeff Barry, Assistant Professor of Orthopedic Surgery and Clinical Fellowship Director, Division of Adult Reconstruction at MarinHealth.

This is The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Dr. Barry, thank you so much for your time. We are very interested in learning about this new surgical solution. But before we get into that, could you just give us a brief snapshot of your background?

Dr. Jeff Barry: Thanks for having me, first of all. I really appreciate the invite and I'm excited to be here. So I'm an orthopedic surgeon at UCSF and MarinHealth who does arthroplasty surgery, so that's joint replacements of the hip and knee. I'm also the Fellowship Director at UCSF for adult reconstruction. I did a lot of training at UCSF, that's where I did medical school and residency. And then I've also done a fellowship in joint reconstruction at a center called OrthoCarolina in North Charlotte.

Bill Klaproth: Great. Well, happy to have you here and very excited to talk about what you have new at MarinHealth. You've acquired the VELYS robotic-assisted Surgical Solution, the first of its kind in the Northern bay area, so congrats on that. So, can you tell us why did you and your physician colleagues identify the VELYS system as an important addition to MarinHealth's orthopedic treatment options?

Dr. Jeff Barry: So before I get started, I want to make sure that we thank the Lindskog Foundation. They were generous enough to supply a donation to MarinHealth and that money was used to acquire the robot. And we're really excited because we're one of the first in California who's been able to obtain it and use the technology.

So why did we think it was important to get this? I think knee replacement is an amazing surgery. It changes lives for our patients, but we're always looking for ways to do it better. As a corollary, if we look at hip replacements, we are really darn good and can get rates of success that are kind of greater than 95% in terms of people getting back to what they want to do and the implants lasting decades and decades.

But conversely, knee replacements, when we take all comers who have their knees done, it's closer to 85% to 90% of patients that are in this category that we would call very satisfied. And that leaves about 10% to 15% of people who aren't completely satisfied with the knee replacement and that's an area that I think that we are looking to improve how we do it. Robotic knee replacement is one way we think we may be able to get to that last 10% to 15% of people. And while the VELYS is a new robotic system, robotic knee replacement is not new. It's been around for about 10 years. And it just provides me another tool in the OR to be able to do the best job possible.

I feel really lucky to be at MarinHealth because they have this kind of shared interest in giving us access to all the state-of-the-art technology and care without any restrictions. So I can use the implants that I want, the technology I want, not really have to worry about cost. I think that kind of alignment of our goals is really good for patients. And the VELYS is really the first robotic platform that myself and my partners felt was going after and pushing for our patients to try and give them the best outcomes.

Bill Klaproth: Yeah, this is really interesting. And as medical devices evolve and things like this to help you do your job better, this is exciting to learn about new technology like this. So then overall, you were just talking about patients. What are the potential patient benefits of this new system?

Dr. Jeff Barry: Yeah, that's a very big question and one that we're still trying to look into as orthopedic surgeons, like how can this help us? But I think it's important to note that a lot of these benefits and things that I'm going to cover are kind of theoretical at this point. Prior iterations haven't really shown a significant advantage in how patients do over manual instruments when they're used by someone like myself, who does this day in and day out. And I think that's one of the reasons that maybe even though the robot's been around for 10 years, it's only used in about 5% to 10% of knee replacements. That said, a knee replacement is something that's going to be stuck with you. It's part of you for the rest of your life, and that may be 20 years, 30 years, even 40 years. So it's hard for us to study long-term how small changes might affect the survivorship of the knee replacements. So while a lot of this stuff hasn't been proven, I think we theoretically think that by doing a better job at how we do a knee replacement, there's going to be a long-term impact.

Now, there's some things that have been shown with the older robotic systems. And so I think that those advantages are something we can talk about. So taking a step back kind of how a robot works, it's not like, you know, Arnold Schwartzenegger coming into the OR as the Terminator doing the knee replacements. I'm still there. I'm not in the corner drinking my coffee. But what the robot does is it's an augmentation. So it's a saw attached to a robotic arm that's going to make me able to do the cuts more precisely and more accurately than kind of the old school way, which was using these things called cutting blocks.

Another thing that it does that's really helpful is it's giving me objective numbers, like how do I size your knee exactly? What is your knee's alignment? How does your knee feel individually? And what used to be a kind of surgeon to surgeon subjective feel is now quantified, and that real-time number feedback is going to let me do adjustments a little more accurately. So I can tell the robot, "Hey, if I move this cut one millimeter or just one degree difference, what's going to happen to this patient's range of motion? What's going to happen to how tight it is?" And that's just something that wasn't doable before.

Those objective numbers are really helpful to us in the longterm from a research perspective, because I can hopefully get to the point where I can predict exactly how a knee's going to end up based on how we put it in with the robot. we get enough patients that have had knees done that are similar, I can ask the robot, "Hey, if Mrs. Jones is a 67-year-old with bow-legged style arthritis, how is she going to do if I put the knee in this alignment with this amount of tightness?" And I think that day's going to come at some point where we can use this robot to help us not only do the knee replacement, but also predict how people are going to do.

Some other advantages over the older systems that are benefits for patients, so I mentioned that the DePuy VELYS is the first robot that we've decided to use here. I'm not a paid consultant. I don't get any money from DePuy or VELYS, so this is purely my opinion and it's what I think is going to be best for my patients. We have a different platform at USCF that most of us don't use because of several of the drawbacks of older systems. So this is first to kind of get rid of a lot of the drawbacks of robotic applications.

the first one is that it uses a modern knee replacement called the DePuy Attune. The older robot made you use an implant that's more than 15 years old. I know a lot of people may still drive their 2004 cars. Mine's not quite that old, it's pretty close. But you're not going to want to buy a new 2004 Toyota Camry today. You want something like a Tesla or something newer, more modern with the gadgets and stuff.

The other thing that's really exciting about this is it's one of the first that doesn't require you to get a CT scan or a CAT scan. So the old robots, you'd have to get radiated and get a full CT scan of your legs that was not only radiation and potentially harmful to patients, but it's unnecessary for the insurance's perspective, so you couldn't get it approved. It's costly. The scan might not be right. So the VELYS is able to learn your knee's kind of shape and anatomy in the operating room in just a few minutes, which is a big advantage.

And then lastly, I think the software, like we talked about, is improved and it's going to help us, not only do your knee better, but hopefully the next one and the next one, all with this theoretical benefit of maybe we're going to be able to do it better and give you a better outcome in the short and long term.

Bill Klaproth: Right. So you're really able to dial it in on a per patient basis and be very targeted for that specific patient. And then how does this system influence treatment options for your patients? And what patient criteria leads you to consider a robotic surgical option?

Dr. Jeff Barry: Yeah. So, eligibility for getting a robotic knee is pretty much the same as people that would be regular total knee candidates. Like I said before, this is just an instrument at our disposal. It's not really like a different surgery, a different outcome. It's just how we do it is a little bit different. it can be especially useful for people that have certain situations like if you've had an old fracture and have metal still in the knee or you have a deformity from a prior surgery. That's where the robot can actually be more helpful than our old school way of doing things. And then there's going to be some patients where the robot is not going to be appropriate and that's things that the robot's just not ready to tackle stuff, like revising or redoing an old knee replacement or situations where the ligaments aren't working. Those things don't really work with the current robotic workflow. So, that's good for a guy like me. Gives me a little bit of job security for a little bit longer.

But I would tell patients not to be disappointed if we tell you we're not going to use the robot for whatever reason. Knee replacement is still a fantastic surgery. And again, no study's really ever shown that clinically patients will have a difference in terms of their outcome. Also importantly, it's never really shown that patients will do worse either though. So it's a very safe operation. It's a very safe way of doing a knee replacement.

Bill Klaproth: Yeah. Well, that is good to hear. So this system adds to an already robust orthopedic program at MarinHealth. So what else does MarinHealth have to support an orthopedic patient?

Dr. Jeff Barry: MarinHealth and this new partnership with UCSF and physicians such as myself who are kind of dual pointed, we now can kind of cover any aspect or any type of orthopedic problem. So any age patient, any activity level, any orthopedic issue, any bone or musculoskeletal issue, we got you covered. And we're lucky because MarinHealth has a brand new hospital, they have brand new clinics that we have access to and that we're a part of now all throughout the North Bay. So, it's been a really nice expansion for all of our practices. And it's been really nice to join the community of healthcare providers at MarinHealth. We've had nothing but fantastic experiences to this point.

Bill Klaproth: Yeah. So Dr. Barry, if someone in the North Bay needs a knee replacement, would it be a good idea to get a second opinion to see if a VELYS robotic knee replacement is a good option for them?

Dr. Jeff Barry: if patients are interested in robots or hearing more about it, I definitely would encourage them to reach out. They can schedule an appointment and they can talk to us any time. it's important though for patients to keep an open mind and not really focus so much on the details of the implant that's being used or exactly how the robot works or this approach to surgery. I think more important is finding a surgeon who each patient trusts and who they think is going to do a good job for them, however that is.

I think we're really lucky here at MarinHealth and with UCSF that all the surgeons here are people that I would trust to operate on me or my family. We see it all. We cover routine cases. We see the incredibly complex things as a tertiary referral center. So I think you're going to get top notch care from any of us. And if the robot is the way to go for you, then great. We're happy to provide.

Bill Klaproth: Absolutely. Well, Dr. Barry, thank you so much for your time and talking with us about the VELYS robotic-assisted surgical solution. Great to know this technology is here at Marin and helping those people that do need knee replacements. Thank you so much for your time again. We appreciate it

Dr. Jeff Barry: Yeah. Appreciate it. Thanks.

Bill Klaproth: And once again, that's Dr. Jeff Barry. And to learn more, please visit my marinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.