As joint arthroplasty volumes continue to rise, particularly in outpatient settings, orthopaedic leaders are finding innovative ways to maximize efficiency to accommodate new procedural growth. At Steindler Orthopedic Clinic in Iowa City, surgeons saw an opportunity to use digital surgical technology to not only improve procedural safety and patient outcomes but also to increase efficiency. While tools like Bovie cords and intraoperative fluoroscopy have improved precision within manual surgery, Steindler Orthopedic Clinic knew that digitally advanced options could help make their surgeries more precise and standardized. Additionally, the limited availability of specific equipment and the varying skill levels of radiology staff often impacted surgery times and imaging quality. The clinic used digital surgical technology to address these challenges.

Steindler Orthopedic Clinic, located in Iowa City, Iowa, specializes in diagnosing and treating a wide range of orthopaedic conditions, with services in joint arthroplasty, sports medicine, spine care, and physical therapy. The clinic features a team of orthopaedic surgeons and healthcare professionals that collaborates closely with Mercy Iowa City Hospital.

In 2019, Steindler Orthopedic Clinic implemented a comprehensive strategy to enhance procedural safety and reduce inefficiencies in joint arthroplasty procedures. Leadership at the clinic convinced hospital executives to integrate enabling technology solutions into their practices. They complemented this technological advancement by optimizing instrument trays and standardizing anesthesia protocols in order to improve precision, improve patient outcomes, and shorten surgery durations.

After reviewing trials of various hip and knee arthroplasty technologies, the clinic selected the VELYS™ Hip Navigation and the VELYS™ Robotic-Assisted Solution. Points of comparison between technologies included implant compatibility and workflow efficiency for VELYS™ Hip Navigation as well as footprint, precision, and imaging for the VELYS™ Robotic-Assisted Solution. To maximize the potential of these technologies, clinic leaders worked closely with surgeons and clinical staff to secure their support and ensure widespread adoption. They aimed to standardize surgical procedures to ensure consistency and high-quality results.

The adoption of VELYS™ Hip Navigation and the VELYS™ Robotic-Assisted Solution at Steindler Orthopedic Clinic has enhanced both surgical precision and operational efficiency. With its seamless implant compatibility, VELYS™ Hip Navigation minimizes the risk of post-surgical complications by improving the accuracy of surgical measurements like leg length and offset. It has also helped contribute to a 13% reduction in average surgery time for hip arthroplasty procedures compared to manual methods with intraoperative fluoroscopy, from 120-125 minutes to 100-105 minutes.

Furthermore, the VELYS™ Robotic-Assisted Solution has led to greater outcome consistency and more predictable recovery trajectories in knee arthroplasty procedures due to the precision of its robotic arm. Its small footprint and need for no post-operative X-rays helps maintain operational efficiency, as well as reduces patient radiation exposure. The VELYS™ Robotic-Assisted Solution has allowed surgeons to achieve time neutrality in cemented knee arthroplasty procedures and increased the number of uncemented knee arthroplasty procedures by 50%, saving 10-12 minutes per case.

To improve precision and efficiency in joint arthroplasty procedures, Steindler Orthopedic Clinic implemented a comprehensive three-step strategy that prioritized in-depth technical training and developed a reproducible process. Steindler’s adoption of VELYS™ Hip Navigation and the VELYS™ Robotic-Assisted Solution has led to more predictable surgical outcomes, more favorable recovery trajectories, and more efficient procedures.

Improvement in measurement precision

• VELYS™ Hip Navigation technology provides actionable data that reduces the likelihood of postoperative complications, specifically with improvements in surgical measurements such as leg length and offset.

Consistency with predictable outcomes

• VELYS™ Robotic-Assisted Solution technology has ensured consistent application of surgical plans in knee arthroplasty. This consistency has led to fewer outliers and revisions as well as more predictable recovery trajectories for patients.

Growth in cases

• At Steindler, over 1,500 cases have been performed using VELYS™ Hip Navigation since 2019 and approximately 800 cases using the VELYS™ Robotic-Assisted Solution since 2021, demonstrating the effectiveness and widespread adoption of the technology.
• The VELYS™ Robotic-Assisted Solution was used in 150 cases in its first year, growing to 300 per year.
• The physician champion has used VELYS™ Hip Navigation in all his hip arthroplasty procedures since its implementation in the clinic in 2019. He performed about 150 cases per year with the technology initially; since then, volumes have grown to about 200 annually with swelling demand for hip arthroplasty procedures.

Greater patient interest

• Patients in need of joint arthroplasty are well-informed due to Steindler’s efforts to increase patient education about the technology in collaboration with Johnson & Johnson. Patient-driven word-of-mouth interest may reflect a strong community buy-in and patient satisfaction.
• The technology reassures patients about expected results, particularly those concerned with precise issues like equal leg length, ensuring surgeries meet their specific expectations without surprises.

Time savings:

• The integration of the VELYS™ Enabling Tech portfolio has decreased the average surgery time from approximately two hours using intraoperative fluoroscopy to about one hour and 45 minutes. This reduction has enabled the scheduling of additional surgical cases.
• For example, in the 1,500 VELYS™ Hip Navigation cases to date, the technology implementation has resulted in 15–20 minutes of time saved per case, totaling 375–500 extra hours of OR/surgeon time. This translates to the capacity for an additional 214–285 hip cases.
• The VELYS™ Robotic-Assisted Solution has allowed surgeons to achieve time neutrality in cemented cases and increased the number of uncemented cases by 50%, saving 10-12 minutes per case.

Decrease in X-ray usage:

• There is a significant reduction in the clinic’s use of X-rays per surgery, decreasing radiation exposure for patients and contributing to quicker procedures.
• Prior to using VELYS™ Hip Navigation, surgeons used fluoroscopy intraoperatively. Since its adoption, there has been about a 50% reduction in fluoroscopy time.
• For the VELYS™ Robotic-Assisted Solution, the practice has evolved from an X-ray after every case to zero X-rays, avoiding a few hundred X-rays per year.

At Johnson & Johnson MedTech Orthopaedics, our mission is to keep people moving through innovations in orthopaedic surgery, support and education for providers, and a dedication to improving diversity, inclusivity, and equality throughout the healthcare system. With one of the most comprehensive orthopaedics portfolios in the world, we help heal and restore movement for millions of patients. Our products span various specialties, including joint reconstruction, trauma, craniomaxillofacial surgery, spinal surgery, and sports medicine.

With new advancements in orthopaedic devices, medical technology, and digital surgery across the continuum of care, we are proud to provide surgeons with solutions as diverse as their patients.

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