Amid growing concerns about crowded emergency departments and too few family doctors, some hope for the future was celebrated at Dartmouth General Hospital on Friday.  

Dr. Jennifer Leighton, an orthopedic surgeon at Dartmouth General, became the first surgeon in Canada to carry out a robotic-assisted total hip replacement last November. The unnamed patient is doing well.

According to Leighton, the procedure involves taking a CT-scan and then using 3-D modelling of bone anatomy to help the surgeon position the titanium implant more precisely than previously possible. The doctor watches a computer screen while using a robotic arm to guide the surgical implements to the pinpoint location where the cutting occurs and the new hip is positioned. 

“Mako Smart Robotics allows us to develop precise surgical plans that are tailored to the individual patient,” said Leighton, who travelled to New Jersey to receive training on the robotic-assisted technology. “This means less pain, quicker recovery, shorter hospital stays, and more natural feeling movement after surgery.”  

A doctor in blue scrubs looks at a screen that shows a knee bone will moving a robotic arm.
Dr. Jennifer Leighton demonstrates how the robotic technology is used in knee replacement surgery. Credit: Jennifer Henderson

Technology should help surgeons avoid redos of surgeries

Leighton added the extra precision enabled by the robotic-assisted technology should also prevent surgeons having to redo hip and knee replacement operations that don’t work out the first time. Redos are common in part because the manufactured implants don’t fit men and women the same way and the position of bones and soft tissues like ligaments are different for every patient.

Avoiding redos could be a huge benefit, not only for the long-suffering patient, but also for the health care system because repeat operations are more complex and require more time and longer hospital stays.  

The robot at the Dartmouth General will also assist in surgeries for knee replacements. The robotic technology is the same model as one at the Halifax Infirmary where four surgeons are now trained to use the Mako to do total knee replacements. In fact, two of only three such robots used to assist orthopedic surgeons in Canada are based in Nova Scotia. The research is the result of a collaboration among the QEII Health Sciences orthopedics division, the Dartmouth General Hospital, the Stryker company that makes the robotics equipment, and the Nova Scotia Health Innovation Hub. 

The machinery on display on Friday was ordered by the Dartmouth General Hospital Foundation, which is currently in the midst of a fundraising campaign to provide the $2 million it will cost to buy.  

“We are excited by this historic first in Canada”, said Stephen Harding, the president and CEO of the Dartmouth General Hospital Foundation. “We love to fund innovation at Dartmouth General and we believe innovation is going to lay the track for how we deliver next generation health care here in Nova Scotia.” 

Long wait times for knee, hip replacements in Nova Scotia

The average wait time for both knee and hip replacements is well above the Canadian average, partly because Nova Scotia has a larger percentage of elderly people than all but two other provinces. The average wait time for a total hip replacement is running between 18 months and two years after the patient has seen a surgeon for a consultation.  

Leighton and senior health officials with Nova Scotia Health said it is too early to say whether this new-and-improved technology will mean more surgical procedures can be done in the run of a day. Right now, the technology is being used by a half dozen surgeons mostly for knee replacements, and only Leighton is trained to perform a robotic-assisted total hip operation.  

But Leighton is hopeful that as the technology becomes more widespread, more patients will be able to receive same-day surgery and experience fewer post-surgery complications. If that happens, that should open up more appointments for orthopedic surgeons to serve more patients more quickly. 

Jennifer Henderson is a freelance journalist and retired CBC News reporter.

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