How One German Doctor Performed a Remote Knee Revision in Nairobi

For Dr Ingo Tusk, Head of Orthopaedics and Endoprosthetics at Frankfurt’s Red Cross Hospital, a knee replacement surgery is a straightforward procedure. “We do about 1,200 hip and knee replacements each year,” explains Dr Tusk.

Knee revisions, on the other hand, are always more of a test. Re-entering a previous operation site to replace a primary implant requires additional finesse. Tack on some additional factors – such as a new, relatively unfamiliar implant system and COVID-19 travel restrictions – and the situation Dr Tusk faced last fall starts to become a true challenge.

The patient in question was a 70-year-old Kenyan citizen, who had received the new Attune knee system from Johnson & Johnson in 2019 in Germany. The initial procedure went smoothly, but a year later the patient fell and broke her tibia. She required surgery, but due to the COVID-19 travel restrictions – and her own high-risk classification – she wasn’t able to return to Frankfurt for the revision surgery.

The local orthopaedic surgeons weren’t as comfortable with such a demanding operation, so Dr Tusk, her original surgeon, decided to fly to Nairobi to perform the surgery himself – but that didn’t quite solve everything.

Compounding Complications

To complete the Johnson & Johnson Attune system revision, the operating team would typically need access to 14 trays of instruments. Furthermore, given how new the system was and how complex the replacement surgery would be, Dr Tusk needed real-time, on-site support from Johnson & Johnson’s medical team. Neither was an option in Nairobi.

The Johnson & Johnson team proposed Rods&Cones glasses as a potential solution. If Dr Tusk agreed, he would be among the first German doctors to test the system – and he would be testing it nearly 10,000km away from Frankfurt.

Planning A Remote Surgery

Planning is taken seriously for any operation, but this particular case had a unique set of needs. A local orthopaedic surgeon in Nairobi stepped in to help make arrangements with the hospital, the OR, and Frankfurt’s Johnson & Johnson team. He needed to ensure a stable virtual circuit connection so that the medtech provider could oversee the procedure from afar.

Since Dr Tusk would only be able to travel with two trays of instruments, they also needed to focus their equipment and ensure that the Johnson & Johnson team was set up with the same limited set of instruments, so that if anything went wrong during the procedure, they could provide accurate guidance.

Dr Tusk flew to Nairobi on February 13th, 2021, just four weeks after the surgery planning began. He was accompanied by his OR nurse, who wore a second pair of Rods&Cones glasses to ensure there was a backup if anything went wrong with the connection. One member of the Johnson & Johnson team guided the nurse through instrument selection, while another oversaw Dr Tusk’s every move.

Accommodating New Distractions

For Dr Tusk, the biggest learning curve was getting comfortable actually wearing the glasses throughout the procedure. “At the beginning, you have to get used to it,” Dr Tusk says, explaining that he could see the Johnson & Johnson team on a small screen off to the side of his vision and had to learn how to concentrate with that distraction and continue to demonstrate leadership in the operating room.

Dr Tusk’s distractions were particularly unique, since he was listening to the Johnson & Johnson representative through his earphone and speaking with his nurse in German, while communicating in English with the local Kenyan team.

Thinking Long Term Once Dr Tusk got used to operating with the Rods&Cones equipment, he quickly found value in the setup. “I think it will be the future of surgery,” he shares. “We will have these glasses – at least one pair – in every OR.” The main value he sees is having support from the device manufacturer. Especially with a more complex procedure, having this oversight instills confidence and ensures success amongst the surgical team.

Speaking of which, Johnson & Johnson’s team was just as happy with the outcome. “He said the connection was as though I was operating next door,” says Dr Tusk. “He was really happy with the quality of the pictures and even the sound.”

All in all, Dr Tusk completed the operation within six weeks of first being contacted by the patient’s family – a major success given the many obstacles his team needed to overcome to make it happen. “The patient is already walking and the outcome was excellent,” Dr Tusk shares. “We had a perfect result.”