Optimising Orthopaedic Surgery: The CORI Robotic Surgical System for Knee Replacement Surgery, is being used in Marbella by Dr. Thomas Boerger.
Dr. Thomas Boerger, MD FRCSI (Tr&Orth) Consultant Hip and Knee Surgeon about robotic-assisted Total Knee Replacement.
Introduction: Orthopaedic surgery has witnessed the introduction of new technologies aimed at improving surgical planning, precision and outcomes in joint replacement. The CORI Robotic Surgical System from Smith+Nephew is an innovative robotic-assisted navigation platform that has transformed the way knee replacement is performed.
I will be using this system for the benefit of my patients at HC International Hospital, Marbella.
Before the evolution of Robotic Surgical Systems some surgeons have used navigation technology to guide cutting block position. The majority of orthopaedic surgeons use mechanical instrumentation this way to effect modelling of the joint surface guided by their own professional experience and a degree of guess work. Image based systems rely on pre-operative CT scans that need to be sent away for processing elsewhere in advance of the procedure.
The CORI Surgical System offers the orthopaedic surgeon intra-operative smart mapping and real-time gap/ligament assessment during the registration process allowing for optimisation of leg alignment and ligament balance. All the information is obtained in real time during the procedure, enhancing surgical accuracy, which in turn may lead to improved clinical outcomes and patient satisfaction.
Patient Specific Precision: The CORI Robotic Surgical System assists the surgeon in dialling-in ‘personalised’, or ‘patient specific leg alignment’ and thereby restore native pre-arthritic knee kinematics. Such alignment ideally minimizes the need for ligament releases, reduces operative trauma and may lead to enhanced recovery and patient satisfaction.
The CORI Robotic Surgical System also assists the orthopaedic surgeon in performing complex joint replacement were pre-existing leg deformity, previous adjacent long bone fractures or knee stiffness complicate the clinical picture.
Surgical Procedure: After attaching temporary reflectors to thigh and shin bone the CORI system registers the precise location of hip, knee and ankle joint. It registers anatomic ‘landmarks’ around the knee and the existing ‘worn’ joint surfaces. Once a complete virtual real-time picture of the joint is established, range of movement and ligament gaps are recorded. Armed with this data and already accumulated anatomical data of hundreds of normal knees the system then helps the surgeon to choose ideal implant sizes and virtually position the chosen knee implants for optimal leg alignment and ligament balance. Once the planning process is completed the robotically guided handheld burr is used to remove peri-articular bone sparingly to allow the insertion of implants.
A similar algorithm exists for partial knee replacement. By only replacing the worn area and preserving healthy portions of the knee, patients may experience faster recovery, reduced post-operative pain, and improved overall function.
Precision: The CORI robotic assisted burr can shave bone with an accuracy of up to 1/100 of a mm, making it very precise. The CORI Robotic Surgical System does not use a cumbersome robotic arm, making it intuitive, user friendly and economical.
Improved Surgical Accuracy: The CORI Surgical System provides the orthopaedic surgeon with precise anatomical mapping of the knee /leg, real-time feedback, advanced virtual planning options and very precise bone resection resulting in optimal implant placement and ‘personalised’ leg alignment aiming at restoring pre-arthritic knee kinematics.
Implant: The system is designed to be used with Smith+Nephew’s Journey II total knee implant, which I have used since its introduction for a number of years. The asymmetrical implant design is based on the study of hundreds of normal knees and matches the actual knee anatomy closer than any other mainstream implant.
Customised Approach: Patient’s knee anatomy and leg alignment can be categorised into patterns. Some patterns are more frequently seen that others. The CORI Surgical System allows the surgeon to account for individual variations. This customisation will, unlike with mechanical guides, lead to ‘personalised’ leg alignment, optimal implant fit, possibly better range of motion, resulting in a more ‘natural knee feel’.
Surgeon Training and Skill Development: Smith+Nephew offers CORI users comprehensive training programs, ensuring that the surgeon is utilising the technology safely and to its full potential. This commitment to ongoing education and skill development ultimately benefits patients by ensuring high-quality surgical care.
Conclusion: The CORI Surgical System represents a significant advancement in orthopaedic surgery for partial and total knee replacement. By combining robotics, real-time feedback, and advanced planning tools, the system is beyond par. In the hands of an already experienced and effective surgeon, it affords the possibility of unprecedented levels of surgical precision and empowers the surgeon to deliver a modern model of orthopaedic surgical care that is truly customized to individual patients, right down to the 0.01mm!
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This article is by Dr Thomas Boerger, MD FRCSI (Tr&Orth) Consultant Orthopaedic Hip and Knee Surgeon. Dr Boerger is consulting and operating at HC International Hospital, Marbella, Costa del Sol, Spain.