Surgical procedure
Robotics, navigation and 3D technology
Different digital tools are available within knee and hip replacement surgery. The surgeon uses information from preoperative planning and modelling to select the technique and systems that support the procedure. The main categories are introduced in the following sections.
FAQ
Digital navigation
NAVISWISS – NAVIPLAN
State-of-the-art digital navigation system Naviswiss for performing total hip arthroplasty with maximum precision and excellent functional outcomes. It is another invaluable tool for implementing the latest and most innovative surgical techniques and methods under the highest safety conditions for the patient.
The Naviswiss is a navigation system compatible with all hip arthroplasty implants, without the need for additional software or components. It supports all types of surgical approaches, primary interventions, and revisions, without requiring preoperative imaging examinations (X-rays, CT, or MRI).
The system's sensors, sized like a postage stamp, are placed on the bones during the surgical procedure, and the infrared camera records the orientation and position of the bone structures with the assistance of the sensors. This enables the system to provide reference angle values for the correct application of the implant.
It provides the ability for precise calculation of the length of the operated limb to ensure patient symmetry. The software offers guidance at every step of the intervention through graphics and text.
Another application of the Naviswiss system is the accompanying Naviplan software (3D pre-operative planning), which can be optionally and complementarily used to assist in the preoperative planning of total hip arthroplasty based on three-dimensional images from computed tomography (CT). It utilizes advanced algorithms that aid the surgeon in selecting the appropriate implants for each patient and contribute during the intervention by providing visual recognition of bony reference points for more detailed implantation of the arthroplasty.
PERSEUS Smart cutting guide
PERSEUS Smart cutting guide PERSEUS is a smart cutting guide, powered by inertial sensors, which allows the surgeon to perform perfectly aligned bone resections with less effort and invasiveness than traditional knee instrumentation.
Characteristics
- • Disposable sensor
- Touchscreen interface
- Integrated with traditional surgery
- Pre-calibrated and sterile
- A single sensor to guide the cuts
- Free app
Design Thanks to its design, PERSEUS makes it possible to perform bone resections without the use of intramedullary nails, thus reducing the risks of a more invasive surgical approach and ensuring optimal limb alignment. With PERSEUS it is possible to perform accurate resections even in cases where instrumentation of the medullary canal is extremely difficult or impossible.
With PERSEUS it is possible to perform accurate resections even in cases where instrumentation of the medullary canal is extremely difficult or impossible.
Benefits for surgeons
- Greater confidence,
- High accuracy in leg alignment
- Avoid the risks associated with intramedullary rods
- More accurate than other similar navigation systems, but smaller footprint and easier to use
- Greater safety in surgical options
- Excellent result repeatability
Benefits for Orthopaedic Dpt.
- cost minimization
- Single-use, requires minimal surgical tools with consequent reduction in sterilization costs
- Faster recovery of the patient
- Minimal hospitalization
- Reducing the risks of surgical complications and associated post-operative rehabilitation costs
Benefits for the patient
- State-of-the-art technology in knee arthroplasty
- Minimal cost of hospitalization
- Minimize risk of complications from the use of intramedullary guides required in traditional knee arthroplasty
- Minimization of complications from skin trauma (M.I.S techniques)Traumatic method
- Ατραυματική μέθοδος
- Minimization of postoperative pain
FAQ
Robotic Systems
ΜΑΚΟ SMART ROBOTICS
MAKO Robotic knee system belongs to the semiactive & potentially active electronical-assisted systems helping performing Unicondylar, Bicondylar , Total Knee & Hip Replacement .
How does the surgery work?
The procedure begins with a specific CT scan of the knee joint, using the MAKO software, which creates a 3D model of the affected knee on the computer of the system, on which the surgeon processes and individualizes the whole procedure, using specific instrumentation and implants depending on the particularities of each patient, creating a personalized preoperative plan
The procedure starts with a specific type of anesthesia, using drugs and rapid recovery protocols. The surgeon uses minimally invasive surgery procedures (M.I.S) to reveal the joint. Then the MAKO robotic arm, guided by the surgeon and following the preoperative plan, performs the appropriate osteotomies around the knee joint and helps placing the implants with excellent precision and without margin of error, balancing the loads distributed on the inner and outer sides of the knee (soft tissue balancing )
This helps to accurately position and align materials, restoring the mechanical loading axis, which is difficult to achieve with traditional surgical techniques. The surgery is completed by knee joint and plastic skin wound repair.
This helps to accurately position and align materials, restoring the mechanical loading axis, which is difficult to achieve with traditional surgical techniques. The surgery is completed by knee joint and plastic skin wound repair.
ADVANTAGES OF ROBOTIC ARM MAKO
- Patient specific surgical planning
- Robotic assisted femoral and tibial osteotomies
- Avoidance of thromboembolic complications, as we do not use intramedullary rods
- Minimizing of peri-operative complications
- Accuracy in prosthetic implantation- Improved leg alignment Excellent leg functionality
- Accuracy in prosthetic implantation- Improved leg alignment Excellent leg functionality
- Maintenance of proprioception
- Minimally invasive surgical technique without extensive soft tissue damage
- Quick mobilization (4-5 hours post surgery)
- Minimal hospitalization ( 1-2 days)Minimizing of pain killers
- Avoiding painful physiotherapy programs (only 1/10th patients need physiotherapy after surgery)
- Quick return to day-to-day activities.
- Full Range of Motion and Absolute Articular Functionality
- No leg-length discrepancy
It is very important to note that the MAKO robotic arm does not, in any case, intervene on its own, does not take final decisions on the operation and does not move without medical guidance. It is the surgeon who directs him throughout the procedure.
This new evolutionary Robotic technology, can guarantee reproducibility of successfully performed uni-or-total knee replacements, longevity of prosthetic implants and minimize peri-operative complications.
The system requires a learning curve and harmonious collaboration between the operator and the surgeon, which is why the procedure is carried out exclusively by trained and certified Orthopedic Surgeons.
This advanced Robotic technology has the potential to ensure successful interventions with excellent outcomes, minimal risks, and an increased lifespan for implants, thus creating new perspectives in Knee & Hip Arthroplasty.
Video here
ROSA ZIMMER – BIOMET
Το ROSA© (Robotic Surgical Assistant) is a system that "collaborates" with the surgeon, is guided by him and adapts to his surgical technique, allowing at all times human-robot interface where this becomes necessary during the operation.
The robot assists the surgeon in all stages to achieve an excellent result.
Pre-operatively, the precise measurement of the data and the high-definition imaging control in the operating room are collected to plan every step of the surgery with an accuracy measured to one millimeter, to choose the appropriate surgical method and prosthetic materials according to the anatomical peculiarities of the patient and to anticipate special difficulties that they may cause.
During the operation, the robotic arm moves with millimeter precision following the surgeon's hand and showing the exact position of the surgical manipulations and osteotomies, in order to perform the operation according to the original pre-operative plan for excellent results.
The great advantage offered by this particular robotic system is that it evaluates the condition of the soft tissues and ligaments to place the implant without injuring the surrounding area. Attention to the soft tissues and balancing of the ligaments is most important for a knee replacement in order to be functionally stable enough to support you normally in your daily activities.
Just after the implantation is done and before the surgery is completed, the robot checks that the operation was performed perfectly, according to the initial pre-operative plan, that the materials were placed correctly, that the mechanical axis of the leg is the desired one and that the movement is complete and excellent.
The advantages of the ROSA© Knee System
- Detailed preparation of the operation on the computer, using personalized data for each patient
- Real-time assessment of leg range of motion
- Minimally invasive method Minimizing the possibility of intraoperative and postoperative complications.
- Reduction of hospital stay.
- Less post-treatment pain and faster recovery
- Ability to perform difficult surgical manipulations with great precision
- Capability to perform complex surgical maneuvers with high precision.
Video here
NAVIO / CORI Robotic Surgical System
Smith & Nephew previous (NAVIO )and latest (CORI )technology features image-free smart mapping to build 3D models of the joint in surgery (without the need for CT/MRI scans), real-time planning for personalized surgery, handheld precision milling and intra-operative gap balancing.
Designed to be portable with a small OR footprint, the CORI Surgical System uses Real Intelligence software to offer broad capabilities and an expanding range of joint reconstruction indications, such as:
Total and partial knee surgery Designed to achieve accuracy in bone resection and alignment,
Revision knee surgery The first system indicated for robotic-assisted revision knee surgery in the US. Image-free smart mapping eliminates potential for image distortion caused by in-situ components, with 3D joint models registering anatomy and bony defects after implant extraction.
Total hip surgery (software only): RI.HIP NAVIGATION allows surgeons to assess pelvic tilt, providing a predicted view of the post-operative anteroposterior (AP) X-ray in surgery and digital measurement of leg length/offset changes
Product Features
Smarter
Image-free smart mapping and real-time gap assessment are designed to help optimize alignment and balancing.
More efficient
Features an ergonomic handpiece with burr designs delivering twice the cutting volumeand 29% faster resection. The ATRACSYS Advanced Tracking System offers a 458% faster refresh rateand an enhanced workflow requires fewer steps (intended to help save time in the OR)
Implant compatibility
The CORI System continues to evolve and expand compatibility with our total, partial and revision knee systems, including cemented and cementless primary knee implant technology. Furthermore, the CORI System is compatible with implants and approaches for total hip arthroplasty.
Video here
ROBIN / ORTHOKEY
A NEW GENERATION OF SURGICAL ROBOTICS SOLUTIONS FOR ORTHOPAEDIC SURGERY
It is a state-of-art solution in terms of a robotic system performance. Affordable and advanced surgical tool. Controlled by surgeons according to patient specific surgical needs. Easy to handle with great precision and repeatability. The whole system is light & flexible.
ROBIN is an advanced surgical solution to support the surgeon to:
- Acquire
- Analyze
- Interpret
- Report TKR
And give the surgeon great confidence and satisfaction operating with a precise and easy to use Collaborative Robotic-COBOT.
Many advantages
- ROBIN is a smooth, interactive robotic tool designed for top quality implants
- Soft tissue balancing
- Mobile robotic system-Doesn’t need space in OR for storage
- Lighter than other robotic systems
- Less consumables
- Improved clinical outcomes with safer intervention and faster recovery of expected quality of life targets
- Patient’s better post-operative satisfaction
FAQ
Technology Systems
MATRIX
Digital Augmented Reality MATRIX Arthroplasty
The world of digital reality has given us the possibility to create a reservoir of information about the function of our joints, the quality of our bones and the existence of possible damage.
So while until now we tried to guess what is happening in our body, now we can see exactly what is ailing inside us, in front of and behind our joint when it bothers us persistently.
Using augmented reality smart glasses, patient and surgeon are inside a simulation, thus gaining possibilities they could not imagine.
The surgeon receives knowledge at an extremely fast pace in his mind, utilizes it surgically during the operation, strikingly identifying reality with the virtual environment created pre-operatively or intra-operatively and ensuring precision and speed in the execution of the surgical operation.
Nothing can go wrong when the digital image of the bone is matched to our own joint using a 3D knee or hip model that will work better than our biological one.
An automatic representation of a three-dimensional model of the bone structure around the knee or hip joint and their anatomical landmarks allows the surgeon to precisely plan the placement of prosthetic materials using augmented reality glasses.
An automatic 3D model representation of the bone structure around the knee or hip joint and their anatomical landmarks allow the surgeon to plan with millimeter precision the placement of the prosthetic materials in special "augmented reality" glasses.
Regarding the preparation of both the acetabulum and the femoral shaft, this is done with absolute precision in a complete anatomical position, individualized per patient. The placement of the prosthetic materials ensures excellent orientation and absolute muscle synergy around the hip muscles.
During surgery, this virtual model sits in front of the surgeon's field of vision and interacts, aligns with the patient's bone, allowing the surgeon to precisely determine the position of the implant, ensuring an exact match to the preoperative design. The images from the augmented reality glasses enhance the surgeon's senses and improve his perception of space.
The levels of osteotomies in the femur and tibia are oriented to the mechanical axis of the limb that is individualized per patient and are calculated with absolute precision according to anatomical data acquired with special registration markers. In a recent study the use of the new technology presented a 98.9% identification of graft placement in relation to the mechanical axis. Image data from augmented reality glasses has changed total arthroplasty which is now performed with great precision, minimizes surgical error, is more efficient and safer for patients, who experience minimal post-operative pain and discomfort from the operation.
Ηolographic 3D "mixed reality" navigation
HoloMedical Assistant, developed by ICB M, is a breakthrough application suite that uses a combination of 3D holographic models and mixed reality to transfer the pre-operative plan directly on the surgery table.
The solution creates precise 3D models of the part of the body undergoing surgery thus improving anatomical assessment, preoperative planning, and surgical interventions. By using the Microsoft HoloLense 2 mixed reality glasses doctors can predefine the surgical steps and pre-visualize the results of the medical procedure.
The tool is converting two-dimensional imagery from scans (CT, MRI) into 3D models allowing doctors to transfer the organ onto the human body in real-time and see with their own eyes details and steps of the operation like they have never seen before. It also helps the surgeon to track the instruments under visual control (chisels, drilling and other cutting instruments) according to several landmarks – lines, axes spheres and a variety of geometrical objects and planes. The platform can be used in preoperative planning and intraoperative navigation as well as for education and real-world training.
The innovative technology helps to make surgery safer, improve the treatment and care of patients and reduce human errors like hand tremors, cutting the wrong osteotomy, or incorrect implant placement.
During surgery, the surgeon can record video or take screenshots with Hololens 2. Information from the system can be stored in the glasses and automatically exported to the patient’s medical record. It can be reviewed by all interested parties – from doctors specializing in different fields of medicine and young surgeons to the person who did the intervention itself to better analyze the results from it.
The recordings can also serve as evidence of the way the surgery has been performed.
PERSONALIZED (CUSTOM-MADE ) ARTHROPLASTY (with 3D printed prosthetic materials)
New modern personalized (tailor-made) Total Knee & Hip Arthroplasty with 3D printing of the prosthetic implants ADAPTED TO THE SPECIFICITIES OF EACH PATIENT SEPARATELY WITH THREE-DIMENSIONAL PRECISION CORRECTION !!!
3D bioprinted objects and bone implants can be used to optimize restoration of the original joint structure and functionality.
They are prepared and designed in every detail and are available to the surgeon before the operation as an exact copy of the bone anatomy of the joint. With the 3D printed prosthetic implants the surgeon can also have the specifically designed instrumentation for a precise osteotomy and implantation.
The surgeon has everything ready and pre-planned before the operation in every detail so that with a very small incision, with minimal invasiveness, in a very short time and without injuring the intramedullary canal of the femur and tibia, he can place the implants with millimeter precision in the most ideal for each patient position and in three-dimensional correction. The detailed indications for the arthroplasty embedded in the instrumentation have been prepared preoperatively at the implant factory to which the MRI or 3D CT scan of the patient's knee and leg have been electronically sent.
The exact 3D copy of the bone articular surfaces with the accompanying deformities corresponding to the patient's joint has also been sent to the surgeon for preoperative study to avoid intra-operative complications.
TECHNOLOGY IN THE PATHWAY
Planning, surgery and continuing care
The surgical procedure in MATRIX knee and hip arthroplasty connects with preoperative VR planning and postoperative monitoring. The sections above introduce different categories of digital tools. Their selection is discussed with the surgeon in relation to the joint, medical history and needs of the individual patient. Return to the three core MATRIX phases for an overview of the pathway. Separate videos about MAKO, ROSA and CORI complement the existing information.