COMPUTER ASSISTED ROBOTIC TOTAL KNEE ARTHROPLASTY

Transcription

1 COMPUTER ASSISTED ROBOTIC TOTAL KNEE ARTHROPLASTY TOD NORTHRUP, DO MEDICAL DIRECTOR Florida Sports Medicine Institute St Augustine and Jacksonville, FL Flagler and Baptist South Hospitals

2 2013 DISCLOSURES No financial interests to disclose Special Thank You to Albert Koenig, MD for great amount of information for this presentation Real Disclosure Always trying to improve my surgical techniques so that my patients can have the best results! TN

3 Computers Have Invaded Our Lives 2013 FLORIDA SPORTS MEDICINE INSTITUE

4 Why Computers and Orthopedics Simply we use CAS to improve the Surgeon s perception of the operative field and the surgery that he or she carries out CAS with Robotics has emerged as one of the most important new technologies in Orthopedic Surgery today Orthopedic Surgeon s Best Friend (BFF)

5 Computers and the Quest for the Perfect TKR Began studying CAOS in the late 1990 s. Early Passive Navigation Systems for TKR GPS for the Knee, finicky and difficult to use, clinically not ready 2nd Generation CAS (Navigation with Integrated Robotics) PiGalileo Plus Orthopedics 2004, Switzerland. 3rd Generation CAS/VPR (Virtual Planning with Robotics) Apex Robotic Technology (A.R.T.) Omni LS & Praxim; USA, France 3D Imageless Bone Morphing with Virtual Planning

6 Keys to Success in TKA Neutral Alignment Ligament Balancing Implant Fixation Appropriate Sizing Good ROM Longevity of Implants

7 Goals of Praxim s ART Virtual Robotic-TKR Maximize Accuracy and Consistency of results Customize the Procedure for every patient Minimize the Invasiveness Reduce the number of early TKR failures 2 to Malalignment and Instability of the components leading to early fixation failures and loosening.

8 Preventable Failures Sharkey et.al. Insall Award Paper Revisions in 203 patients 56% of Revisions done within 2 yrs of index TKA Reasons for the Early Failures: Fixation failure (17%) Instability (21%) Malalignment (12%) 50% Preventable CORR Nov FLORIDA SPORTS MEDICNE INSTITUTE

9 The Literature is Clear Limb alignment is crucial for TKR Mechanical Axis within 3 of neutral CAS-TKR is more Accurate than Conventional TKR CAS-TKR is also more Accurate than CCB-TKR or PSG s* *Accuracy of CT-Based Patient Specific Total Knee Arthroplasty Instruments ~ Francis B. Gonzales, MD, C. Anderson Engh, Jr., MD, Deborah Ammeen, BS, Robert Hopper, PhD AAHKS 2010 Poster Presentation.

10 CONVENTIONAL TKA

11 CONVENTIONAL TKA FLO

12 CONVENTIONAL TKA FLOFLFFFFFFFLO

13 CONVENTIONAL TKA

14 CONVENTIONAL TKA FFFFLO

15 CONVENTIONAL TKA FILL THE IMPERFECT CUTS IN WITH CEMENT!!!

16 CAS-TKR Frustrating Early Passive Navigation Early CAS-TKR Navigation was performed manually. Surgeon had to physically move cutting blocks by hand in 3 dimensions at once; in the hopes of making 1 mm or 1 corrections. Difficult at best. As you moved block in one plane the cutting block often moved in two other planes. SFI & increased time. Frustrating Fiddle Factor.

17 Navigation without Automation (Is like Driving a Porsche with a Foot Pedal Engine!) VPR-TKR CAS-TKR

18 ART-TKR What is Passive Robotics? An automated device that very accurately helps or assists to perform a task but does not do the task on its own. Examples: PiGalileo Mako (partial knee replacement) A.R.T.

19 Omnilife Science & Praxim The ART of TKR Excellent APEX TKR High Flex technology CAS 3-D Bone Morphing & Virtual Robotic Surgery Allows for Imageless Custom Implantation of every APEX TKR Sizing Alignment Position

20 Omni Praxim ART Apex Robotic Technology Accurate & Robust Imageless 3D model of the Pt s anatomy Intuitive and Fast Acquisitions (Simple screens & workflow) No change in preferred Surgical approach Virtual Femoral and Tibial Surgery (prior to any bone cuts) Easily Navigable with Passive Robotics and Nano Tech. (No Fiddle Factor & High SFI) Quick Accurate Real Time Validations Consistent Excellent Results Will help to make you a better and more accurate surgeon!

21 Normal TKR Exposure Depending on Morphology

22 ART of TKR iblock Surgical Workflow TRACKING REGISTRATION NAVIGATION and CUTS VALIDATION

23 Tracking Applying Arrays

24 Monitor Positioning

25 Registration / Acquisitions Hip Center Kinematic Approach

26 Registration / Acquisitions

27 Femoral Acquisitions

28 Femoral Acquisitions Bone Morphing Validation Checks for Accuracy of 3D Model Will not let you proceed until you have an accurate robust model of patient s knee

29 Tibial Acquisitions

30 Tibial Acquisitions

31 Pre-Resection ROM and Kinematics

32 Virtual Femoral Surgery

33 Virtual Femoral Surgery

34 Conventional Referencing when in-between sizes Anterior Referencing Larger Size Smaller Size Posterior Referencing

35 ART Referencing A.R.T. Referencing Perfect Size & Fit

36 Comparison Virtual Femoral Cuts vs. Actual iblock Cuts

37 Virtual Planning Press Fit Adjustment

38 Virtual Planning Press Fit Adjustment

39 Virtual Planning Press Fit Adjustment

40 Virtual Planning Press Fit Adjustment

41 Virtual Femoral Surgery

42 Adjusting iblock

43 Adjusting iblock

44 iblock Calibration

45 Surgery with the Omni Praxim i-block

46 Active Automated Robotic Navigation

47 Active Automated Navigation

48 Femoral iblock Validation

49 Femoral iblock Validation

50 Active Navigation Recutting the Femur Select Positive Recut (or negative) Select once for each mm. Step on Blue Pedal to Activate and Set iblock

51 Virtual Tibial Surgery

52 The NanoBlock

53 The NanoBlock

54 The NanoBlock

55 Tibial Validation

56 CAS Alignment Data

57 CAS Alignment Data

58 ART of TKR Final Implants

59 ART of TKR Cases

60 ART of TKR Cases

61 ART of TKR Cases

62 6 Weeks Post Op 78 y/o male: one PT visit

63 Six wks post-op: one PT visit

64 ART of TKR Cases S/P HTO

65 ART of TKR Cases S/P HTO

66 ART of TKR Cases S/P ACL

67 ART of TKR Cases S/P ACL

68 ART of TKR Cases

69 ART of TKR Cases

70 ART of TKR Cases

71 ART of TKR Cases

72 ART of TKR Cases

73 ART of TKR Cases

74 iblock Clinical Study Koenig & Plaskos CAOS / ISTA 2011 Retrospective review of first 107 cases June 2010 Jan 2011 Study Outcomes: Accuracy & Efficiency Final leg alignment, standing long-leg x-rays Bone-cut precision (planned vs. measured cuts) Tourniquet time iblock use time Statistical analysis of the learning curve Group 1: cases 1-25 Group 2: cases Group 3: cases Group 4: cases Baseline Factors Group p-value* BMI mean Age mean Gender (M:F) 11:14 10:13 8:15 11: Deformity mean (max) 6(20) 4.2(12) 6.0(12) 4.8(13) 0.46 *Oneway ANOVA with bonferroni adjustment 2012 ORTHOPEDIC EXCELLENCE OF LONG ISLAND

75 Results: Femoral and Tibial Component Alignment Femoral Component Alignment ( ) Tibial Component Alignment ( ) 99% (76/77) within ±3 99% (76/77) within ±3 92% (71/77) within ±2 94% (72/77) within ±2 No significant effect of the learning curve on accuracy 2012 ORTHOPEDIC EXCELLENCE OF LONG ISLAND

76 Omni Praxim vs. Custom Cutting Blocks (Patient Specific Guides)

77 Custom Cutting Blocks or Patient Specific Guides AAHKS 2010 Poster Presentation. Accuracy of CT-Based Patient Specific Total Knee Arthroplasty Instruments ~Francis B. Gonzales, MD, C. Anderson Engh, Jr., MD, Deborah Ammeen, BS, Robert Hopper, PhD Measured radiographic anatomic alignment and full limb mechanical alignment (50 cases / 40 follow up) The mechanical axis was within 3 of zero for 63% of cases. Conclusion Leg alignment is similar to that obtained with traditional instruments but not as good as imageless computer assisted total knee arthroplasty.

78 CT / MRI Custom Cutting Blocks Increased Cost of Blocks, Scans, FTE s, Cancelations Radiation Burden Increased Time for Authorizations, time lost going for study, Pre-op planning, Shipping & Check in No Real Time Validation Takes the Computer out of the OR where you need it most. (like leaving your car s GPS at home) Not Proven & Not as Accurate as CAS (2010 AAKHS Poster Engh.) $1000/scan x 1,000,000 patients = $ 1 BILLION $1500/case x 1,000,000 patients = $1.5 BILLION (and that s only 20% market intrusion by 2015.) Who s paying? Hospitals? MD s? Patients? Industry?

79 Omni Praxim iblock Low Cost Extremely Accurate Validated Imageless Custom Implantation of every case for sizing, alignment and position. Virtual Robotic Surgery Cut through large Slots, not 4 or 5 in 1 cutting blocks. No Added Cost to the Health Care System. No Radiation No loss of time ( average time 49 minutes / case) Consistent Excellent Results case after case

80

81 CCB / PSG Takes the Computer out of the OR where you need it most. (like leaving your car s GPS at home)

82 VALUE = Product vs. Cost

83 The Bottom Line Omni Praxim s ibot Makes me a better and more accurate surgeon affording my patients their best potential TKR outcomes and that s what it s really all about. FFFFF

84 THANK YOU!!