CAOS UK at the BOA 2024

“Robotic Arthroplasty Systems-Current and Future Innovations”

Wednesday 18th September 2024 at 16:30hrs-18:00hrs 

Chairs: Mr Dinesh Nathwani President CAOS Uk and  Mr Ajeya Adhikari Past President

 Robotic arthroplasty systems represent a noteworthy advancement and certainly a disruption in Orthopaedic Surgery. These systems combine robotics, computer navigation, and advanced imaging technologies to enhance the precision and accuracy of joint replacement surgeries, leading to better patient outcomes, faster recovery times and better long-term survivorship. Robotic systems allow surgeons to create true personalisation in alignment and implant placement. The plans are based on advanced imaging techniques such as CT scans for pre-operative systems whereas intra-operative systems are anatomical landmark data collection based. During surgery, the robot assists the surgeon in executing this plan with a high level of accuracy, guiding the placement of implants, and ensuring optimal alignment and position.

 Many robotic systems offer real-time feedback to the surgeon, providing data on bone cuts, implant positioning, and soft tissue balancing throughout the procedure. This feedback allows for adjustments to be made intraoperatively enabling the creation of patient-specific implants tailored to the individual's anatomy. Advanced robotic systems incorporate techniques for assessing and managing soft tissue tension during surgery. This allows surgeons to achieve optimal balance and stability in the joint, which is crucial for long-term implant success and patient satisfaction.

Robotic arthroplasty systems often collect and offer the opportunity to analyse data from each procedure, contributing to a growing database of surgical outcomes. Machine learning algorithms can then be applied to this data to identify trends, refine surgical techniques, and improve patient selection criteria. Some of these systems are becoming smaller and more portable allowing surgeries to be performed in smaller facilities with smart hand-held tools.

 The future of this technology is promising. Integration with advanced imaging modalities such as MRI or intraoperative CT could provide even more detailed anatomical information to guide surgical planning and execution. Continued advancements in robotics and artificial intelligence may enable greater levels of automation in joint replacement surgery, with robots performing certain aspects of the procedure autonomously under the supervision of the surgeon. Future systems may incorporate sensors capable of providing real-time biomechanical feedback, allowing surgeons to assess joint stability and function with greater precision during surgery. By integrating with wearable sensors and digital health platforms, robotic systems could facilitate the development of personalized rehabilitation protocols tailored to each patient's specific surgical outcome and recovery trajectory. Augmented reality (AR) technology could be integrated into robotic systems to provide surgeons with enhanced visualization and guidance during surgery. AR overlays have the potential to display real-time anatomical information directly onto the surgical field, improving spatial awareness and facilitating more precise implant placement.

 The robotic arthroplasty systems are ushering in an era of safer, more personalized, and more effective joint replacement surgeries. As technology continues to evolve, it's likely that we'll see continued convergence of robotics, artificial intelligence, leading to improve patient care and outcomes.

Program

Features key clinical leaders using the current leading systems and an overview from leading academics involved in development.

·       16:30-16:38 hrs -Welcome and Introduction. Professor Fred Picard/ Mr Dinesh Nathwani

·       16:38-16:50 hrs -CORI current and future innovation. Mr D Nathwani- London UK

·       16:50-17:02 hrs -VELYS current and future innovation. Mr Ben Bloch- Nottingham UK

·       17:02-17:14 hrs -ROSA current and future innovation. Mr Akash Sharma-Birmingham UK

·       17:14-17:26 hrs -MAKO current and future innovation. Mr Nick Ohly- Glasgow UK

·       17:26-17:38 hrs -Future Orthopaedic Technologies on the Horizon. Prof F Rodriguez y Baena

           London UK

17:38-18:00 hrs -Roundtable discussion. Chair Mr Ajeya Adhikari

BOA Programme: September 20th, 2023 from 14:00hr to 15:30hrs (90 minutes)

CAOS UK Revalidation session:

Chairs: Mr Dinesh Nathwani, Prof Frederic Picard, Mr Kamal Deep.

Alignment options in Navigated and Robotic knee replacement- the new generation of accurate alignment execution

Alignment options in knee joint replacements is not a new topic but has regained popularity since the introduction of the anatomical studies related to knee flexion axis documented by Eckhoff D. et al. and new alignment ideas around the so-called kinematic axis disseminated by a few authors such as Howell et al. More recently there has been much interest in the CPAK classification as described by Chen and colleagues in Sydney.

Opponents and proponents of these various knee alignments supposedly ideal for optimal and better functional and long-term outcomes have debated on the subject at the very early stage of modern condylar total knee joint replacement surgery (mechanical vs anatomical axes) and has been revived with the use of the technology in knee replacements.

Over the years, abundant discussions drove orthopaedic companies to design more sophisticated standard TKA instrumentations to address a variety of issues raised by arthroplasty surgeons. Original rudimentary traditional ancillary systems were gradually replaced by advanced tools to tackle evidence-based theories such as gap knee balancing, implant rotation placements or alignment options. However, despite abundant new designs of more complex standard instrumentation with the subsequent increase in number of jigs during surgery, it is apparent that none of them could really beat or even match the most modern computer assisted navigated and robotic assisted technology devices in term of accuracy and precision.

Research has undoubtedly proved the superiority of computer assisted navigated and robotic technology over conventional instrumentation as far as accuracy and precision are concerned and confirmed time and time again that these devices are reliable measurement tools to assess gaps and alignments in knee replacement surgery. Technological enhancements of intraoperative measurements have generated new interest back on alignments on knee replacements. New concepts such as kinematic and restricted kinematic alignments have arisen as well as others and new theories such as individual personalised alignments have been introduced in symbiosis with the growth of robotic systems.

This revalidation session of CAOS UK (Computer Assisted Orthopaedic Surgery UK) will review the current concepts of alignment and balance currently used in modern computer assisted navigated and robotic systems. The panel of experts will go through all prominent systems and will demonstrate how each of them can be used to reach preferential alignment and balance in total knee replacements.

A panel of national and international faculty will demonstrate the pros and cons of each system.

Following the immense success of the previous CAOS UK BOA revalidation sessions, we look forward to seeing you all in Liverpool.

Mr Dinesh Nathwani/Prof Fred Picard Chairmen’s Intro 14:00-14:08hrs

Dr William Barrett - Seattle, USA VELYS alignment options 14:08-14:20hrs

Mr Dinesh Nathwani – London UK CORI alignment options 14:20-14:32hrs

Mr Jonathan Phillips -Exeter UK MAKO alignment options 14:32-14:44hrs

Mr Akash Sharma -Birmingham UK ROSA alignment options 14:44-14:56hrs

Prof Frederic Picard- Glasgow UK Accuracy and precision of CAS in TKA 14:56-15:08hrs

Round table Discussion-Chair Mr Kamal Deep. 15:10-15:30hrs