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Total Knee Arthroplasty Utilizing Surgical Navigation with an Automated Robotic Cutting Guide

February 01, 2013

Contributors: Timothy McTighe, PhD; Louis James Keppler, BS; Louis James Keppler, BS

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

Automated cutting guides are the next progression for surgical navigation. The accuracy and efficiency of automated cutting guides in CAS systems has been FDA approved and is now entering the market place. As with any new technology technique is key to the overall success. This video address, the specific techniques that are encountered to successfully prepare and implant a conventional cemented total knee with the use of automated cutting guides. Material and Methods For video production one female patient under the age of sixty years of age with osteoarthritis was selected for TKA. Patient consent for educational purposes was achieved in standard operative consent form. The device selected is an intelligent instrument allowing intraoperative customization in TKA using real time virtual planning technology followed by automated placement of the cutting guides. An ultra congruent insert was used to substitute the sacrificed PCL and both tibial and femoral components were cemented in place. Technique In the operating room, the navigation system can be installed on either side of the operated knee. The camera needs to be placed about 5 to 6 feet (1.5 to 1.8 meters) from the knee. Registration and calibration of reference points are carried as with most navigation systems. A single, automated cutting guide mounted to the robotic housing unit guides five distal femoral osteotomies. The surgeon may custom adjusts the size and position of the implant specific to every patient. The basis for custom positioning is the data accumulated in the patient’s bone morphing model. All cuts can be validated and modifications made if necessary. Clinical Observations The use of surgical navigation with the use of automated (Robotic) cutting guides allows for virtual surgical preparation and evaluation prior to making any bone cuts. The precision and speed of the automated gutting guide is accurate and allows for fine-tuning of cuts that were not possible in the past by hand held guides. The accuracy of the surgical cuts is impressive and we believe will provide for better alignment and outcomes. Additional studies are underway to validate these observations.

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