Ken Urish, MD, PhD, is a knee and hip replacement orthopedic surgeon. He completed his fellowship at the Massachusetts General Hospital and was an instructor with the Harvard Medical School. His practice focuses on primary and revision hip and knee arthroplasty (joint replacement). He is an innovator with extensive experience in robotic surgery, minimally invasive techniques, and addressing issues with failed or painful hip and knee replacements. He is Director of the Arthritis and Arthroplasty Design Group, a laboratory funded by the NIH to improve arthroplasty outcomes. He obtained his PhD in Bioengineering and was a visiting scientist with the Carnegie Mellon Robotics Institute.

Meet the NAVIO Surgical System, a robotics-assisted knee surgery platform that adds an extra layer of pre-surgical planning and improved precision for partial and total knee replacement procedures.

NAVIO Robotics-assisted knee replacement surgery

Your knee replacement surgery is unique, based on your knee anatomy and the implant used. Designed to help ensure your knee replacement is positioned and aligned correctly, surgeons use the NAVIO Surgical System. Proper positioning of the implant is important because implant alignment is a crucial factor in determining how long your implant may last.1, 2

Decades of innovation in knee replacement surgery

Surgical techniques have evolved considerably since the earliest knee implant procedures were performed in 1968. These procedures relied on manual guides, external pins and cutting jigs to remove damaged bone and place the prosthetic implant.

Eventually more advanced implant positioning techniques were introduced that used long rods drilled into the central canal of the femur (thigh bone). These rods provide an attachment point for surgical cutting guides. More recent improvements introduced CT (computerized tomography) scan/MRI image guidance to create an individualized computer-generated surgical plan for each patient.

The latest innovation is the NAVIO Surgical System, a robotics-assisted platform that uses CT-free technology for precise implant sizing and positioning without the need for rods. The NAVIO Surgical System can be used for either a partial or total knee replacement procedure.

NAVIO system benefits: accuracy, less exposure to CT radiation

The NAVIO system offers two important benefits for people undergoing a knee replacement procedure. First, it helps your surgeon create a highly individualized plan that is specific to the unique shape and motion of your knee. Traditional planning may require CT scans, a series of images similar to x-rays that shows cross-sections of your knee. While other robotic-assisted platforms require CT scans, the NAVIO system works without them, meaning you are not exposed to the potentially harmful radiation experienced with this type of imaging.

The second benefit is robotic assistance. This combination of advanced technology is designed to help your surgeon and may result in more accuracy, giving you better long-term outcomes.

The NAVIO system is used for both partial and total knee replacement, which are distinctly different procedures. Here's a bit more information on how the NAVIO system is used in these surgeries:

Partial knee replacement

In partial knee replacement, your supporting tissue and ligaments that help stabilize your knee are spared and only the damaged portion of the knee is replaced. This means that healthy cartilage and bone remain intact to help your knee joint move smoothly with the prosthetic implant. Patients with osteoarthritis in only one area of their knee may be candidates for partial knee replacement.

Patients who undergo partial knee replacement often report a 'more normal' feeling knee, less pain and quicker rehabilitation.3

Robotics-assisted planning and partial knee surgical procedure

Using the NAVIO system, your surgeon creates a 3D representation of the unique shapes and profiles of your knee without the need of a pre-operative CT scan.

Using all of this information your surgeon can then determine the correct size and position of the implant. Implant size and position is critical to knee alignment and stability.

Next, your surgeon uses robotic assistance of NAVIO to physically remove only the damaged bone, preparing the site for the prosthesis, before placing and adjusting your partial knee implant.

Total knee replacement

In total knee replacement, the entire knee joint is replaced with a prosthetic implant designed to replicate the shape, motion and stability of your natural knee joint. Total knee replacement is one of the most common procedures performed in all of medicine, with over 600,000 performed in the U.S. every year. Ninety percent of people who receive a total knee replacement experience a dramatic decrease in knee pain, and an improvement in their ability to perform daily activities. 4

Robotics-assisted planning, and total knee surgery guidance

Just as in the partial knee procedure described above, your surgeon creates a 3D representation of the unique anatomy of your knee without the need of a pre-operative CT scan.

Your surgeon uses your knee anatomy information to determine the correct size and position of the implant, and creates a surgery plan unique to your anatomy.

Important safety notes

Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.

Disclaimer

Individual results may vary. There are risks associated with any surgical procedure including NAVIO-enabled Knee Replacement. NAVIO is not for everyone. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients and patients contraindicated for UKR, PFA and TKA should not undergo a NAVIO procedure. Consult your physician for details to determine if NAVIO is right for you.

  1. 1. Collier, Matthew, et al., "Patient, Implant, and Alignment Factors Associated With Revision of Medial Compartment Unicondylar Arthroplasty.", Jour of Arthro, Vol 21 No 6, Suppl. 2, 2006.
  2. 2. Hernigou, Ph, Deschamps, G., "Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty.", Clin Orthop Relat Res., Volume 423, June 2004, pp 161-165
  3. 3. Hall et al., "Unicompartmental Knee Arthroplasty (Alias Uni-Knee): An Overview with Nursing Implications," Orthopaedic Nursing, 2004; 23(3): 163-171.
  4. 4. American Academy of Orthopaedic Surgeons website, accessed March 7, 2017: //orthoinfo.aaos.org/topic.cfm?topic=A00389

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