USER FRIENDLY The Navio orthopedic surgical system features a hand-held bone-sculpting tool.

Robotics have come to partial knee replacements, which "are unforgiving of even a very subtle amount of misalignment or imbalance," says Jess Lonner, MD, one of the first surgeons to use the Navio system from Blue Belt Technologies (bluebelttech.com/products) to perform a partial knee replacement. "This device reduces variability, enhances the precision with which we can prepare the bone and dramatically improves the ability to balance soft tissues."

In treating a patient presenting with medial osteoarthritis, Dr. Lonner used Navio to create a surgical plan, resurface the patient's diseased bone, and implant a prosthesis to restore function to the patient's knee and reduce the pain associated with osteoarthritis.

"It's long been known that partial knee replacements fare far better when they're aligned well and balanced well," says Dr. Lonner, associate professor of orthopaedic surgery at Thomas Jefferson University Hospital and attending orthopaedic surgeon at the Rothman Institute in Philadelphia, Pa. "But they can be very challenging for surgeons who don't do many. It's hard to become proficient. Even in the hands of a proficient surgeon, it's difficult to be as precise as you'd like with conventional methods."

Navio gives surgeons robotic control via a handheld, computer-assisted bone-cutting tool along with a navigation platform that presents a detailed virtual cutting guide. The system, built on an open implant-architecture platform, supports multiple implant systems, says the company.

The Navio handpiece lets surgeons precisely resurface bone based on a predefined plan. Coupled with navigation tracking the real-time position of the hand-piece and the patient, freehand sculpting removes only the targeted bone while the robotics enforces a safety zone, says the company. And it does it all without a pre-op CT scan, instead using the limb's natural landmarks to map the cutting parameters.

"The original robotic technology required a pre-op CT scan," says Dr. Lonner. "With this system you do all the mapping and planning based on intraoperative registration of landmarks of the limb. Our research has shown that it is equally as precise as the CT-based technology with a considerable per-case savings."

Robotic systems have helped foster greater precision, but their price tag has been a deterrent. "The predicate robotic system that was released in 2006 cost about $1.2 million," says Dr. Lonner. At about one-third of that price, the Navio "is much more affordable and far more palatable for administrators and physicians."

Navio is simple for surgeons to master, says Dr. Lonner, who's used the sculpting tool to perform cases at the Thomas Jefferson Riverview Surgical Center in Philadelphia. "The mapping performed during surgery creates your parameters. And since it's a hands-on sculpting tool, it's actually quite easy to use. There's not much of a learning curve — maybe 5 or 10 cases," he says.

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ethicon.com

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keysurgical.com