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Surgeons at Bucks County Orthopedic Specialists (BCOS) outside of Philadelphia performed the practice’s first navigated total knee replacement surgery in 2021. Since that landmark case, surgical navigation has helped the group optimize outcomes for individual patients.
“No two knee replacements are alike,” said Joshua Steere, M.D., a surgeon who specializes in performing computer-assisted knee replacements at BCOS. “A successful surgery relies on careful planning to understand each patient’s anatomy. Computer assistance increases the accuracy of implant placement and ligament balancing. The goal is a properly aligned limb.”
Surgical navigation allows surgeons to develop detailed clinical plans for joint replacements and spine procedures. The platforms provide computerized measurements taken from individual patients’ pre-op CT scans to help surgeons provide personalized surgical care, now a growing trend in orthopedics.
“Surgical navigation is here to stay,” said Anthony Boyer, President and CEO of Blue Ortho, an Exactech company that is developing navigation systems for joint replacement surgery. “It’s becoming obvious for surgeons, especially younger surgeons, that it’s important to enhance their skills with technology for the benefit of patients.”
More Information Leads to Better Outcomes
Accelus is one of several medtech companies that offers solutions for minimally invasive spine surgery, most notably with its Remi Robotic Navigation System.
“Surgical navigation and robotic assistance are great tools to make surgeons’ lives easier,” said Brad Clayton, CTO of Accelus. “The technologies lower the stress of procedures and eliminate some of the unknowns. They therefore often shave an hour off overall surgical times.”
Lessening the amount of time that a patient is under anesthesia is one of the biggest advantages of using surgical navigation systems. Shorter procedures and faster recovery times are important ways that navigated surgery improves the patient experience.
Navigation can also reduce the need for intraoperative imaging — and the surgical team’s exposure to radiation — during procedures when the ongoing monitoring of implant placement is essential.
Clayton believes that navigation technologies have tremendous potential to improve hip and knee replacement procedures — perhaps even more so than spine surgery. He said the technology leads to enhanced clinical outcomes, including an improved range of motion in the replaced joint and reduced postoperative complications and revision rates.
Boyer said pre-op planning has been a major focus of Blue Ortho’s ExactechGPS solution, which helps guide surgeons to make the best possible decisions during shoulder and knee replacements based on each patient’s unique anatomy.
“The standard shoulder replacement involves reviewing CT scans, which inform the surgeon about the implant to use and where to place it,” Boyer said. “Pre-op planning software helps surgeons by turning what they think will be best for patients into a concrete 3D planning model. They’re able to select the correct implant and determine its exact position before surgery based on the accurate locations of anatomical landmarks.”
ExactechGPS pre-op planning software takes the process a few steps further with Predict+, a data-driven prediction model and decision support tool for shoulder replacement surgery that is based on a database of thousands of patient outcomes. “This information helps surgeons develop surgical plans with clinical scores that are based on outcomes data,” Boyer said.
Each prediction model is accessible during surgery, therefore eliminating the need for CT scans. “Surgeons can decide which components to use before making any bone cuts,” Boyer said. “The GPS system then helps them execute the surgical plan.”
Orthopedic surgeons can adjust the position of instruments during a procedure. They use real-time feedback to ensure that the instruments are in the best possible location for accuracy.
Surgical navigation is gradually replacing manual cutting guides that have long been used to align knee joints. “The precision and safety of knee replacement are greatly improved, especially during difficult cases when surgeons are faced with difficult anatomy resulting from fractures, bone development issues, previously placed rods or screws and dense bone calcification,” Dr. Steere explained.
“Creating a digital plan that can be brought into the O.R. improves overall outcomes,” Clayton said. “Better results come from better planning.”
A New Way of Seeing Surgery
Augmented reality navigation systems give surgeons real-time access to clinical information in line-of-sight displays that allow them to remain focused on the surgical field. Preoperative planning and surgeries are streamlined for even the most complex cases, making them easier to perform.
A few of the leaders in the industry have been bringing augmented reality surgical guidance to orthopedic surgery in new and promising ways.
Pixee Medical introduced an augmented reality platform aimed at improving joint replacement outcomes. Its Knee+ platform helps surgeons optimize the positioning of their instruments in real time with 3D tracking and augmented reality glasses.
Enovis acquired and launched ARVIS, an augmented reality visualization and information system. It’s one of the only hands-free augmented reality technologies engineered specifically for hip replacement and knee replacement surgery.
Michael Nett, M.D., Chair of Orthopedic Surgery at South Shore University Hospital in Bay Shore, N.Y., has been using the system since its launch. He said that it provides real-time feedback during surgery and guides him as he makes bone cuts to ensure the angles offer the best fit and alignment of the joint implants.
“I’m placing small components that make a big difference in the long- and short-term arthritis relief my parents expect and deserve,” Dr. Nett said. “Augmented reality is a game changer.”
Guiding the Next Generation
Companies like Blue Ortho are banking on robotics having a big future in orthopedic and spine surgery — but with a wider scope of what’s possible today, thanks to the growing number of clinical benefits provided by surgical navigation.
“Successful robotic solutions comprise a strong navigation platform that does 95% of the work through anatomical acquisition, planification and instrument guidance,” Boyer said. “The other 5% comes from the actual execution with the robot.”
Future iterations of surgical navigation systems will be smarter, easier to use and significantly more affordable, according to Boyer. “I think platforms will become less intrusive,” he said. “They will be better integrated into the O.R. and the surgical workflow.”
Boyer expects increasing numbers of younger surgeons to adopt surgical navigation as they’re exposed to the technology and the platforms become standard elements in the high-tech O.R. Marketing the benefits of the technologies — shorter surgeries, faster recoveries — to patients who increasingly expect quality outcomes could also have an impact on adoption, thanks to word of mouth and social media buzz.
Surgeon adoption will be key to the technology’s success. Boyer said that will require simplicity and intuitiveness. “Remember suction cup GPS holders for your car that were popular 20 years ago?” he asked. “GPS systems are now integrated into a car’s dashboard. You could see the same type of user-friendly evolution in augmented reality surgical navigation.”
Clayton said that surgical navigation needs to become affordable before it’s widely adopted in ambulatory surgery centers, where more joint replacements and spine procedures are being performed. “Costs will trend downward and more compact, intuitive systems will come to market. That will increase surgical efficiencies and make the platforms more accessible to smaller and mid-size facilities,” he said.
