Orthorobotics® is a medical research organization dedicated to enhance patient outcomes and help surgeon improve surgical precision with robotic prosthetic joint technology. The institute is firmly committed to research new methods of diagnosis and treatment of arthritic joints and development of next generation orthopedic surgical systems including robotics and other cutting-edge techniques.

Today is era of precision. What does precision means? How the word precision used for industrial and labor equipments started to be used in medical field? Surgeons want to perform each operation as perfectly as possible. How to improve surgical performance? Surgeons working with their experience, intuition and instinct may still commit errors. How to reduce these judgment errors - human errors? Joint replacement surgeries are the most successful surgeries, but few patients may still complain of pain. What are the causes of such failures? What are the parameters of how good your surgery will be? What is the guarantee perse of the surgical procedure? The answers to all these questions form the basis for the evolution of orthorobotics.

Osteoarthritis afflicts an estimated 15 million adults in India. Osteoarthritis, once known as a disease of the elderly, is increasingly seen in young and active people within the age 35-55 years. India has the second largest knee osteoarthritis world-base, disabling major chunk of our productive population. Joint replacement is the treatment for end stage osteoarthritis. The field of joint replacement evolved rapidly over last 40 years. Innovations in the material of implants/components, surgical instrumentation, anaesthesia, pain management protocols revolutionized the field of joint replacement. Joint replacement surgeries are now routinely performed all over India and their numbers are increasing dramatically. The numbers increased by 30% from 2004 to 2008. The same period also saw a 61% rise among men and women ages 45-64.

The joint replacement surgeries are most successful surgeries. The functional outcome with the latest joint replacement implants is excellent and most patients are able to do almost all activities, that too without any pain. However few patients may not be satisfied, may still have pain or limitations of their activities. Failures in the decade of the 2000s can be attributed to failure of performance of the operation by the surgeon. Surgeons operate using their experience, instinct, and intuition to create a result. This is effective for most patients. Successful joint replacement surgery depends on proper positioning of components. A few mm of few degree of difference in the component position may lead to pain, stiffness and early loosening. Human anatomy is very individual (there are variations in human anatomy) and studies have shown that even the experienced surgeons in Boston and Stanford medical centers have struggled with orientation during surgery in 53% of their cases. Even with the same surgeon, there is variation in every step of surgery and so the results not consistent.

A expert surgeon does not mean a surgeon who does a single surgery perfectly but means a surgeon who does number of surgeries without any gross mistake. Experienced surgeon can be accurate but not precise, precise but not accurate, neither or both. Accuracy is the nearness (closeness) to a set standard or true value. Precision defines the limits of error/failure i.e maximum deviation from the set standard or true value. Drones (unmaned aerial vehicles) are the most advanced robots with an unknown precision. A experienced fighter jet pilot shoots at a fixed target, he misses 10 out of 100 shots. The distance of farthest missed shot is 5 meters. A student fighter jet pilot shoots at the same target and he misses 20 out of 100 shots. The distance of farthest missed shot is 2 meters. Who is better – the experienced or the student ? This is where precision matters. Precision measures failures, how severe the failures are? The student is definitely better. The experienced pilot has accuracy of 90 but his precision is 5 whereas the student has accuracy of 80 but his precision is 2. Drone with a 1.8 gigapixel camera can shoot all shots on target within cms. These robots have literally made the most skilled jet pilots jobless. The current surgical techniques lack predictions and increasing number of the patients are dissatisfied and are required to undergo revision surgery. The number of patients requiring a second or even a third surgery is increasing dramatically, especially in India.

Joint replacement surgery not only requires good hand eye co-ordination but also ability to visualize structures in three dimensions. The surgeons place the instruments over the bones and then cut and prepare the bone. It is not always possible for the human hand to place and control the tools as accurately as planned. The surgeon struggle between the surgical field and their continuous hold over the instruments. Bone quality varies with patients. The strength or forces applied on instruments also vary. All these things cause deviations in surgeons’ hands and limits consistency and reproducibility of surgeries. Robotic joint replacement is the new standard. The robot is the surgeon’s assistant. It does not replace a surgeon but creates a physical constraint on surgeons’ hand to ensure precise positioning of surgical tools. The system automatically stops even with minor hand deviation, eliminating or reducing the inevitable margin of error.

Orthorobotic technology enables the surgeon to reproduce his/her best performance on a consistent basis. Orthorobotics incorporates computer navigation program with a robotic arm which holds the instruments while the final control of each instrument remains in surgeon’s hand. During mechanical preparation of bone the robotic arm system allows the surgeon to work within a virtual haptic interface (stereotactic tunnel) and the system automatically stops (fail safe mechanism) if the surgeons hand goes outside the interface. The failsafe mechanism stops the instruments even with minor deviation, eliminating or reducing the inevitable margin of error. The dynamic tactile constraint ensures solid intraoperative fixation within the set plan. Robot helps the surgeon to understand the variation of individual anatomy and so the surgery is personalized. Orthorobotic technology enables the surgeon to reproduce his/her best performance on a consistent basis; thus, making the best orthopedic surgeon better.

The field of orthorobotics is expanding rapidly and many new robotic systems are under development in multiple centers worldwide. Orthorobotics company is developing hip replacement, knee replacement surgery and bone tumour application. The robotic arm greatly improves accuracy and precision. The robot has a margin of error within 3mm and 3 degrees. Dr. Vaibhav Kanawade Patils study has shown that the robotic arm violated the 2mm and 2 degree of surgical margin error in only 20% of the surgeries. This is currently an expensive technology but in future, we will see smaller, low-cost systems utilizing smart sensing technology resulting in greater accuracy and precision.

Robotic Joint Replacement

Because of recent advancements in medical technology, joint replacement has become a practical option for more individuals who suffer from severe hip pain or knee pain. Joint replacement is indicated in individuals whose musculoskeletal injuries haven't responded to non-operative treatments such as corticosteroid injections and pain management (physical therapy, rehabilitation). When these non-surgical therapies can't alleviate pain, joint replacement is an option to relieve pain and limited range of motion associated with a joint injury.

How Robot improves Joint Replacement

Robotic surgery improves the likelihood of relieving joint pain and increasing range of motion in the affected joint by giving the greatest amount of accuracy and precision to the operative surgeon. The GPS-like dashboard for navigating the injured joint gives the surgeon more control and helps ensure everything is aligned properly. The software aids in decision making when positioning instruments and orthopedic implants during the surgery. Systems allow the most accurate tracking and analysis possible for the surgical instruments involved in the joint replacement or joint reconstruction process.

Benefits of Robotic Joint Replacement
• Helps the surgeon place joint replacement implants with increased accuracy and precision, contributing to a longer-lasting replacement.
• Reduces the risk of dislocation & revision surgery.
• Better joint placement contributes to more stability in the joint as well as improved range of motion.
• Minimally Invasive Surgery.
• Reduced blood loss during surgery
• Reduced post-operative downtime
• Shorter hospital stay due to faster recovery time
• Smaller incision means reduced / smaller scarring

How Robotic Hip Replacement Works

The System uses tracking devices that utilize infrared technology and sends data back to the computer dashboard. These infrared trackers detail instrument positions to a fraction of a degree. As the surgeon moves the instrument around the joint to position the orthopedic implantthe robot navigation system displays a dynamic image of the anatomy of the joint. The robot provides feedback in real-time as the surgeon moves the instrument around the joint, giving precise and accurate measurements to help the surgeon perfectly place the joint replacement.