An evolution that leads to success

Going pinless - the latest development in Computer Navigated Total Knee Replacement Procedure

Dr. Ishwar Bohra

Dr. Ishwar Bohra
Sr. Consultant
Centre for Orthopaedics,
Joint Reconstruction & Spine
Surgery, BLK Super Speciality

Third generation computer guided pinless Total Knee Replacement procedure is now regularly done in BLK Super Speciality Hospital without any additional cost to the patient.

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Total Knee Replacement (TKR) is a widely performed surgery nowadays. Over the years, the surgery has evolved quite significantly in terms of the techniques utilised and the outcome thereof. It has come a long way from the monoblock technique to the more advanced high flex TKR. In today’s digital era, computer is an integral part of TKR surgery, creating milestones of accomplishment with the success rate as high as 99 percent.

Computer was first introduced in Orthopaedics in France, 1980 for Anterior Cruciate Ligament (ACL) surgery. In the late 90s, computer technology was introduced for Joint Replacement Surgery. Many organisations have invented surgical navigation system to assist during the surgery, some major ones being - BrainLabs, Medtronics, Aesculap, Zimmer and Stryker. These are all closed systems with limited popularity as they are error prone and are not considered as userfriendly technology. The evolution of the technology in this field could be summarised as follows:

The first generation - Single way communication, closed system, pins in bones.
The second generation- Two way communication, open system, pins in bones.
The third generation - Pinless- World’s only 3rd generation surgical navigation system for Knee: ASM (Articular Surface Mounted), Stryker, produced in 2010.

BLK Super Speciality Hospital is equipped with third generation pinless ASM (Articulate Surface Mounted) Nav3 Express software technology. Previous versions involved wire and lesser sensitive trackers whereby, the surgeon had to drill a pin in the thigh and leg bone to fix the tracker, leaving accuracy in doubt and increasing risk of fracture of shaft because of the pin. If the pin is loose by any chance, not holding in osteoporotic bone, all the efforts would be wasted.

The present generation navigation system has successfully done away with the drilling of pin and sports highly sensitive wireless infra-red tracker which works with high accuracy. It is a two-way open system, which provides the surgeon real time correction of desired parameters. It also reproduces absolute neutral mechanical alignment ‘0’ – ‘0’, accurate sizing, rotation and balancing of knee. This system provides the perfect bridging of the gap between planning and execution. The best part is that this technology has become routine and is quite economical as patients who go for it do not have to shell out any additional cost. Looking ahead in the days to come, we can look forward to Navigation Guided Robotic Knee Replacement surgeries.