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Name:
Robotic Navio All Burr TKR by Dr. Anoop Jhurani
Description:
Robotic Navio All Burr TKR by Dr. Anoop Jhurani
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https://cadmoremediastorage.blob.core.windows.net/4fe60e6e-b0a1-4244-8f2d-10f0aa719713/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H12M28S
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https://cadmoreoriginalmedia.blob.core.windows.net/4fe60e6e-b0a1-4244-8f2d-10f0aa719713/Robotic Navio All Burr TKR by Dr. Anoop Jhurani.mp4?sv=2019-02-02&sr=c&sig=UsLQVBHb0Dg2drn0ZkzO2TS5nZrrOLbQNFMeRGYDwMQ%3D&st=2024-11-23T09%3A49%3A07Z&se=2024-11-23T11%3A54%3A07Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
ANOOP JHURANI: Hello, friends. This is a video for demonstrating the all burr surgical technique with robotic NAVIO system. This is a case of valgus knee. As you can see, it's about 5 degree valgus deformity, bone-on-bone arthritis. And on the long leg, you saw that we see the hip, knee, ankle, and this the lateral view showing minimal arthritis of the lateral compartment and a subluxing patella.
ANOOP JHURANI: So this is the surgical technique for robotic NAVIO system, and we put two pins in the femur, two in the tibia, and you can see the RA's. And then we register all the boundary of the femur and the tibia, and you can see the femur is reconstructed there very nicely. In this 3D model, we see the anterior surface, the distal points, the distal marking, the posterior condyles, and you can see the epicondyles, and we are seeing the axis of rotation.
ANOOP JHURANI: The robotic system automatically shows us the planning of the component, and it's showing us the size 5. You can take it up or down depending on the flexion gap. The tibia is size 3 and it's pretty accurate in its sizing. You can take it little anterior or posterior or lateral or medial, depending on how you feel. On the previous model, the yellow line is the bone and the implant is obvious with its shape.
ANOOP JHURANI: You can take it slightly posteriorly depending on the anatomy of the tibia and the femur, as you saw in the previous picture. And then it shows this beautiful gap balancing chart, and gap balancing is the key. And this is advantage over navigation because in navigation, the post-op gaps are not predicted accurately. Now here you can see that the flexion and the extension gap on the lateral side are tight, which is there in the valgus knee.
ANOOP JHURANI: And on the medial side, the opening is about 1.5 to 2 millimeters, which is what we want. Now here you can see that the femur, you can see without the implant and with the implant to see that there is no notching of, obviously there has to be no notching. And you can take it 1 millimeter anteriorly or posteriorly, sitting it flush on the anterior surface, and there you can see the femur beautifully is sitting on the 3D model.
ANOOP JHURANI: You can also see the rotation of the femoral component. That's another advantage that this robotic system predicts the rotation of the femoral component more accurately. Now the gaps are far better. You can see the flexion gap opening about 2 millimeters. That's what we want. In extension, the gap is tight. That is the red part and that will only come with soft tissue release.
ANOOP JHURANI: So you do not have to adjust what you will do with soft tissue release with the bony cuts. Bony cuts, as we know, are within one or two degrees of varus and valgus, but you can keep the femur component in one or two degree varus very accurately. Now, here, you can see the red side that's tight in extension, the lateral side, which will do a soft tissue release.
ANOOP JHURANI: The rest of the gaps look pretty good, 1 or 2 millimeter opening, both in flexion and medial extension. Lateral side in extension is tight, which we will do a soft tissue release. The femur component, you can see all around, you can move the screen up and down, and here again you can see the femur is cleaned beautifully. You can see the anterior-posterior medial lateral, the rotation, all three axes of the femur component and the tibial component you can see. This is the all burr technique here, again you can see the femur component beautifully.
ANOOP JHURANI: And this is how the burr will exactly prepare this surface for a 5-side lesion PS knee. This is exact way of determining where your components will sit. Now we do the all burr technique, so here we are not using any saw, which is a little different because we are all used to using saws on the femur for our cuts. Here we burr actually the femur, so the pre-op planning has to be very good, and then you start burring.
ANOOP JHURANI: Burring also is through the robotic system, and you know that the arrays are there on the... handheld robotic system, and the burring starts from the anterior side. We should always start burring from the anterior aspect on the medial side and then go on the lateral side. And as per plan, obviously there is no notching.
ANOOP JHURANI: The, while it is about 3 millimeters and you come down to green, which is 1 millimeter, and you go on to the white, which is where you have to be. And then you are {INAUDIBLE} the anterior, you can see nicely the {INAUDIBLE} boot or the grand piano sign. So the robotic system very accurately gives us the rotation, and the burrs very accurately burrs the surface of the femur as per our pre-op planning. And here you can see we are burring the distal surface, and we keep seeing the robotic screen and keep burring.
ANOOP JHURANI: It takes a little extra time initially, but ultimately the time is same as of a navigated TKR, and all this can be finished within 1 hour 15 minutes to 1 hour 30 minutes. And as you become better at it, there are surgeons who can do it in about one hour, and that's the ultimate goal. But it takes a little time to get used to burring and not sawing.
ANOOP JHURANI: So here you can see, I'm burring the... ...medial surface, and then the chamfer cuts, and all this surface ultimately is very accurate and the component sits beautifully, as you'll see in a while. The handheld burr is to be held firmly, very closely. This is a cylindrical burr on exposure control, so it will only burr when it comes near the bone that the robot has planned.
ANOOP JHURANI: If it's even half a millimeter out, it will stop burring, so you can't possibly burr on the soft tissues or the MCL, or any other area that is not planned in the robotic screen. This you can see we are burring all the violet up to the green, and then coming to the white, and now we are burring the lateral surface. Initially it may look a little different, but ultimately the bony preparation is the same and it becomes a very nice surface, raw porous surface for nice cemented {INAUDIBLE} once it is finished, as you will see in a while. Now we burr the distal surface, doing the fine tuning of the anterior champhers, and then we'll go on the posterior condyles.
ANOOP JHURANI: There are two control modes for the cylindrical burr. One is exposure control and one is a speed control. Most of our work is done in the exposure control where the burr retracts inside a sheath, even if it is outside the plan. So it's very safe. It does not harm any soft tissues. It does not go anywhere other than what is planned. Now we are doing the posterior condyles.
ANOOP JHURANI: You can see the posterior condyles. We are burring the violet and then the blue and then the green, and then we come to the white, as you will see. So there we go on the posterior surface. The burr can be held in two hands, the right hand above and the left hand, very close to the burr to get a good hold of it and to get good control.
ANOOP JHURANI: And the whole femur can be burred roughly in about 10 to 15 minutes. Just like the femur preparation, we're doing a TKR which takes about 15, 20 minutes. This also takes about that much time. Now here we are burring the posterior condyle as per the pre-op plan, getting away the violet and the greens to a nice white. As you can see, there are minimal red spots.
ANOOP JHURANI: The red is where, the burr is very sensitive to red, so even if you touch it more than white, it will mark a red. So it's very sensitive. Now we are burring the posterior medial condyle, as you can see there, protecting the MCL. Burr held nicely, strongly in both the hands. And you can see the arrays on the femur and tibia, which are always visible to the robotic screen.
ANOOP JHURANI: The constant saline irrigation, so that no heat is generated, and the burr works only on the surface that is removed. And you can see now I'm burring the posterior medial condyle, all that violet is going and white is appearing gradually. So all work can be done, It's a different way of doing things, the robotic planning is executed by the burr very accurately.
ANOOP JHURANI: And it's very accurate. We have been researching on this and studying it very closely, and it's pretty safe, accurate. And time gradually decreases. You can see that now we have burred the whole thing. And you will see the surface is just the way we finish with a saw. It's very accurate.
ANOOP JHURANI: In fact, it is the surface area provided where this is little more, because it's burring and not cutting. And you can see this beautiful white surface that we have created all around. And that is a replica of the bone that we have prepared on this patient's right femur with the valgus knee of about 5 degrees.
ANOOP JHURANI: Then we will check our rotation and our distal cut. And that's a good, interesting way to check the robot. And you will see that it shows us very accurately, we are seeing the rotation. You can see it's less than 0.5 degree error by what we had planned. So that's very, very accurate. And you can see that everything is as per plan. It is still cut also. As you can see, it's absolutely as per plan. Deflection, the depth of the cut, the varus-valgus.
ANOOP JHURANI: So all 3 axes, the coronal, sagittal, and the axial part of any cut can be done very accurately with the robot, and you can check it just like navigation here, and that there is no error. And robotic system is very accurate, and you can see the component sits beautifully, the preparation is very good, very accurate, and there is no struggle to put the component after you've burred the whole femur.
ANOOP JHURANI: This is size 5 narrow as you can see here, it sits accurately, and then we prepare the box. Currently the box is not prepared where the robotic arm, the tibia, and the femur can be all burred. And here you can see that, we'll see the kinematic graph in a minute, and you can see that we are in two-degree flexion, that is very good, you should be anywhere between 1 to 3 or 4 degrees, not more than that. Varus is zero, so we really corrected the coronal plane alignment.
ANOOP JHURANI: And this is the opening on the medial and lateral side. The orange is lateral, the blue is medial, and we can see that from extension to flexion, we are opening 1 millimeter or 2 millimeters. That's very, very accurate. Flexion is.
Segment:0 .
ANOOP JHURANI: Hello, friends. This is a video for demonstrating the all burr surgical technique with robotic NAVIO system. This is a case of valgus knee. As you can see, it's about 5 degree valgus deformity, bone-on-bone arthritis. And on the long leg, you saw that we see the hip, knee, ankle, and this the lateral view showing minimal arthritis of the lateral compartment and a subluxing patella.
ANOOP JHURANI: So this is the surgical technique for robotic NAVIO system, and we put two pins in the femur, two in the tibia, and you can see the RA's. And then we register all the boundary of the femur and the tibia, and you can see the femur is reconstructed there very nicely. In this 3D model, we see the anterior surface, the distal points, the distal marking, the posterior condyles, and you can see the epicondyles, and we are seeing the axis of rotation.
ANOOP JHURANI: The robotic system automatically shows us the planning of the component, and it's showing us the size 5. You can take it up or down depending on the flexion gap. The tibia is size 3 and it's pretty accurate in its sizing. You can take it little anterior or posterior or lateral or medial, depending on how you feel. On the previous model, the yellow line is the bone and the implant is obvious with its shape.
ANOOP JHURANI: You can take it slightly posteriorly depending on the anatomy of the tibia and the femur, as you saw in the previous picture. And then it shows this beautiful gap balancing chart, and gap balancing is the key. And this is advantage over navigation because in navigation, the post-op gaps are not predicted accurately. Now here you can see that the flexion and the extension gap on the lateral side are tight, which is there in the valgus knee.
ANOOP JHURANI: And on the medial side, the opening is about 1.5 to 2 millimeters, which is what we want. Now here you can see that the femur, you can see without the implant and with the implant to see that there is no notching of, obviously there has to be no notching. And you can take it 1 millimeter anteriorly or posteriorly, sitting it flush on the anterior surface, and there you can see the femur beautifully is sitting on the 3D model.
ANOOP JHURANI: You can also see the rotation of the femoral component. That's another advantage that this robotic system predicts the rotation of the femoral component more accurately. Now the gaps are far better. You can see the flexion gap opening about 2 millimeters. That's what we want. In extension, the gap is tight. That is the red part and that will only come with soft tissue release.
ANOOP JHURANI: So you do not have to adjust what you will do with soft tissue release with the bony cuts. Bony cuts, as we know, are within one or two degrees of varus and valgus, but you can keep the femur component in one or two degree varus very accurately. Now, here, you can see the red side that's tight in extension, the lateral side, which will do a soft tissue release.
ANOOP JHURANI: The rest of the gaps look pretty good, 1 or 2 millimeter opening, both in flexion and medial extension. Lateral side in extension is tight, which we will do a soft tissue release. The femur component, you can see all around, you can move the screen up and down, and here again you can see the femur is cleaned beautifully. You can see the anterior-posterior medial lateral, the rotation, all three axes of the femur component and the tibial component you can see. This is the all burr technique here, again you can see the femur component beautifully.
ANOOP JHURANI: And this is how the burr will exactly prepare this surface for a 5-side lesion PS knee. This is exact way of determining where your components will sit. Now we do the all burr technique, so here we are not using any saw, which is a little different because we are all used to using saws on the femur for our cuts. Here we burr actually the femur, so the pre-op planning has to be very good, and then you start burring.
ANOOP JHURANI: Burring also is through the robotic system, and you know that the arrays are there on the... handheld robotic system, and the burring starts from the anterior side. We should always start burring from the anterior aspect on the medial side and then go on the lateral side. And as per plan, obviously there is no notching.
ANOOP JHURANI: The, while it is about 3 millimeters and you come down to green, which is 1 millimeter, and you go on to the white, which is where you have to be. And then you are {INAUDIBLE} the anterior, you can see nicely the {INAUDIBLE} boot or the grand piano sign. So the robotic system very accurately gives us the rotation, and the burrs very accurately burrs the surface of the femur as per our pre-op planning. And here you can see we are burring the distal surface, and we keep seeing the robotic screen and keep burring.
ANOOP JHURANI: It takes a little extra time initially, but ultimately the time is same as of a navigated TKR, and all this can be finished within 1 hour 15 minutes to 1 hour 30 minutes. And as you become better at it, there are surgeons who can do it in about one hour, and that's the ultimate goal. But it takes a little time to get used to burring and not sawing.
ANOOP JHURANI: So here you can see, I'm burring the... ...medial surface, and then the chamfer cuts, and all this surface ultimately is very accurate and the component sits beautifully, as you'll see in a while. The handheld burr is to be held firmly, very closely. This is a cylindrical burr on exposure control, so it will only burr when it comes near the bone that the robot has planned.
ANOOP JHURANI: If it's even half a millimeter out, it will stop burring, so you can't possibly burr on the soft tissues or the MCL, or any other area that is not planned in the robotic screen. This you can see we are burring all the violet up to the green, and then coming to the white, and now we are burring the lateral surface. Initially it may look a little different, but ultimately the bony preparation is the same and it becomes a very nice surface, raw porous surface for nice cemented {INAUDIBLE} once it is finished, as you will see in a while. Now we burr the distal surface, doing the fine tuning of the anterior champhers, and then we'll go on the posterior condyles.
ANOOP JHURANI: There are two control modes for the cylindrical burr. One is exposure control and one is a speed control. Most of our work is done in the exposure control where the burr retracts inside a sheath, even if it is outside the plan. So it's very safe. It does not harm any soft tissues. It does not go anywhere other than what is planned. Now we are doing the posterior condyles.
ANOOP JHURANI: You can see the posterior condyles. We are burring the violet and then the blue and then the green, and then we come to the white, as you will see. So there we go on the posterior surface. The burr can be held in two hands, the right hand above and the left hand, very close to the burr to get a good hold of it and to get good control.
ANOOP JHURANI: And the whole femur can be burred roughly in about 10 to 15 minutes. Just like the femur preparation, we're doing a TKR which takes about 15, 20 minutes. This also takes about that much time. Now here we are burring the posterior condyle as per the pre-op plan, getting away the violet and the greens to a nice white. As you can see, there are minimal red spots.
ANOOP JHURANI: The red is where, the burr is very sensitive to red, so even if you touch it more than white, it will mark a red. So it's very sensitive. Now we are burring the posterior medial condyle, as you can see there, protecting the MCL. Burr held nicely, strongly in both the hands. And you can see the arrays on the femur and tibia, which are always visible to the robotic screen.
ANOOP JHURANI: The constant saline irrigation, so that no heat is generated, and the burr works only on the surface that is removed. And you can see now I'm burring the posterior medial condyle, all that violet is going and white is appearing gradually. So all work can be done, It's a different way of doing things, the robotic planning is executed by the burr very accurately.
ANOOP JHURANI: And it's very accurate. We have been researching on this and studying it very closely, and it's pretty safe, accurate. And time gradually decreases. You can see that now we have burred the whole thing. And you will see the surface is just the way we finish with a saw. It's very accurate.
ANOOP JHURANI: In fact, it is the surface area provided where this is little more, because it's burring and not cutting. And you can see this beautiful white surface that we have created all around. And that is a replica of the bone that we have prepared on this patient's right femur with the valgus knee of about 5 degrees.
ANOOP JHURANI: Then we will check our rotation and our distal cut. And that's a good, interesting way to check the robot. And you will see that it shows us very accurately, we are seeing the rotation. You can see it's less than 0.5 degree error by what we had planned. So that's very, very accurate. And you can see that everything is as per plan. It is still cut also. As you can see, it's absolutely as per plan. Deflection, the depth of the cut, the varus-valgus.
ANOOP JHURANI: So all 3 axes, the coronal, sagittal, and the axial part of any cut can be done very accurately with the robot, and you can check it just like navigation here, and that there is no error. And robotic system is very accurate, and you can see the component sits beautifully, the preparation is very good, very accurate, and there is no struggle to put the component after you've burred the whole femur.
ANOOP JHURANI: This is size 5 narrow as you can see here, it sits accurately, and then we prepare the box. Currently the box is not prepared where the robotic arm, the tibia, and the femur can be all burred. And here you can see that, we'll see the kinematic graph in a minute, and you can see that we are in two-degree flexion, that is very good, you should be anywhere between 1 to 3 or 4 degrees, not more than that. Varus is zero, so we really corrected the coronal plane alignment.
ANOOP JHURANI: And this is the opening on the medial and lateral side. The orange is lateral, the blue is medial, and we can see that from extension to flexion, we are opening 1 millimeter or 2 millimeters. That's very, very accurate. Flexion is.
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