Dr. Jimmy Chow shares his experience performing robotic-assisted revision knee surgery using the CORI™ Surgical System and conveys the value of CORI™ Digital Tensioner- the first handheld digital tensioning device that allows surgeons to define a target force and assess joint laxity in native knee before any bony resection.
I think Corey brings a certain amount to revision. And I think the mistake that a lot of the a lot of the surgeon population might make is that we're just adding an indication to something we've got. Oh, this is a G whiz maybe we can add something cool that maybe broadens the indication. So the core platform by its design is image free. So you don't have to worry about a CT scan or an MRI having any kind of scatter or any kind of pre predetermined image parallax or distortion from metal that's there. So by virtue of the fact that the way it collects data already is ideal for revision setting where there's a lot of metal and plastic. That's the first thing. The second thing is that the system already had built into it. This thing called the refined mode and refined mode is for those of you who have not used Cora is the method of re registering the surface after you've originally registered it, meaning that you can register what you've got, take off implants, identify defects and re register all of that. So now you've mapped every single defect in the knee that you had before and then you have the ability to, you know, Corey has a precision mill on the end of it. And that mill is an error correcting mill, which is what makes it robotic. Well, we've also realized now in using this as an application that milling the distal femur the proximity, especially in terrible bone quality, especially when things are kind of fragile and knowing exactly where that goes is by far the most bone and tissue friendly way you can do a revision knee. So now you've got a circumstance where it's not expanding in indications and making something kind of fit something and saying, hey, wait, we can do this. And what it's done is it's made it more approachable and easier to do because now you're anticipating during the surgery, you're anticipating exactly where these implants are going before making bony preparation. You're taking a large section of revision work, that large section of revision work is the trial and error part of it. So we know that revision work, you remove implants and then you kind of establish canals and then you try to recreate a joint line using the implants that you have and you try to put implants, you put the trials in and that's where the surgeon surgeon's experience really drives from because the surgeon experience goes, oh, I need an augment here. I need to do this here and then they keep trialing back and forth. So you get something that's some semblance of a knee replacement and you think, oh, this is good enough and this is great. Now I've got, now I've got my answer with the core that's all planned. And while you're doing the bone preparation, your assistant is building the construct on the back table. And as soon as you're done, you, you put it right in and you're choosing between a 9, 10 or 11 of plastic, you don't have to go back and forth and back and forth trying to figure out what you're doing. It is really surprisingly elegant. Not only is it elegant, it may be the very best way to possibly do a revision need. So the question is, does, does the coy robot allow us to maybe move away from longer stem constructs? And I think the industry as a whole is doing that. I think the industry as a whole is starting to recognize that that shorter stems using a fully cemented, shorter stem with cones as biologic fixation seems to have the best results. And I think the reason for that is, is, is, is an academic one, but you can see it in real life. Historically speaking, we were so worried about bony fixation, which is a real concern. That's the main reason that one of the main reasons that revision needs fail. And so instead what we were doing, we were taking Midshaft Femur Midshaft Tibia and building from that. But we all know that the joint line and the kinematics and the mechanics of the knee is not dictated by the shaft of the long bones. We know that very clearly. So we were making concessions. And so the entire industry moving towards shorter stems, I think is the industry recognizing that we need to start reconstructing the knee, the way the knee is working because it is a joint in itself, not by where the fixation is coming from. The hard part of that is that you're anticipating that you're relying on surgeon and experience to figure that out. And more experienced surgeons do it better than less experienced surgeons. And there's no way to truly measure that it is still a trial and error phase. It is still, I'm guessing this and I hope that this is working Corey specifically allows you to measure plan and identify what it looks like. And so now you're taking the guess, work out of doing exactly that I couldn't be more excited about that because as someone who's been involved with computer assisted surgery for a while and subsequently robotic surgery. And as someone who likes to study history and knowing that ever since the nineties, we've been dealing with computer assisted surgery around the knees. The biggest hole that we've seen is data acquisition, like every computer system that you ever have crap in crap out. And so much of the learning curve that computer assisted surgeons have to deal with is how to acquire the data. And so much is left subjectively to the surgeon's hands. And if there's any way that we can control the way that data is inputted, we can be so much more sophisticated about how we can use that data afterwards. And this speaks to learning curves, it speaks to adoption, it speaks to consistency, it speaks to even the most experienced surgeons getting more consistent results and it speaks to research. This is one of those things that we're moving away from just getting through the surgery properly and getting good results to now, we can argue the fine details of how we're planning because we're consistently taking the initial data. This is a game changer with respect to all computer assisted surgery, let alone robotics. And I'm pretty proud to say that it's part of the core platform.