Automated Markerless Robotic Assisted Orthopaedic Surgery

In the UK, the total number of Total Knee Replacements(TKA's) per year has increased from 13,546 in 2003 to 98,147 in 2019 costing the NHS an estimated £585m per year\[1\]. During the same period the number of TKA revisions increased from 630 to 5,932, the majority of these (\>60%) attributed to malalignment, implant wear/fracture and aseptic loosening\[2\].Robotic-assisted surgery has the potential to reduce these complications providing a more natural-feeling knee and increasing implant survivorship\[3\]. In the UK, robot-assisted TKA surgery(r-TKA) is becoming more frequently used. Evidence from national joint registries has shown that people who have undergone r-TKA suffer lower blood loss during surgery, reduced hospital stay and improved joint function\[3\].

A major limitation of the current generation of surgical robots is the need for an infrared optical tracking system to monitor the position of the patient , surgical instruments and robot in theatre. To achieve this, a marker has to be attached to each target. However, if these markers become occluded during surgery, they cannot be detected by the camera, which results in loss of data. Attaching rigid markers to the patient is also time consuming and invasive increasing the risk of complications such as infection and fracture \[4-5\].The average cost of a TKA in the UK is £12,000, however, post-surgical complications, e.g surgical site infection, increases this cost by between £1618 and £2398 per patient\[6\].Marker-based navigation also requires several instrument trays that increases sterilisation burden in hospitals, amounting to £4.1m per year globally based on the current utility of S&N's robotic system.

Our consortium, which is comprised of Smith&Nephew Ltd, DCSL Ltd and Imperial College London,is pursuing Innovate-UK funding to carry out an ambitious and innovative project that is focussed on developing markerless and automated registration and tracking of the patient's limbs tailored for robotic-assisted orthopedic procedures using structured light technology assisted by deep learning to continuously capture the patient's anatomy during surgery.This new platform will be integrated within S&N's commercially available robotic platform"NAVIO," which was previously supported by I-UK funding, and will obviate the need for percutaneous markers reducing set-up time, cost and complexity during surgery.

The consortium will utilise public funding to advance the automated markerless tracking technology from initial proof of concept\[7\] to practical demonstration in a surgical theater in live surgeries with patients over a 28month period in order expedite market adoption within 3yrs.

\[1\][https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303][0]

\[2\]T.Peters-and-K.Cleary,Eds.,Image-Guided-Interventions:Technology-and-Applications.Berlin,Germany:Springer-Verlag,2008\.

\[3\]National-Joint-Registry.http://www.njrcentre.org.uk/njrcentre/default.aspx.

\[4\]Wysocki-et-al,Femoral-fracture-through-a-previous-pin-site-after-computer-assisted-total-knee-arthroplasty.The-Journal-of-Arthroplasty,2008,Apr1:23(3):462-5\.

\[5\]Kamara-et-al.,Pin-site-complications-associated-with-computer-assisted-navigation-in-hip-and arthroplasty.The-Journal-of-Arthroplasty.2017Sep1;32(9):2842-6\.

\[6\]NICE(2008a)Surgical-Site-Infection:the-preventions-and-treatment-of-surgical-site-infection.http://guidance.nice.org.uk/CG74\.

\[7\]Rodriguez-&-Liu-Automatic-Markerless-Registration-and-Tracking-of-the-bone-for-Computer-Assisted-Orthopaedic-Surgery-IEEE-Access,Vol.8,Feb,2020,42010--42020\.

[0]: https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303