NAVIO™ and CORI™ Robotic Surgery Systems

Revolutionizing Surgical Precision

Overview

The CORI™ Surgical System (successor to the NAVIO™ Surgical System) is a handheld robotic-assisted platform developed by Smith+Nephew for knee arthroplasty.

The CORI system represents the next generation of the NAVIO platform, with significant improvements in tracking speed, software capability, and clinical indications.

At Apollo Hospitals, these systems are part of our comprehensive robotic-assisted joint replacement programme, reflecting our commitment to providing patients with the most advanced surgical technologies for improved outcomes and faster recovery.

Purpose

The primary purpose of CORI Robotic Surgery Systems is to enhance the precision and outcomes of orthopedic surgeries.

The system is designed specifically for joint arthroplasty procedures and assists the surgeon with personalised surgical planning, precise bone preparation, accurate implant alignment, and real-time intraoperative guidance.

These systems offer several key benefits for patients, including:

• Minimally Invasive Procedures: The handheld robotic system enables surgeons to perform surgeries through smaller incisions, reducing trauma to surrounding tissues.
• Enhanced Accuracy: The robotic assistance allows for precise alignment and placement of implants, which is crucial for the longevity and functionality of joint replacements.
• Faster Recovery Times: Patients often experience quicker recovery and less postoperative pain, leading to shorter hospital stays and a faster return to daily activities.
• Personalized Surgical Planning: The system creates a patient-specific 3D model of the joint — either through intraoperative smart mapping (image-free) or through optional pre-operative MRI planning via CORIOGRAPH — allowing for customised surgical approaches.

NAVIO™ and CORI™ provide unique solutions that address the challenges faced in traditional orthopedic surgeries, making them a preferred choice for both surgeons and patients.

Key Feature: Image-Free Technology

Unlike many other robotic surgery systems, the CORI system is image-free by default. It does not require a pre-operative CT or MRI scan.

Instead, the surgeon uses the handheld robotic device to map specific anatomical landmarks within the knee joint during surgery. The system’s software creates a patient-specific 3D model of the joint in real time through this intraoperative mapping process (called smart mapping).

This eliminates the time, cost, and radiation exposure associated with pre-operative CT imaging.

Note: With the newer CORIOGRAPH™ service (launched June 2024), surgeons can optionally choose to use a pre-operative MRI for planning, making CORI the only orthopaedic robotic system to offer both image-free and image-based registration.

This flexibility allows the surgeon to choose the most appropriate workflow based on the individual patient’s needs and clinical situation.

Indications

The CORI Surgical System is indicated for the following joint arthroplasty procedures:

• Total knee arthroplasty (TKA)
• Unicompartmental (partial) knee arthroplasty (UKA)
• Revision knee arthroplasty (FDA 510(k) cleared, CORI is the first robotics platform indicated for revision TKA)
• Computer-guided total hip arthroplasty (software-only, via RI.HIP NAVIGATION)

The CORI system is not indicated for soft-tissue surgeries such as urological, gynaecological, cardiac, or general surgical procedures.

How It Works

The CORI Surgical System operates through a combination of handheld robotic technology, infrared optical tracking, and AI-driven software.

The process involves the following steps:

Step 1: Intraoperative Joint Mapping

The surgeon maps the joint surface using the handheld device with infrared tracking.

Unlike systems that require a pre-operative CT scan, the CORI system builds its understanding of the patient’s anatomy directly in the operating room through this smart mapping process.

(If the surgeon has opted for CORIOGRAPH planning, a pre-operative MRI-based 3D model is available and integrated at this stage.)

Step 2: 3D Model Creation and Surgical Planning

The CORI software builds a patient-specific 3D model from the mapped data and calculates the surgical plan, including optimal implant size, position, and alignment based on the patient’s unique anatomy.

Step 3: Robotic-Assisted Bone Preparation

The surgeon uses the robotic handpiece for precision bone milling guided by the surgical plan.

The system’s speed-controlled milling tool removes bone according to the planned parameters, with the infrared tracking system providing real-time feedback to ensure accuracy.

Step 4: Gap Balancing and Implant Placement

Real-time gap balancing helps optimise ligament tension and implant positioning.

The system provides the surgeon with quantitative data on soft-tissue balance, allowing for fine adjustments before final implant placement.

This step is particularly important for ensuring joint stability and a natural-feeling knee after surgery.

Benefits for Patients

The benefits of CORI™ Robotic Surgery Systems extend beyond the operating room.

Key advantages for patients include:

• Non-Invasive Nature: The minimally invasive approach reduces trauma to surrounding tissues, leading to less pain and quicker recovery.
• Reduced Side Effects: Patients experience fewer complications and side effects compared to traditional surgical methods.
• Improved Outcomes: The precision of robotic assistance contributes to better alignment and placement of implants, enhancing the longevity and functionality of joint replacements.
• No Pre-Operative CT Required: The image-free default workflow eliminates the time, cost, and radiation exposure associated with pre-operative CT imaging.
• Flexible Planning Options: With CORIOGRAPH, surgeons can optionally use pre-operative MRI for more complex cases, making the system adaptable to a wide range of clinical scenarios.
• Suitability for Complex Cases: The systems are designed to handle complex anatomical challenges, making them suitable for a broader range of patients.

Limitations and Considerations

As with any surgical technology, it is important for patients to understand the limitations of the CORI system:

• Initial setup and registration time may be slightly longer than conventional surgery, particularly during the early phase of adoption. Surgical time typically improves with surgeon experience.
• The system is designed specifically for joint arthroplasty and is not suitable for soft-tissue, spine, urological, or cardiac procedures.
• While robotic assistance is designed to improve precision, surgical outcomes are also influenced by surgeon experience, patient health, and post-operative rehabilitation.
• Availability may vary across Apollo Hospitals centres. Please check with your local Apollo orthopaedic department.

Regulatory Status

The CORI Surgical System has received FDA 510(k) clearance and is available in India, the UK, Canada, Australia, and other markets.

It is manufactured by Smith+Nephew, a global medical technology company.

CORI is the first robotic platform to receive FDA clearance for revision total knee arthroplasty.

Patients should discuss with their orthopaedic surgeon whether robotic-assisted joint replacement is appropriate for their specific condition.

Frequently Asked Questions

1. Is the CORI system the same as the NAVIO system?

CORI is the next-generation successor to the NAVIO Surgical System, also developed by Smith+Nephew.

It features a significantly faster infrared tracking camera (more than four times faster than NAVIO), improved software (RI.KNEE ROBOTICS), and an expanded range of clinical indications including revision TKA and computer-guided hip arthroplasty.

If your hospital currently uses NAVIO, your surgeon can advise on whether an upgrade to CORI is available.

2. Does the system require a CT scan before surgery?

No. The CORI system is image-free by default and does not require a pre-operative CT scan.

The surgeon maps the joint anatomy during surgery using smart mapping technology.

However, with the optional CORIOGRAPH service (launched 2024), surgeons can choose to use a pre-operative MRI if they prefer image-based planning for a particular case.

3. Is the procedure painful?

While individual experiences may vary, the minimally invasive nature of CORI procedures typically results in less pain and discomfort compared to traditional surgeries.

Most patients report manageable pain levels postoperatively.

4. How long does the treatment take?

The duration of the procedure can vary depending on the complexity of the surgery, but most CORI surgeries are completed within 1 to 2 hours.

5. What are the potential side effects?

As with any surgical procedure, potential side effects may include infection, bleeding, or complications related to anaesthesia.

However, the minimally invasive approach generally reduces the risk of these complications.

6. How many sessions are required?

Most patients require only one surgical session for their joint replacement.

Follow-up appointments will be scheduled to monitor recovery and assess the success of the procedure.

7. What is the recovery time?

Full recovery may take several months, depending on individual healing rates.

8. Are there any age restrictions?

There are no strict age restrictions; however, eligibility is determined based on the patient’s overall health, joint condition, and specific surgical needs.

9. Can I return to normal activities after surgery?

Most patients can resume light activities within a few weeks, while more strenuous activities may take several months.

Physical therapy is often recommended to aid recovery.

10. Can the CORI system be used for hip replacement?

The CORI system supports computer-guided total hip arthroplasty through its RI.HIP NAVIGATION software.

This is a navigation-only (software-guided) capability, not robotic milling.

Your orthopaedic surgeon can advise whether this is appropriate for your case.

11. How do I find a surgeon who uses NAVIO™ or CORI™?

To find a qualified surgeon, consult your primary care physician or contact Apollo Hospitals to find an orthopaedic specialist trained in robotic-assisted surgeries using the CORI system.

Book an Appointment

If you or a loved one is considering joint replacement surgery, the CORI™ Robotic Surgery System may be the right choice for you.

Experience the benefits of advanced surgical technology and personalised care at Apollo Hospitals.

To book an appointment with an orthopaedic specialist, visit apollohospitals.com/book-doctor-appointment or contact your nearest Apollo Hospitals centre.