Mixed-Reality TKA Guidance System Announced

A mixed-reality total knee arthroplasty was announced by its manufacturer, Miami-based Polaris. “Mixed Reality” refers to systems—which, incidentally, came out of the gaming industry—that combine the real information (images, sounds, etc.) with digital sound, graphics, labels, or 3D models. By using a mixed reality system, surgeons can interact with both physical and virtual objects simultaneously.

Polaris’s new mixed reality system, brand named the STELLAR Knee system, received FDA clearance in 2023 and has just recently been employed at New York-Presbyterian/Columbia University’s Irving Medical Center.

“This initial case represents a transition from a development stage to a commercial stage company,” said Polaris^AR CEO Paul Mikus. “We hired brilliant engineers from a variety of backgrounds so that there would be a divergence of thought. Our goal was to move away from the thinking in the orthopedic space and really create from a place of no limits. We are not just overlaying holographics, but also using mixed reality as the tracking and guidance device.”

“We are using mixed reality to spatially map the clinical field and then precisely capture digital measurement,” explained Mikus to OTW. “Using mixed reality visualization surgeons can see through to the site and accurately plan, place and confirm the location of instruments in the scene. The image of the real-time intraoperative plan is dynamically developed and displayed on the actual knee—without the need for CT or X-ray.”

“Surgeons have long been stuck with technology that doesn’t allow them to make important intraoperative adjustments. The STELLAR Knee, however, gives surgeons enhanced decision making capabilities as they can easily make real-time changes to the surgical plan.”

“Approximately 30% of TKA cases have access to robotics. Thus, if you have 10 surgeons on staff and only 2 robots, then some people won’t have that access. A hospital is not going to buy eight more robots. Also, while you can’t take a robotic system to an ASC, with our technology, you just need a small headset. In addition, we’re agnostic to implants so there is none of the ‘Oh, it’s a Stryker robot so you have to use a Stryker implant.’”

Particularly interesting, said Mikus to OTW, is that the STELLAR Knee creates a continuous data exchange between the surgeon and the software. “I think our system actually facilitates an intimacy between the surgeon and the technology. For the first step, taking measurements, information is coming from the surgical field into the headset, so there is a flow. In stage two—planning—the surgeon is interacting with the information and making adjustments where necessary. Then the surgeon uses that information to guide the instruments, so information is going out of the headset.”

Not only does their technology create a flow, explained Mikus, but it relieves surgeons of the need to do calculations in their heads. “With the STELLAR Knee, we do the data gathering, focusing on optimization of lower limb alignment, soft tissue balance, joint line maintenance and component positioning. That way, surgeons can give 100% of their focus to the patient and procedure.”

“I think there is a growing sense that robotics is reaching a flattening point. The reception from investors, doctors, and potential partners has been fantastic…they are saying, ‘This mixed reality technology is the future!’”

“Democratization of vital technologies is a key objective for our company,” Mikus told OTW. “Indeed, the STELLAR Knee’s small intraoperative footprint opens robotics up to more widespread adoption.”