I, CORI: The coming robotics revolution in orthopaedic surgery

doctor with robotic machine


It’s difficult to overstate the profound impact technology has had on health care. As our understanding of the natural world continues to advance, innovative minds help translate these new insights into practical applications. Changes in liquid density with respect to temperature saw the introduction of the thermometer. Our grasp of sound amplification led to the stethoscope. But as we move further into the 21st century, technologies are being adapted to fit various specialties and subspecialties of medicine. 

In the realm of orthopaedics, for example, the development of highly cross-linked polyethylene was a game-changer for hip and joint replacements in the early 2000s. To illustrate the scope of orthopaedics at London Health Sciences Centre (LHSC), of the 17 operating rooms (OR) at University Hospital, three to four are dedicated to joint replacement surgery every single day. As such, efficiency and accuracy are crucial ingredients to meeting the high demand for service. 

“Without a doubt, the future of orthopaedics is robotics,” says Dr. Douglas Naudie, orthopaedic surgeon at LHSC. 

Enter CORI, the latest addition to the orthopaedic surgeon’s toolkit at LHSC, and funded through a generous donation to London Health Sciences Foundation. Short for Core of Real Intelligence, CORI is a handheld, portable and intuitive system designed for robotic-assisted surgery. 

“Early studies have shown robotic-assisted knee-replacement surgery leads to improved accuracy and improved clinical outcomes,” Dr. Naudie explains. “This has pushed us to explore in more detail the role of robotics in the OR.” 

For the past year, LHSC’s orthopaedics team has been doing their due diligence in evaluating CORI in saw bone and cadaveric specimens to prepare them for clinical use. What makes this particular robot unique is its ability to provide real-time feedback. Other systems available on the market today require a preoperative CT or MRI scan to landmark a patient’s anatomy, making the road to surgery slightly more cumbersome. 

“With CORI, we can actually digitize anatomic landmarks and create a model of the knee at the time of surgery,” Dr. Naudie says. He moves his index finger across the screen to manipulate the knee-bone he has pulled up. “We can then adjust sizes, angles, alignment and rotation to execute the plan with a very high level of accuracy.” 

Built-in fail-safes also work in conjunction with the digital mapping software. With the operating area fully entered into the computer, the handheld milling tool can only function where allowed. Dr. Naudie demonstrates this by trying to cut outside the designated field on a sawbones model: nothing happens. Similarly for depth, calibration prevents the operator from pushing too far into the bone.  

For orthopaedic surgeons at LHSC, it’s like being given a paintbrush that can’t paint outside the lines. The combination of precision and real-time data is invaluable in its capacity to improve patient outcomes at the time of surgery. And when it comes to including cutting-edge advancements such as this to our hospital’s ORs, Dr. Naudie recognizes the importance of donor support. 

“We are always striving to be the best, but our ability to adopt emerging technologies is only possible with the generous donations we receive through the Foundation,” he says. 

The orthopaedics department at LHSC is approaching robotics with cautious optimism. By taking the time to study objectively and understand fully the extent these systems will play in their ORs, the team is focused solely on providing the best care possible. They want to optimize not only the tools but the process as well, ensuring they’re well-prepared for the future when it gets here.