Method for robotic arthroplasty using navigation

• US 8,641,726 B2
• Filed: 03/14/2013
• Issued: 02/04/2014
• Est. Priority Date: 08/28/2001
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US13/802,914
• Publication Number:
  US 20130204272A1
• Time in Patent Office: 327 Days
• Field of Search: 623/20.15, 623/20.14, 623/16.11, 623/22.11, 623/901, 128/898, 606/86.R, 606/130, 606/91, 606/102, 606/87, 600/424, 600/587, 600/595, 703/11, 703/258
• US Class Current: 606/130
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/158 Cutting patella
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1626 Control means; Display units
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1717 for applying intramedullary nails or pins
• CPC Class Codes: A61B 17/1721 for applying pins along or parallel to the axis of the femoral neck
• CPC Class Codes: A61B 17/1735 for rasps or chisels
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/809 with bone-penetrating elements, e.g. blades or prongs bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233
• CPC Class Codes: A61B 2017/00004 : (bio)absorbable, (bio)resorbable or resorptive
• CPC Class Codes: A61B 2017/00557 : inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 : for the knee
• CPC Class Codes: A61B 2017/0409 : Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0414 : having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2034/102 : Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 : Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2051 : Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2055 : Optical tracking systems
• CPC Class Codes: A61B 2046/201 : for extremities, e.g. having collection pouch
• CPC Class Codes: A61B 2046/205 : Adhesive drapes
• CPC Class Codes: A61B 2046/236 : with means for collecting drain fluid, e.g. drain tubes
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 2090/366 : using projection of images directly onto the body
• CPC Class Codes: A61B 2090/374 : NMR or MRI
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 42/00 : Surgical gloves; Finger-stalls specially adapted for surgery; Devices for handling or treatment thereof
• CPC Class Codes: A61B 46/00 : Surgical drapes
• CPC Class Codes: A61B 5/4533 : Ligaments
• CPC Class Codes: A61B 5/4851 : Prosthesis assessment or monitoring
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/13 : guided by light, e.g. laser pointers
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61F 2/30721 : Accessories
• CPC Class Codes: A61F 2/30724 : Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30771 : applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/34 : Acetabular cups
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3868 : with sliding tibial bearing
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4609 : of acetabular cups
• CPC Class Codes: A61F 2/461 : of knees
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30079 : magnetic
• CPC Class Codes: A61F 2002/30326 : differing in height or in length
• CPC Class Codes: A61F 2002/30331 : made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30364 : Rotation about the common longitudinal axis
• CPC Class Codes: A61F 2002/30387 : Dovetail connection
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30761 : Support means for artificial cartilage, e.g. cartilage defect covering membranes
• CPC Class Codes: A61F 2002/30883 : dovetail-shaped
• CPC Class Codes: A61F 2002/30892 : parallel
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30975 : made of two halves
• CPC Class Codes: A61F 2002/3401 : with radial apertures, e.g. radial bores for receiving fixation screws
• CPC Class Codes: A61F 2002/3403 : Polar aperture
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4677 : using a guide wire
• CPC Class Codes: A61F 2210/009 : magnetic
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2250/0037 : differing in height or in length
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00365 : Proteins; Polypeptides; Degradation products thereof
• CPC Class Codes: A61G 13/0045 : specially adapted for hand or wrist surgeries
• CPC Class Codes: A61G 13/0054 : specially adapted for back or spinal surgeries
• CPC Class Codes: A61G 13/0063 : specially adapted for knee surgeries
• CPC Class Codes: A61G 13/0072 : specially adapted for shoulder surgeries
• CPC Class Codes: A61G 13/0081 : specially adapted for hip surgeries
• CPC Class Codes: A61G 13/1245 : Knees, upper or lower legs
• CPC Class Codes: A61G 13/125 : Ankles or feet
• CPC Class Codes: A61M 1/77 : Suction-irrigation systems aspiration tips supplying fluids A61M1/85; specific for negative pressure wound therapy A61M1/92; combined with tracheal tubes A61M16/0463

Abstract

A method for robotic surgery on a joint using a robotic system and a navigation system. The robotic system includes a base, a plurality of arms, and a cutting tool. The navigation system tracks movement of bones associated with the joint during the surgery. Information related to tracked positions of the bones is communicated from the navigation system to the robotic system. The navigation system may include a plurality of locating devices.

Claims

1. A method for robotic knee surgery on a femur and tibia of a knee joint, said method comprising the steps of:

providing a robotic system including a base, a plurality of articulate arms movable relative to the base, motors and controls supported by the base, and a cutting tool coupled to the plurality of articulate arms so that the cutting tool is capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system;

tracking positions of the femur and tibia during the surgery with the navigation system as the femur and tibia move during the surgery;

communicating information related to the tracked positions of the femur and tibia from the navigation system to the robotic system;

guiding movement of the cutting tool of the robotic system relative to the femur and tibia so that material from the femur and tibia can be removed by the cutting tool without the use of physical resection guides; and

removing material from the femur and tibia with the cutting tool and without the use of physical resection guides.

2. The method as set forth in claim 1 wherein guiding movement of the cutting tool includes one of:

guiding user-controlled movement of the cutting tool with optical cutting guides;

or

robotically guiding movement of the cutting tool using the motors and controls of the robotic system.

3. The method as set forth in claim 2 wherein guiding movement of the cutting tool includes guiding user-controlled articulation of the plurality of articulate arms.

4. The method as set forth in claim 1 including determining a position of the cutting tool relative to the femur and determining a position of the cutting tool relative to the tibia wherein the navigation system cooperates with the robotic system to determine the positions of the cutting tool relative to the femur and tibia during the surgery.

5. The method as set forth in claim 1 wherein providing the navigation system includes providing a plurality of locating devices and a plurality of photo cells to receive light from the plurality of locating devices to determine the positions of the femur and tibia.

6. The method as set forth in claim 1 including indicating volumes of material to be removed from the femur and tibia using non-physical cutting guides and monitoring the removal of material from the femur and tibia with respect to the volumes of material thereby facilitating use of the cutting tool of the robotic system without the use of physical resection guides.

7. The method as set forth in claim 6 wherein indicating the volumes of material to be removed from the femur and tibia includes indicating desired femoral cuts relative to a distal end portion of the femur based on a size of a femoral component of a knee implant and indicating desired tibial cuts relative to a proximal end portion of the tibia based on a size of a tibial component of the knee implant.

8. The method as set forth in claim 7 including adjusting the size of one of the femoral or tibial components during the surgery and adjusting the volume of material to be removed from one of the femur or tibia based on the adjusted size.

9. The method as set forth in claim 7 including detecting a discrepancy between the desired femoral or tibial cuts and actual cuts made with the cutting tool of the robotic system and activating one of an audible alert or a visual alert in response to detecting the discrepancy.

10. The method as set forth in claim 9 wherein activating one of the audible alert or visual alert includes activating the visual alert by changing displayed colors viewable by a user from green to red.

11. The method as set forth in claim 9 including interrupting operation of the robotic system upon detecting the discrepancy.

12. The method as set forth in claim 1 including displaying desired cuts to be made to the femur or tibia wherein the desired cuts correspond to a desired size of one of a femoral or tibial component of a knee implant.

13. The method as set forth in claim 12 including displaying the desired cuts with respect to a distal end portion of the femur or a proximal end portion of the tibia.

14. The method as set forth in claim 12 including generating an image of the desired cuts to be made to the femur or tibia.

15. The method as set forth in claim 14 wherein generating the image of desired cuts to be made to the femur or tibia includes generating a three-dimensional optical image.

16. The method as set forth in claim 1 including:

transmitting images of the knee joint to a control unit; and

displaying the transmitted images on a display for viewing during the surgery.

17. The method as set forth in claim 16 wherein displaying the transmitted images includes displaying relative movement between a distal end portion of the femur and a proximal end portion of the tibia.

18. The method as set forth in claim 1 including displaying relative movement of a distal end portion of the femur and a proximal end portion of the tibia on a display.

19. The method as set forth in claim 1 including:

tracking movement of the femur with a first plurality of locating devices attached to the femur; and

tracking movement of the tibia with a second plurality of the locating devices attached to the tibia.

20. The method as set forth in claim 1 including:

tracking movement of the femur with a first plurality of emitters attached to the femur; and

tracking movement of the tibia with a second plurality of emitters attached to the tibia.

21. The method as set forth in claim 1 including:

tracking movement of the femur with a first plurality of reflectors attached to the femur; and

tracking movement of the tibia with a second plurality of reflectors attached to the tibia.

22. The method as set forth in claim 1 including supporting a lower portion of a leg on a movable foot holder operative to move the lower portion of the leg during the surgery so that the tibia is movable relative to the femur during the surgery.

23. The method as set forth in claim 1 including affixing femoral and tibial components of a knee implant to the femur and tibia.

24. The method as set forth in claim 23 including displaying relative movement between the femoral and tibial components on a display to evaluate a fit of the femoral and tibial components.

25. The method as set forth in claim 1 including displaying movement of the cutting tool relative to the femur on a display and displaying movement of the cutting tool relative to the tibia on the display.

26. A method for robotic surgery on a joint formed by first and second bones, said method comprising the steps of:

providing a robotic system including;

a base;

a support having an upper end portion rotatable relative to the base;

a main arm pivotally attached to the upper end portion of the support and having an outer end portion;

a secondary arm pivotally mounted to the outer end portion of the main arm, the secondary arm defining a longitudinal axis;

a mounting section rotatable about the longitudinal axis, the mounting section including a mount which is rotatable about a mounting axis;

motors and controls supported by the base; and

a cutting tool mounted to the mounting section and capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system;

tracking positions of the first and second bones during the surgery with the navigation system as the first and second bones move during the surgery;

communicating information related to the tracked positions of the first and second bones from the navigation system to the robotic system;

guiding movement of the cutting tool of the robotic system relative to at least one of the first and second bones so that material from the at least one of the first and second bones can be removed with the cutting tool without the use of physical resection guides; and

removing material from the at least one of the first and second bones with the cutting tool and without the use of physical resection guides.

31. The method as set forth in claim 26 wherein guiding movement of the cutting tool includes one of:

guiding user-controlled movement of the cutting tool with optical cutting guides;

or

robotically guiding movement of the cutting tool using the motors and controls of the robotic system.

32. The method as set forth in claim 26 including determining a position of the cutting tool relative to the first bone and determining a position of the cutting tool relative to the second bone wherein the navigation system cooperates with the robotic system to determine the positions of the cutting tool relative to the first and second bones during the surgery.

33. The method as set forth in claim 26 wherein providing the navigation system includes providing a plurality of locating devices and a plurality of photo cells to receive light from the plurality of locating devices to determine the positions of the first and second bones.

34. The method as set forth in claim 26 including indicating volumes of material to be removed from the first and second bones using non-physical cutting guides and monitoring the removal of material from the first and second bones with respect to the volumes of material thereby facilitating use of the cutting tool of the robotic system without the use of physical resection guides.

35. The method as set forth in claim 34 wherein indicating the volumes of material to be removed from the first and second bones includes indicating desired femoral cuts relative to a distal end portion of a femur based on a size of a femoral component of a knee implant and indicating desired tibial cuts relative to a proximal end portion of a tibia based on a size of a tibial component of the knee implant.

36. The method as set forth in claim 35 including adjusting the size of one of the femoral or tibial components during the surgery and adjusting the volume of material to be removed from one of the femur or tibia based on the adjusted size.

37. The method as set forth in claim 35 including detecting a discrepancy between the desired femoral or tibial cuts and actual cuts made with the cutting tool of the robotic system and activating one of an audible alert or a visual alert in response to detecting the discrepancy.

38. The method as set forth in claim 37 wherein activating one of the audible alert or visual alert includes activating the visual alert by changing displayed colors viewable by a user from green to red.

39. The method as set forth in claim 26 including displaying desired cuts to be made to the first or second bones wherein the desired cuts correspond to a desired size of an implant component.

40. The method as set forth in claim 26 including:

transmitting images of the joint to a control unit; and

displaying the transmitted images on a display for viewing during the surgery.

41. The method as set forth in claim 40 wherein displaying the transmitted images includes displaying relative movement between a distal end portion of the first bone and a proximal end portion of the second bone.

42. The method as set forth in claim 26 including displaying relative movement of the first and second bones on a display.

43. The method as set forth in claim 26 including:

tracking movement of the first bone with a first plurality of locating devices attached to the first bone; and

tracking movement of the second bone with a second plurality of the locating devices attached to the second bone.

44. The method as set forth in claim 26 including affixing femoral and tibial components of a knee implant to the first and second bones.

45. The method as set forth in claim 44 including displaying relative movement between the femoral and tibial components on a display to evaluate a fit of the femoral and tibial components.

46. The method as set forth in claim 26 including displaying movement of the cutting tool relative to the first bone on a display and displaying movement of the cutting tool relative to the second bone on the display.

27. A method for robotic knee surgery on a femur and tibia of a knee joint, said method comprising the steps of:

providing a robotic system including;

a base;

a support having an upper end portion rotatable relative to the base;

a main arm pivotally attached to the upper end portion of the support and having an outer end portion;

a secondary arm pivotally mounted to the outer end portion of the main arm, the secondary arm defining a longitudinal axis;

a mounting section rotatable about the longitudinal axis, the mounting section including a mount which is rotatable about a mounting axis;

motors and controls supported by the base; and

a cutting tool mounted to the mounting section and capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system comprising a plurality of locating devices;

tracking positions of the femur and tibia during the surgery with the navigation system as the femur and tibia move during the surgery;

communicating information related to the tracked positions of the femur and tibia from the navigation system to the robotic system;

guiding user-controlled movement of the cutting tool relative to the femur using a first optical cutting guide;

guiding user-controlled movement of the cutting tool relative to the tibia using a second optical cutting guide; and

removing material from the femur and tibia with the cutting tool.

28. The method as set forth in claim 27 including displaying movement of the cutting tool relative to the femur on a display and displaying movement of the cutting tool relative to the tibia on the display.

29. A method for robotic knee surgery on a femur and tibia of a knee joint, said method comprising the steps of:

providing a robotic system including;

a base;

a support having an upper end portion rotatable relative to the base;

a main arm pivotally attached to the upper end portion of the support and having an outer end portion;

a secondary arm pivotally mounted to the outer end portion of the main arm, the secondary arm defining a longitudinal axis;

a mounting section rotatable about the longitudinal axis, the mounting section including a mount which is rotatable about a mounting axis;

motors and controls supported by the base; and

a cutting tool mounted to the mounting section and capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system comprising a plurality of locating devices;

tracking the positions of the femur and tibia during the surgery with the navigation system as the femur and tibia move during the surgery;

communicating information related to the tracked positions of the femur and tibia from the navigation system to the robotic system;

robotically guiding movement of the cutting tool of the robotic system relative to the femur and tibia using the motors and controls of the robotic system and based on the information related to the tracked positions of the femur and tibia being communicated to the robotic system from the navigation system so that material from the femur and tibia can be removed without the use of physical resection guides; and

removing material from the femur and tibia with the cutting tool and without the use of physical resection guides.

30. The method as set forth in claim 29 including displaying movement of the cutting tool relative to the femur on a display and displaying movement of the cutting tool relative to the tibia on the display.

47. A method for robotic surgery on a joint formed by first and second bones, said method comprising the steps of:

providing a robotic system including;

a base;

a support column having an upper end portion rotatable relative to the base;

a main arm pivotally attached to the upper end portion of the support column and having an outer end portion;

a secondary arm pivotally mounted to the outer end portion of the main arm, the secondary arm defining a longitudinal axis;

a mounting section rotatable about the longitudinal axis, the mounting section including a mounting flange which is rotatable about a mounting axis;

motors and controls supported by the base; and

a cutting tool mounted to the mounting section and capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system comprising a plurality of reflective locating devices;

tracking positions of the first and second bones during the surgery with the navigation system as the first and second bones move during the surgery;

communicating information related to the tracked positions of the first and second bones from the navigation system to the robotic system;

guiding movement of the cutting tool of the robotic system relative to at least one of the first and second bones so that material from the at least one of the first and second bones can be removed with the cutting tool without the use of physical resection guides; and

removing material from the at least one of the first and second bones with the cutting tool and without the use of physical resection guides.

48. A method for robotic knee surgery on a femur and tibia of a knee joint, said method comprising the steps of:

providing a robotic system including;

a base;

a support column having an upper end portion rotatable relative to the base;

a main arm pivotally attached to the upper end portion of the support column and having an outer end portion;

a secondary arm pivotally mounted to the outer end portion of the main arm, the secondary arm defining a longitudinal axis;

a mounting section rotatable about the longitudinal axis, the mounting section including a mounting flange which is rotatable about a mounting axis;

motors and controls supported by the base; and

a cutting tool mounted to the mounting section and capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system comprising a first plurality of reflective locating devices for attaching to the femur and a second plurality of reflective locating devices for attaching to the tibia;

tracking positions of the femur and tibia during the surgery with the navigation system as the femur and tibia move during the surgery;

communicating information related to the tracked positions of the femur and tibia from the navigation system to the robotic system;

guiding user-controlled movement of the cutting tool relative to the femur using a first optical cutting guide;

guiding user-controlled movement of the cutting tool relative to the tibia using a second optical cutting guide; and

removing material from the femur and tibia with the cutting tool.

49. A method for robotic knee surgery on a femur and tibia of a knee joint, said method comprising the steps of:

providing a robotic system including;

a base;

a support column having an upper end portion rotatable relative to the base;

a main arm pivotally attached to the upper end portion of the support column and having an outer end portion;

a secondary arm pivotally mounted to the outer end portion of the main arm, the secondary arm defining a longitudinal axis;

a mounting section rotatable about the longitudinal axis, the mounting section including a mounting flange which is rotatable about a mounting axis;

motors and controls supported by the base; and

a cutting tool mounted to the mounting section and capable of movement in at least five degrees of freedom relative to the base;

providing a navigation system comprising a first plurality of reflective locating devices for attaching to the femur and a second plurality of reflective locating devices for attaching to the tibia;

tracking the positions of the femur and tibia during the surgery with the navigation system as the femur and tibia move during the surgery;

communicating information related to the tracked positions of the femur and tibia from the navigation system to the robotic system;

robotically guiding movement of the cutting tool of the robotic system relative to the femur and tibia using the motors and controls of the robotic system and based on the information related to the tracked positions of the femur and tibia being communicated to the robotic system from the navigation system so that material from the femur and tibia can be removed without the use of physical resection guides; and

removing material from the femur and tibia with the cutting tool and without the use of physical resection guides.