A Pivot Forward: Uncemented
Medial Pivot Knee & Robotic TKR

Can you believe it?

Advanced robotic knee replacement using an uncemented medial pivot knee implant happened recently in India! This advancement is the first step combining the power of robotics, surgical precision, and next-generation implant design.[1]

With the advent of uncemented medial pivot knee systems like Concor, gone are the days when cemented implants were the only option. While the medial pivot design in Concor mimics natural knee motion, its cementless fixation allows the patient’s own bone to integrate naturally with the implant.

Pairing this with a fully automatic surgical robot like Cuvis, achieve sub-millimetre precision, even during complex bone cuts.[4] [5]

As India’s elderly population grows—and with it, osteoarthritis cases, we’re on track to become the “Osteoarthritis Capital,” with about 60 million active cases and a 32% CAGR in knee replacements over 25 years. [6]

Globally, Total Knee Arthroplasty (TKA) demand is expected to surge by 673% by 2030.[4]

Clearly, the demand is rising and so are expectations. People aren’t just asking for better implants that feel like natural and better procedures that minimize pain, reduce complications or revision and accelerate recovery. That’s where robotic precision along with this new implant step in—not as a luxury, but as the new.

How are knee replacement solutions evolving to meet rising expectations?

Knee replacement surgery has been evolving from being a structural solution to becoming a movement revolution—the solution space being shaped by three powerful advances:

• A smarter implant design that mimics natural knee motion (the medial pivot knee)
• A better fixation method (cementless integration)
• A highly precise surgical technique (robotic assistance with Cuvis)

Each one offers unique advantages but together, they can transform surgical outcomes in different ways.

Medial Pivot Knee (MPK): A design that mimics natural knee motion

One of the biggest concerns after knee replacement is how “natural” the joint feels during movement. Traditional implants often use multiple points of rotation, which can make the knee feel unstable or mechanical. The MPK is designed differently.[7]

It uses a single-radius femoral component, allowing it to move around one consistent centre, just like a healthy knee.

How this helps:

• Natural motion: The knee mimics the ball-and-socket motion, giving the feel of a natural knee during daily movements.
• Improved joint stability: Even when ligaments are surgically removed, the implant remains steady through a wide range of motion.[8] [9]
• Better comfort and confidence: Whether walking, rising from a chair, or climbing stairs, patients report more controlled and comfortable movement. [10]

Additionally, the anatomic insert and tibial tray are engineered to support this design, helping align the joint and reduce unnecessary strain or wear over time.[11]

Cementless fixation: A smarter way to integrate with the body

Instead of using cement to fix the implant in place, the surface of a cementless implant is built to encourage natural bone growth. Over time, your own bone grows into the implant surface, anchoring it securely.[12]

Why this matters:

• Biologic fixation means better long-term outcomes: Your body forms a natural bond with the implant, reducing the risk of it loosening over time.[12] [13]
• Lower revision rates: Large national registries have reported lower reoperation rates in cementless cases compared to cemented ones.[14] [15]
• Better functional recovery: Patients show improved knee function scores, especially over long-term follow-up.[14]
• Ideal for high-risk groups: Cementless knees have performed particularly well in patients over 75, those with obesity, and individuals with inflammatory conditions like rheumatoid arthritis.[16] [17] [18]
• Cost-effective over time: Some studies also report lower long-term costs due to reduced complications and revision surgeries.[19]

Advances in implant materials—such as titanium alloys (CoCrMo alloy and Ti6Al4V alloy) and trabecular porous structures—have only strengthened the case for this newer method of fixation.

Cuvis: Robotic assistance that elevates every step

Even the best implant needs to be placed just right. That’s where robotic technology adds a new level of confidence.

Cuvis is a fully automatic joint replacement robot that uses CT-based 3D imaging to map your knee and guide the surgery with sub-millimetre accuracy.

What patients gain:

• A personalised surgical plan: Based on their unique bone shape and alignment.[20]
• Highly accurate bone cuts with sub-millimetre accuracy: The robotic arm follows the plan precisely, ensuring the implant fits as it should.[20]
• Better alignment and soft tissue preservation: It supports functional knee alignment and minimises tissue trauma during the surgery.[20] [22]
• Minimal complications: Reduced surgical variability and enhanced precision often lead to shorter hospital stays and quicker return to activity. [22]

In studies comparing robotic-assisted and manual knee replacement surgeries, robotic-assisted ones are found to consistently deliver more accurate implant positioning and improved short-term patient outcomes, especially in complex cases.[21]

Three technologies, one transformative result

All three innovations came together recently in a landmark case performed by Dr. Sujoy Bhattacharjee in Delhi. The patient, a 54-year-old man living with eight years of disabling pain, advanced osteoarthritis, and joint deformities, receive this combination of an uncemented medial pivot knee implant placed with Cuvis robotic guidance.[1]

What this meant for him was more than just a new joint—a return to his daily activities and a restored sense of confidence in every step.

Together, Concor, a cementless medial pivot knee system, and Cuvis by Biorad Medisys represent advancements in orthopaedic care, supporting precision, stability, and movement in knee replacement procedures.

References:

1. https://www.business-standard.com/india-news/delhi-hospital-performs-world-s-first-robotic-cementless-knee-surgery-125070201484_1.html
2. Newman JM, Khlopas A, Chughtai M, Gwam CU, Mistry JB, Yakubek GA, Harwin SF, Mont MA. Cementless Total Knee Arthroplasty in Patients Older Than 75 Years. J Knee Surg. 2017 Nov;30(9):930-935. doi: 10.1055/s-0037-1599253. Epub 2017 Apr 11. PMID: 28399605.
3. Mosher ZA, Bolognesi MP, Malkani AL, Meneghini RM, Oni JK, Fricka KB. Cementless Total Knee Arthroplasty: A Resurgence-Who, When, Where, and How? J Arthroplasty. 2024 Sep;39(9S2):S45-S53. doi: 10.1016/j.arth.2024.02.078. Epub 2024 Mar 7. PMID: 38458333.
4. Shailendra Patil, Chetan Wankhede, Achieving accuracy and gap balancing with fully autonomous Cuvis Joint Robot assisted total knee arthroplasty: A single-center, non-randomized retrospective study, Journal of Orthopaedic Reports, Volume 3, Issue 4, 2024, 100365, ISSN 2773-157X, https://doi.org/10.1016/j.jorep.2024.100365. (https://www.sciencedirect.com/science/article/pii/S2773157X24000602)
5. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy and Precision to Plan Compared with Manual Techniques. J Knee Surg. 2019 Mar;32(3):239-250. doi: 10.1055/s-0038-1641729. Epub 2018 May 1. PMID: 29715696.
6. https://www.business-standard.com/content/specials/joint-replacement-surgery-led-orthopedics-projected-to-be-next-big-thing-in-india-121082501494_1.html
7. Shi W, Jiang Y, Wang Y, Zhao X, Yu T, Li T. Medial pivot prosthesis has a better functional score and lower complication rate than posterior-stabilized prosthesis: a systematic review and meta-analysis. J Orthop Surg Res. 2022 Aug 19;17(1):395. doi: 10.1186/s13018-022-03285-0. PMID: 35986362; PMCID: PMC9392246.
8. Gómez-Barrena E, Fernandez-García C, Fernandez-Bravo A, Cutillas-Ruiz R, Bermejo-Fernandez G. Functional performance with a single-radius femoral design total knee arthroplasty. Clin Orthop Relat Res. 2010 May;468(5):1214-20. doi: 10.1007/s11999-009-1190-2. PMID: 20012237; PMCID: PMC2853642.
9. Mahoney OM, McClung CD, dela Rosa MA, Schmalzried TP. The effect of total knee arthroplasty design on extensor mechanism function. J Arthroplasty. 2002 Jun;17(4):416-21. doi: 10.1054/arth.2002.32168. PMID: 12066269.
10. Atzori F, Salama W, Sabatini L, Mousa S, Khalefa A. Medial pivot knee in primary total knee arthroplasty. Ann Transl Med. 2016 Jan;4(1):6. doi: 10.3978/j.issn.2305-5839.2015.12.20. PMID: 26855942; PMCID: PMC4716939.
11. Łapaj Ł, Mróz A, Kokoszka P, Markuszewski J, Wendland J, Helak-Łapaj C, Kruczyński J. Peripheral snap-fit locking mechanisms and smooth surface finish of tibial trays reduce backside wear in fixed-bearing total knee arthroplasty. Acta Orthop. 2017 Feb;88(1):62-69. doi: 10.1080/17453674.2016.1248202. Epub 2016 Oct 26. PMID: 27781667; PMCID: PMC5251266.
12. Schwabe, M.T.; Hannon, C.P. The Evolution, Current Indications and Outcomes of Cementless Total Knee Arthroplasty. J. Clin. Med. 2022, 11, 6608. https://doi.org/10.3390/jcm11226608
13. Sultan AA, Khlopas A, Sodhi N, Denzine ML, Ramkumar PN, Harwin SF, Mont MA. Cementless Total Knee Arthroplasty in Knee Osteonecrosis Demonstrated Excellent Survivorship and Outcomes at Three-Year Minimum Follow-Up. J Arthroplasty. 2018 Mar;33(3):761-765. doi: 10.1016/j.arth.2017.10.018. Epub 2017 Nov 8. PMID: 29128233.
14. Liu, Y., Zeng, Y., Wu, Y. et al. A comprehensive comparison between cementless and cemented fixation in the total knee arthroplasty: an updated systematic review and meta-analysis. J Orthop Surg Res 16, 176 (2021). https://doi.org/10.1186/s13018-021-02299-4
15. de Grae MNM, Nasehi A, Dalury DF, Masri BA, Sheridan GA. Improved performance of cementless total knee arthroplasty (TKA)across international registries: a comparative review. Ir J Med Sci. 2025 Apr;194(2):675-681. doi: 10.1007/s11845-025-03888-6. Epub 2025 Feb 10. PMID: 39928234; PMCID: PMC12031968.
16. Sinicrope BJ, Feher AW, Bhimani SJ, Smith LS, Harwin SF, Yakkanti MR, Malkani AL. Increased Survivorship of Cementless versus Cemented TKA in the Morbidly Obese. A Minimum 5-Year Follow-Up. J Arthroplasty. 2019 Feb;34(2):309-314. doi: 10.1016/j.arth.2018.10.016. Epub 2018 Oct 17. PMID: 30446183.
17. Newman JM, Khlopas A, Chughtai M, Gwam CU, Mistry JB, Yakubek GA, Harwin SF, Mont MA. Cementless Total Knee Arthroplasty in Patients Older Than 75 Years. J Knee Surg. 2017 Nov;30(9):930-935. doi: 10.1055/s-0037-1599253. Epub 2017 Apr 11. PMID: 28399605.
18. Maniar AR, Howard JL, Somerville LE, Lanting BA, Vasarhelyi EM. Cementless Total Knee Arthroplasty: Does Age Affect Survivorship and Outcomes? J Arthroplasty. 2024 Aug;39(8S1):S95-S99. doi: 10.1016/j.arth.2024.04.027. Epub 2024 Apr 16. PMID: 38626864.
19. Lawrie CM, Schwabe M, Pierce A, Nunley RM, Barrack RL. The cost of implanting a cemented versus cementless total knee arthroplasty. Bone Joint J. 2019 Jul;101-B(7_Supple_C):61-63. doi: 10.1302/0301-620X.101B7.BJJ-2018-1470.R1. PMID: 31256655.
20. T RK, Bhat AKK, Biradar N, Patil AR, Mangsuli K, Patil A. Gap Balancing Technique With Functional Alignment in Total Knee Arthroplasty Using the Cuvis Joint Robotic System: Surgical Technique and Functional Outcome. Cureus. 2025 Feb 12;17(2):e78914. doi: 10.7759/cureus.78914. PMID: 40091934; PMCID: PMC11908966.
21. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy and Precision to Plan Compared with Manual Techniques. J Knee Surg. 2019 Mar;32(3):239-250. doi: 10.1055/s-0038-1641729. Epub 2018 May 1. PMID: 29715696.
22. Chandrashekar P, Babu KA, Nagaraja HS, Hiral SG, Karthikeyan S, Bajwa S. Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India. Indian J Orthop. 2023 Sep 5;57(11):1800-1808. doi: 10.1007/s43465-023-00970-y. PMID: 37881287; PMCID: PMC10593704.