For Surgeons

TOKA is giving surgeons powerful tools for delivering precise and repeatable knee-preserving surgery

1. The TOKA Device

Knee Surgery in the 21st century

Knee osteoarthritis (OA) is the most common musculoskeletal disease in the world, affecting approximately 20% of the population. In the UK alone, 4.5 million people aged 40–65 suffer from radiographic knee arthritis but are not yet suitable for knee replacement.

Total Knee Arthroplasty (TKA) remains the most adopted surgical treatment particularly in elderly patients with advanced disease, however, the increasing demand for knee replacement and the large burden it places on healthcare systems is becoming unsustainable. Moreover, procedures that preserve the natural knee joint are an increasingly attractive option for patients.

TOKA is a disruptive technology which can relieve patients from pain and mitigate the societal impact of knee osteoarthritis. Designed to minimise costs within NHS-tariff, TOKA combines 3D Printing and medical imaging technologies for a truly personalised treatment benefitting patients and healthcare providers, while relieving the societal cost of knee osteoarthritis.

"For young and active people effected with knee osteoarthritis, HTO has been shown to be the best solution."

Joint preserving treatments for knee osteoarthritis

Without the correction of the patients’ mechanical axes for the redistribution of the forces imposed on the knee by exercise, other treatments to address the symptoms of osteoarthritis will not be as effective. For example, the implant lifespan of a Total Knee Replacement can be reduced, forcing patients to lead a sedentary lifestyle, impacting their overall health and quality of life. The younger a patient has a Total Knee Replacement, the higher the risk of revision and complications.

Our approach is based on a well-established procedure: High Tibial Osteotomy, where the tibia is modified to redistribute load away from the medial compartment of the knee (where osteoarthritis often begins). This offers many advantages including alignment restoration, knee preservation and a return to an active lifestyle.

"TOKA is a precision engineered personalised HTO surgical solution, particularly designed for young patients suffering from radiographic knee arthritis but not yet suitable for Knee-Replacement."

The TOKA Solution – The perfect fit

HTO is a craft surgery and must be performed by experienced surgeons meaning the options currently available are technically demanding and present the risk of complications – particularly those associated with not achieving the required correction angle.

With TOKA, each surgery is completely planned around the patient. This begins with the surgical instrumentation used in theatre. Compared to existing solutions, TOKA presents a tailor-made and precise personalised intervention and potentially a faster procedure and a faster recovery time.

A simple to use surgical guide based on the patient’s CT scan containing the exact information to reproduce the digitally planned surgery reducing the need for intra-operative radiology and measurements.

The TOKA system removes the need for large inventory trays by using a 3D-printed titanium cutting and drilling guide, precisely fitting patient’s bone anatomy. Uniquely, TOKA pioneered an integrated osteotomy opening mechanism – a system allowing precision bi-planar limb alignment without the need for lamina spreaders or measuring tools.

"The corrective plate matches the bone perfectly, reducing patient  discomfort during the recovery period, while TOKA’s bespoke surgery guide brings down surgery times and drastically reduces the risk of complications."

2. TOKA Surgery Planning Software Suite

A key part of the TOKA ecosystem is our Surgical Planning Suite, where the patient's current weight-bearing alignment can be determined from CT and x-ray imaging. This imaging is then used to create an accurate anatomical model of the affected knee and plan the whole surgery.

The position of the osteotomy, the location and shape of the plate and surgical guides, as well as the length and orientation of the screws are then planned - saving time in theatre.

The software can also simulate the outcome of the surgery - showing expected post-operative alignment as well as highlighting any changes in anatomical parameters such as posterior tibial slope.

TOKA lead the first ever recorded clinical trial
of AM components in the UK & Europe.

3. TOKA Surgical Simulator

The holistic approach of TOKA to knee surgery is driven by the suite of planning and training tools available for surgeons to learn in an interactive 3D environment how different cut angles and ways of carrying out the operation could affect patient outcomes.

The TOKA Surgical Simulator supports surgeons select the optimum treatment for every case. By applying algorithms and computational modelling, surgeons can virtually predict the surgery and visualise patient outcomes such as the alignment of the leg, anatomical changes, and likelihood of any complications. Virtual reality training provides convenient alternative to cadavers and other physical training methods for surgeons, which makes learning the TOKA HTO procedure cheaper and faster.

TOKA Surgical Simulator aims to inform and train surgeons in high tibial osteotomy (HTO), a proven and cost-effective alternative to joint replacement for treating early-stage knee OA in active or young patients. Orthopaedic surgery is a craft speciality; virtual training aims to inform and educate medical professionals and students about the benefits of TOKA HTO surgery.

TOKA also provides benefits to healthcare providers by rationalising resources with no inventory of stock parts required.

'"TOKA Surgical Simulator provides a single environment to visualise, plan and perform personalised HTO surgical procedures to deliver unparalleled patient experience."

4. Web Portal

Our web portal plays a key role in the TOKA lifecycle. It allows surgeons and other medical staff to access information about upcoming and ongoing TOKA procedures, such as the state of patients who are waiting for surgery, and any action which needs to be taken.

It is also possible to upload and view detailed models of a patient's CT scan, ensuring no crucial details are left unnoticed before surgery begins.

This gives a fine level of control over all aspects of the TOKA solution which take place outside the operating room, streamlining them into a single user-friendly application.


Hear from the surgeons that we are proud to work with

Professor Andrew Toms
Royal Devon and Exeter NHS Foundation Trust

“‘What is the existing solution to the problem and why is the existing solution not good enough?’
High tibial osteotomy is a complex three-dimensional alignment puzzle which currently we are only able to try and solve in two dimensions. The current implants and techniques are a one size fits all solution with one sized large metal plate with instrumentation and relies entirely on the surgeon’s intra-operative technical ability. As such the results can be variable, take a significantly longer rehab period, are associated with high incidents of complications and often require metalwork removal at a later date.”