Postoperative limb alignment in total knee replacement. Conventional versus navigated versus robotic techniques

Current developments in robotic assistance technology for total knee arthroplasty: a comprehensive overview

Knee arthritis is a common degenerative joint disease, usually with joint swelling, chronic pain, and dysfunction as the main clinical manifestations. At present, the conservative treatment for knee arthritis is mostly using anti-inflammatory and analgesic drugs, but the effect is mostly temporary, and can not prevent its progress and surgery is usually the last treatment method. Total knee arthroplasty, also known as TKA, is one of the most effective treatments for osteoarthritis of the knee that has progressed to the end stage. The inevitable human factor in conventional total knee arthroplasty (TKA) frequently results in poor positioning of the prosthesis during the reconstruction of the lower limb's biomechanical axis. This can lead to severe postoperative pain, accelerated wear of the prosthesis, early loosening, and other problems in the affected knee, which has always been a primary concern for orthopaedic surgeons. Over the course of the past few years, China has gradually begun to develop joint robots. The idea is to plan the surgical plan based on the anatomical structure of the affected limb before the operation, and then to use a mechanical arm and a visual system to assist in the implantation of the prosthesis while the operation is being performed. The treatment costs of robot-assisted technology, on the other hand, vary greatly, and there is still a relatively small amount of high-quality evidence on clinical efficacy. This is because the field of robotic-assisted technology is a relatively new one that has gradually developed over the past few years. In order to provide a fundamental reference for the application value of new treatment methods for advanced knee osteoarthritis, it is necessary to conduct an analysis of the current status of the application of joint robots, as well as the technical advantages and disadvantages that they bring.This narrative study delineates the historical context and current clinical application of robots in knee replacement surgery. An examination of the advantages and disadvantages of RATKA in comparison to TKA offers insights on the prospective application value of the technology.Clinical trial number: Not applicable.

The Alignment of the Tibial Component in Total Knee Arthroplasty: Is a Technology-Assisted System Better Than Conventional Instrumentation?

Background Technologies such as navigation and robotics are aimed at improving tibial alignment in total knee arthroplasties (TKA) and eliminating the errors resulting from the use of manual instrumentation. Methods This prospective study analyzed 130 arthroplasties in order to determine whether navigation can improve the frontal mechanical axis of the tibia and whether the postoperative angulation of this axis differs from the preoperative one. The mean patient age was 71.8 years, and the mean BMI was 31.17. Eighty-six patients were female. The same cemented TKA model and the same imageless navigation system were used in all cases. Results The mean postoperative tibial angle following implantation was 87.65°, without any statistically significant differences with respect to the previous angulation. However, navigation was seen to result in a nearly neutral tibial axis, a larger number of cases (41.5%-60.8% {p = 0.002}) aligned within the safe zone (90° ± 3°), a smaller number of outliers, and a clustering of values around the mean. Conclusions Navigation improves the frontal positioning of the tibial component in total knee arthroplasties but does not offer any advantages as compared with conventional instrumentation.

Comparing an imageless hand-held robotic-assisted system versus conventional technique for component positioning and early clinical outcomes in total knee arthroplasty

BACKGROUND

This study aimed to examine the component positioning and early clinical outcomes in total knee arthroplasty (TKA) using an imageless hand-held robotic-assisted system compared with those without robotics.

METHODS

Component positioning, hip-knee-ankle angle (HKA), and clinical outcome 1-year postoperatively were compared between 40 patients who underwent TKA with Navio (robot group) and 40 control patients who underwent TKA with a jig-based technique (manual group). The clinical outcomes evaluated were range of motion and the 2011 Knee Society Score.

RESULTS

Implantation errors in the coronal and sagittal alignments were significantly fewer in the robotic group than in the manual group. All knees in the robotic group achieved component positions within 3°. However, the HKA and clinical outcomes did not differ between the groups.

CONCLUSION

Although the accuracy of implantation in the robotic group was superior to that in the manual group, the clinical outcomes were similar.