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Cosendey K, Stanovici J, Mahlouly J, Omoumi P, Jolles BM, Favre J. The usability of robotic-assisted systems for total knee arthroplasty can be improved without hindering the accuracy of the bone cuts. Arch Orthop Trauma Surg 2025; 145:320. [PMID: 40423815 PMCID: PMC12116841 DOI: 10.1007/s00402-025-05818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 03/07/2025] [Indexed: 05/28/2025]
Abstract
INTRODUCTION This study assessed the bone cuts accuracy of a robotic-assisted system for total knee arthroplasty (TKA) that was recently upgraded. MATERIALS AND METHODS Three orthopaedic surgeons planned and executed TKA on 24 sawbones. Bone cut accuracy was assessed using CT scans, comparing the planning and the actual bone cuts in all six degrees-of-freedom. RESULTS The root-mean-square (RMS) values were below 2 mm or 2° for all error types, except for the medio-lateral position (2.4 mm) and internal-external rotation (2.3°) of the left tibias. The maximal amplitude of the 288 errors (6 degrees-of-freedom * 2 bones * 24 knees) was observed in tibial external rotation (3.2°). Most error types reported a bias, with limited variations among knees. CONCLUSIONS The errors were in the same range as those of the prior version of the system, suggesting that the improvements brought by the system upgrade were not obtained at the expense of accuracy.
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Affiliation(s)
- Killian Cosendey
- Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.
| | - Julien Stanovici
- Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Jaad Mahlouly
- Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Brigitte M Jolles
- Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Institute of Electrical and Micro Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Julien Favre
- Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- The Sense Innovation and Research Center, Sion, Lausanne, Switzerland
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Chen J, Loke RWK, Lim KKL, Tan BWL. Survivorship in robotic total knee arthroplasty compared with conventional total knee arthroplasty: A systematic review and meta-analysis. ARTHROPLASTY 2025; 7:21. [PMID: 40197345 PMCID: PMC11978122 DOI: 10.1186/s42836-025-00304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 03/02/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is the gold standard surgical management for end-stage knee osteoarthritis (OA). Robotic TKA (rTKA) was developed to improve bone preparation accuracy and increase reproducibility. In many settings internationally, rTKA systems have significantly higher costs for patients, and survivorship outcomes are unclear. There are several prior meta-analyses, but these focused on clinical and radiologic outcomes, and to our knowledge, none have evaluated survival. Differences in survival between semi-active or active robotic systems are also not well investigated. STUDY DESIGN Meta-analysis. METHODS A random-effects meta-analysis was conducted on comparative studies between robotic-assisted TKAs and conventional TKAs (cTKAs) in patients undergoing TKA for primary knee OA. We searched MEDLINE, Embase, Cochrane Library, and SCOPUS from inception to 19 December 2024. Outcomes assessed were the implant survival in robotic-assisted TKA compared to conventional methods in standard primary knee OA cases, with subgrouping between active and semi-active systems performed. Secondary outcomes included associated complications, post-operative pain scores, and functional outcomes. RESULTS A total of 20 comparative studies were included in the meta-analysis. Among them, 2,804 patients underwent cTKA, while 2,599 underwent rTKA. At two years, the pooled survivorship rate was 97.9% (95% CI: 96-99) in the conventional group and 98.3% (95% CI: 96.2-99.2) in the robotic group. There were no significant differences between the groups (P = 0.7). There were no significant differences between the robotic (semi-active) group and the conventional group (P = 0.5) on further unpaired T-Testing. Between 2 and 5 years, pooled survivorship rates in the conventional group were 96.8% (95% CI: 90.3-99) and 97.1% (95% CI: 91.3-99) in the robotic group. There were no significant differences between groups (P = 0.9). At ten years postoperatively, pooled survivorship rates in the conventional group were 96.9% (95% CI: 95-98) and 97.8% (95% CI: 96.7-98.5) in the robotic group. There were no significant differences between the groups (P = 0.3). CONCLUSION Conventional TKA is non-inferior to rTKA at short and long-term follow-up with regard to implant survival, complications, and postoperative pain scores, while rTKA shows subtle improvements in functional outcome measures. TRIAL REGISTRATION CRD42024540997.
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Affiliation(s)
- Jiawei Chen
- National University of Singapore, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Ryan Wai Keong Loke
- National University of Singapore, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Katelyn Kaye-Ling Lim
- National University of Singapore, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore
| | - Barry Wei Loong Tan
- Department of Orthopaedics, National University Hospital, National University Health System, Singapore, Singapore.
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Tran JYS, Tang AYT, Wong CK, Lam GYT, Choi TL, Mak RWF, Ng JP, Ho KKW, Ong MTY, Yung PSH. Handheld imageless robotic total knee arthroplasty improves accuracy and early clinical outcomes when compared with navigation. ARTHROPLASTY 2025; 7:18. [PMID: 40181427 PMCID: PMC11969756 DOI: 10.1186/s42836-025-00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 03/02/2025] [Indexed: 04/05/2025] Open
Abstract
BACKGROUND This study compared imageless robotic-assisted total knee arthroplasty (RATKA) with accelerometer-based navigation (ABN) systems in terms of surgical accuracy and early clinical outcomes. METHODS A retrospective analysis was conducted on 153 patients (178 knees) who had undergone primary TKA from 2017 to 2023. Surgical accuracy and functional outcomes were assessed up to 12 months post-operation using the Chi-square test, Student's t-test, and ANCOVA. Subgroup analyses based on patient demographics were also conducted. RESULTS Among 153 patients, 101 underwent RATKA, and 52 received ABN. RATKA demonstrated superior alignment accuracy with a significantly lower deviation from the planned alignment (P < 0.05). Additionally, RATKA led to significantly better postoperative functional scores at 6 weeks (P = 0.001) and 3 months (P = 0.001), even after adjusting for preoperative functional differences. CONCLUSIONS RATKA offers enhanced precision and improves early recovery compared to ABN, supporting its potential as a preferred technology for TKA. Its ability to optimize kinematic alignment may contribute to superior patient outcomes. Compared to ABN, RATKA provides a unique advantage by achieving greater accuracy in planned alignment, which may translate into improved functional recovery. Further research with larger cohorts is recommended to confirm these findings.
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Affiliation(s)
- Joshua Yeuk-Shun Tran
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Abbie Yan-Tung Tang
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cham-Kit Wong
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Gloria Yan-Ting Lam
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Tsz-Lung Choi
- Department of Orthopaedics & Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Rex Wang-Fung Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Kevin Ki-Wai Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Orthopaedics and Traumatology, CUHK Medical Centre, Hong Kong SAR, China.
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, CUHK Medical Centre, Hong Kong SAR, China
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Scott DF, Horton EN. Femoral resection accuracy and precision in manual caliper-verified kinematic alignment total knee arthroplasty. J Exp Orthop 2025; 12:e70234. [PMID: 40256668 PMCID: PMC12006286 DOI: 10.1002/jeo2.70234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/03/2025] [Accepted: 03/07/2025] [Indexed: 04/22/2025] Open
Abstract
Introduction The accuracy and precision of bone resections in total knee arthroplasty (TKA) are essential to avoid poor implant positioning, which can lead to component wear, pain, and instability, reducing patient satisfaction and implant survivorship. Technology-assisted TKA techniques aim to improve accuracy but come with added costs, increased operative time, and varying success in clinical outcomes. Caliper-verified kinematic alignment (KA) attempts to restore the joint line by precisely measuring resections to equal implant thickness. We evaluated the accuracy and precision of caliper-verified KA-TKA performed with manual instruments. We hypothesised that this technique would achieve high accuracy and precision, with an average absolute difference between actual and target distal and posterior femoral resection measurements of ≤ 0.5 mm. Methods 385 consecutive patients underwent primary unrestricted caliper-verified KA-TKA with manual instrumentation. The thickness of the distal medial (DM), distal lateral (DL), posterior medial (PM) and posterior lateral (PL) femoral condyle resections were measured with a caliper and compared to a target determined by the degree of cartilage loss, saw blade kerf, and femoral component thickness. Results The mean differences between the resected and target thicknesses for DM, DL, PM and PL femoral resections were 0.1 ± 0.2 mm, 0.1 ± 0.3 mm, 0.3 ± 0.5 mm and 0.2 ± 0.4 mm, respectively (mean ± std. dev.). Most femoral resections were within 0.5 mm of the target-97.7%, 94.5%, 85.7% and 89.4% of DM, DL, PM and PL resections, respectively. Conclusion Manual caliper-verified KA-TKA achieved highly accurate and precise femoral resections with absolute differences from target that averaged 0.175 mm. This simple, logical, efficient, and reproducible surgical technique may be an option for surgeons contemplating the use of technology-assisted options, such as patient-specific instrumentation or robotic arm-assisted TKA, and surgeons without access to such technologies. Level of Evidence Level II.
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Affiliation(s)
- David Forrest Scott
- Spokane Joint Replacement Center, Inc.SpokaneWashingtonUSA
- Washington State University Elson S. Floyd College of MedicineSpokaneWashingtonUSA
| | - Emma N. Horton
- Spokane Joint Replacement Center, Inc.SpokaneWashingtonUSA
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Andriollo L, Koutserimpas C, Gregori P, Servien E, Batailler C, Lustig S. A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2025. [PMID: 40099499 DOI: 10.1002/ksa.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/22/2025] [Accepted: 02/27/2025] [Indexed: 03/20/2025]
Abstract
PURPOSE Alignment strategies in total knee arthroplasty (TKA) have predominantly emphasized coronal alignment in extension, with minimal focus on dynamic alignment during flexion. This study aims to identify the predictors of the intraoperative robotic hip-knee-ankle angle at 90° of flexion (rHKA-90F) and assess its clinical significance in postoperative outcomes, proposing that rHKA-90F may be a critical factor in enhancing functional results in TKA. METHODS A retrospective analysis was conducted on 180 patients with varus deformity undergoing robotic-assisted TKA under the functional alignment principles. Clinical outcomes were assessed using the Knee Society Score (KSS), Forgotten Joint Score (FJS-12) and Kujala Anterior Knee Pain Scale (AKPS) score. Predictors for final rHKA-90F and its intraoperative changes were identified using multiple linear regression models. Initial and intraoperative robotic measurements were also analyzed. RESULTS Significant predictors of the final rHKA-90F included femoral rotation, tibial varus/valgus alignment, initial rHKA-90F and the final robotic axis in extensions. Patients with a final rHKA-90F ≥ 5° of varus demonstrated superior KSS function and KSS knee compared to those with a final rHKA-90F between 0° and 4° of varus. Furthermore, patients with intraoperative changes of rHKA-90F > 2.5° neutralization (varus reduction or with a valgus value) achieved better FJS and AKPS score. CONCLUSIONS This study highlights the clinical relevance of rHKA-90F as an intraoperative tool in robotic knee arthroplasty, emphasizing the need to balance the correction of varus deformity with the maintenance of slight varus alignment in flexion. Personalized alignment strategies tailored to patient-specific anatomy and kinematics are crucial to optimizing outcomes. There is still a need for future research on the long-term effects of dynamic alignment. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Luca Andriollo
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia Dello Sport, Ortopedia e Traumatologia, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christos Koutserimpas
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
| | - Pietro Gregori
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, Lyon, France
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Yang HY, Cheon JH, Kang SJ, Seon JK. Effect of tibia-first, restricted functional alignment technique on gap width changes, and component positioning in robotic arm-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2025; 33:987-996. [PMID: 39324361 DOI: 10.1002/ksa.12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE This study aims to quantitatively assess the predictability of post-resection gap dimensions and the attainment of balanced gaps using robotic arm-assisted total knee arthroplasty (TKA). METHODS This retrospective cohort study included 100 consecutive patients who underwent robotic arm-assisted TKA for knee osteoarthritis using a restricted functional alignment (FA) technique. Tibial cuts were performed based on preoperative tibial anatomy within predefined boundaries, followed by femoral component adjustments according to tensioned soft tissues to optimise gap balance. The primary outcome was the proportion of balanced gaps, defined as differential laxities of ≤2 mm, across extension, flexion, lateral, and medial gap measurements. Ligament balancing in lateral and medial compartments was assessed using a robotic system at 10° and 90° flexion to evaluate if restricted FA facilitated a balanced knee. Secondary outcomes included implant alignment, resection depth, and patient-reported outcome measures (PROMs). RESULTS Significant increases in both lateral and medial gaps at 10° and 90° flexion were observed following tibial and femoral bone resections (p < 0.001). At extension, average gap changes were 0.9 mm (lateral) and 1.6 mm (medial) after tibial cuts, and 0.5 mm (lateral) and 1.2 mm (medial) after femoral cuts. At 90° flexion, changes were 0.3 mm (lateral) and 1.7 mm (medial) following tibial cuts, and 1.0 mm (lateral) and 1.4 mm (medial) after femoral cuts. Despite these variations, the tibia-first, gap-balancing technique achieved overall balance in 98% of gap measurements. The tibial component was placed at an average of 2.1° varus, while the femoral component was positioned at 0.3° varus and 1.3° external rotation relative to the surgical transepicondylar axis. Significant improvements in PROMs were noted between preoperative and one-year postoperative evaluations (all p < 0.05). CONCLUSIONS The tibia-first, restricted FA technique achieved a well-balanced knee in 98% of cases, despite inconsistent gap increments observed between initial assessments and post-resection. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Hong Y Yang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
| | - Jae H Cheon
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
| | - Sung J Kang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
| | - Jong K Seon
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Hwasun, Chonnam, Republic of Korea
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Summers SH, Cagney PS, Youngman TR, Nunley RM, Barrack R, Hannon CP. Computed Tomography-Based Robotics Are More Accurate than Manual Instruments in Achieving Sagittal Alignment Targets in Total Knee Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00156-1. [PMID: 39956488 DOI: 10.1016/j.arth.2025.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND Implant malalignment may predispose patients to implant failure or pain following total knee arthroplasty (TKA). Previous studies indicate that robotically-assisted total knee arthroplasty (RA-TKA) can achieve coronal alignment targets more accurately and precisely than manually instrumented total knee arthroplasty (M-TKA). The purpose of this study was to evaluate the accuracy of RA-TKA versus M-TKA in achieving predetermined coronal and sagittal alignment targets in TKA. METHODS A total of 201 RA-TKAs performed by three high-volume, fellowship-trained surgeons between June 2021 and June 2022 were compared to a historical control of 365 M-TKAs performed between 2013 and 2017 by the same surgeons. Coronal and sagittal component alignments were assessed using standing antero-posterior and lateral radiographs. Included measurements were femoro-tibial angle (FTA), medial distal femoral angle, proximal tibial angle, femoral sagittal angle, tibial sagittal angle, anterior condylar offset, and posterior condylar offset ratio. Normal and outlier ranges were determined from prior studies. The proportions of outliers were compared using univariate analyses. RESULTS The RA-TKA was more accurate than M-TKA in achieving all four sagittal alignment targets and two of the three coronal alignment targets. The RA-TKA group exhibited fewer radiographic outliers for distal femoral angle (zero versus 2.5%; P = 0.03), proximal tibial angle (one versus 10.1%; P < 0.001), femoral sagittal angle (7.0 versus 15.6%; P < 0.01), tibial sagittal angle (5.0 versus 14.3%; P < 0.01), anterior condylar offset (8.5 versus 30.6%; P < 0.01), and posterior condylar offset ratio (1.5 versus 9.5%; P < 0.01). Patients in the RA-TKA group had a higher proportion with no radiographic outliers (58.2 versus 35.2%; P < 0.001) and a lower incidence of ≥ two outliers (5.5 versus 25%; P < 0.001) compared to the M-TKA group. CONCLUSIONS The RA-TKA is more effective than M-TKA in achieving coronal and sagittal alignment, potentially enhancing surgical outcomes.
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Affiliation(s)
- Spencer H Summers
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Paraic S Cagney
- Department of Orthopaedic Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Tyler R Youngman
- Department of Orthopaedic Surgery, The Carrell Clinic, Dallas, Texas
| | - Ryan M Nunley
- Division of Joint Preservation, Reconstruction and Replacement, Washington University, St. Louis, Missouri
| | - Robert Barrack
- Division of Joint Preservation, Reconstruction and Replacement, Washington University, St. Louis, Missouri
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
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Yu M, Yang X, Xu Y, Zhu W, Peng H, Lin J, Weng X, Feng B. Comparison between ligament balancing and measured resection in robot-assisted total knee arthroplasty: a 2-year follow up cohort study. BMC Musculoskelet Disord 2025; 26:152. [PMID: 39953453 PMCID: PMC11827435 DOI: 10.1186/s12891-025-08388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 02/03/2025] [Indexed: 02/17/2025] Open
Abstract
PURPOSE The two most commonly used techniques for gap balancing in robot-assisted total knee arthroplasty (RA-TKA) are measured resection (MR) and ligament balancing (LB). There are limited studies have reported differences in intraoperative and postoperative outcomes between MR-TKA and LB-TKA in RA-TKA. This study aims to compare the intraoperative and postoperative outcomes of primary RA-TKA between LB and MR techniques. METHODS This cohort study utilized prospectively collected data from a single center, spanning from January 2021 to December 2022. We compared the intraoperative procedures and postoperative clinical and imaging results between two groups. RESULTS The LB group had a thinner distal femur cut and a lower usage of thicker polyethylene. Additionally, the LB group exhibited a higher mean femoral component external rotation and greater tibial posterior slope. The rate of soft tissue release and bone recut was lower in the LB group, as was the mean C-reactive protein level. CONCLUSION In RA-TKA, LB offers advantages in soft tissue protection and bone mass preservation. However, no differences were observed in clinical and radiographic outcomes after a 2-year follow-up.
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Affiliation(s)
- Muyang Yu
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xingdong Yang
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yiming Xu
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhu
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huiming Peng
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jin Lin
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Bin Feng
- Department of Orthopedics Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Lim PL, Sayeed Z, Gonzalez MR, Melnic CM, Bedair HS. Time to Achieve Minimal Clinically Important Difference (MCID) in Robotic Versus Manual Total Knee Arthroplasty: A Comparative Analysis. J Arthroplasty 2025:S0883-5403(25)00159-7. [PMID: 39956487 DOI: 10.1016/j.arth.2025.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 02/07/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND Robotics in arthroplasty remains controversial due to the uncertainty of clinical outcomes in robotic total knee arthroplasty (rTKA). This study aimed to compare the time to achieve the minimal clinically important difference (MCID) between rTKA and manual TKA (mTKA). METHODS A total of 726 TKAs (416 robotic and 310 manual) were analyzed. We conducted a retrospective analysis of 726 TKAs performed between 2019 and 2022. Patient-reported outcomes were assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) global physical, PROMIS physical function-10a (PF-10a), and Knee Injury and Osteoarthritis Outcome Score-physical function short-form (KOOS-PS) scores, both preoperatively and postoperatively. Survival curves, accounting for interval censoring, were utilized to evaluate the time to achieve MCID. Statistical comparisons between groups were made using log-rank and weighted log-rank tests. RESULTS Comparing time to achieve MCID without interval censoring, the median time for rTKA was significantly lower than mTKA for PROMIS global physical (3.5 versus 3.7 months, P = 0.032) and KOOS-PS (3.7 versus 5.3 months, P = 0.002) but similar for PROMIS PF-10a (6.0 versus 6.7 months, P = 0.16). Notably, interval censoring showed similar times to achieve MCID for rTKA and mTKA in PROMIS global physical (0.53 to 0.54 versus 1.23 to 1.24 months, P = 0.31), PROMIS PF-10a (3.03 to 3.03 versus 2.17 to 2.17 months, P = 0.89), and KOOS-PS (1.47 to 1.47 versus 2.17 to 2.17 months, P = 0.27). CONCUSIONS Using time to MCID methodology, the median time to achieve MCID did not differ by surgical technique. The present study offers valuable patient-centric insights into preoperative expectations management and patient education. Further prospective studies with more granular patient-reported outcomes measurement collection are needed to evaluate the true effectiveness of robotics in arthroplasty. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Perry L Lim
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Marcos R Gonzalez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Shatrov J, Coulin B, Batailler C, Servien E, Brivio A, Barrett D, Walter B, Lustig S. Redefining the concept of patellofemoral stuffing in total knee arthroplasty. J ISAKOS 2025; 10:100364. [PMID: 39577567 DOI: 10.1016/j.jisako.2024.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 11/02/2024] [Accepted: 11/04/2024] [Indexed: 11/24/2024]
Abstract
INTRODUCTION Balancing the patellofemoral joint (PFJ) in total knee arthroplasty (TKA) involves avoiding over-stuffing. The purpose of this study was to assess how often a strategy of recreating the anterior space of the trochlea (full extension) led to the trochlea depth being recreated in both mid-flexion (30-40°) and deep flexion (80-90°). METHODS One hundred and twenty two consecutive patients undergoing robotic-assisted TKA had femoral components placed according to functional alignment principals and were assessed. The femoral component was sized and positioned in order to ensure that the anterior flange was within 2 mm of the native anatomy, corresponding to a patella position of full extension (0° flexion). Trochlea depth restoration in 3 positions along the floor of the trochlea groove was compared and measured. The trochlea was defined as balanced if the prosthesis was within 2 mm of the native anatomy. Patients were divided into over-stuffed (prosthesis >2 mm above the native anatomy) or under-stuffed (prosthesis >2 mm beneath the native anatomy). RESULTS All patients 122/122 (100%) had a balanced trochlea in full extension. In total 54 TKA were over or under-stuffed at either mid-flexion or deep flexion. In mid-flexion, 3/122 (2.5%) trochlea were over-stuffed and 39/122 (32%) trochlea were under-stuffed. In deep flexion, 25/122 (20.5%) of trochlea's were overstuffed and 30/122 (24.6%) were under-stuffed. In mid-flexion, balanced trochlea components were more externally rotated relative to the posterior condylar axis compared to unbalanced components (2.35° external rotation vs 1.21°, p=0.004). There were no other significant differences observed between the balanced and unbalanced trochlea groups in mid or deep flexion. CONCLUSION Over 40% of TKA over or under-stuff the trochlea in deeper flexion despite the anterior flange being positioned within 2 mm of the native anatomy in full extension. The rate of over or under-stuffing in mid and deep flexion was similar (>40%); however, in mid-flexion, under-stuffing of the native trochlea was more common. The concept of PFJ over or under-stuffing in TKA needs to be redefined to consider the full arc of flexion of the trochlea groove, and the biomechanical and clinical consequences of under-stuffing the trochlea investigated further. EVIDENCE Level IV.
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Affiliation(s)
- Jobe Shatrov
- Landmark Orthopaedics, St. Leonards, Sydney, Australia; The University of Sydney, Australia; Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
| | - Benoit Coulin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
| | - Angela Brivio
- King Edward VII Hospital, London, United Kingdom; Instituto Clinico Citta Studi, Milan, Italy
| | - David Barrett
- King Edward VII Hospital, London, United Kingdom; School of Engineering Science, University of Southampton, United Kingdom
| | | | - Sebastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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11
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Richards JA, DeFroda SF, Nuelle CW. Robotic-assisted surgery in sports medicine: Where is it? Knee Surg Sports Traumatol Arthrosc 2025; 33:393-396. [PMID: 39403786 DOI: 10.1002/ksa.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/29/2024] [Accepted: 09/30/2024] [Indexed: 02/05/2025]
Affiliation(s)
- Jarod A Richards
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Clayton W Nuelle
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
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12
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Yang HY, Seon JK, Yim JH, Lee DH, Song EK. Functional Alignment Achieved a More Balanced Knee After Robotic Arm-Assisted Total Knee Arthroplasty than Modified Kinematic Alignment. J Clin Med 2025; 14:820. [PMID: 39941491 PMCID: PMC11818173 DOI: 10.3390/jcm14030820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/17/2025] [Accepted: 01/24/2025] [Indexed: 02/16/2025] Open
Abstract
Background: The aim of this study was to evaluate the balance in extension and flexion achievable after total knee arthroplasty (TKA) using a modified kinematic alignment (KA) plan and the subsequent balance achievable after adjusting the component based on the functional alignment (FA) principle. Methods: This retrospective cohort study included 100 consecutive patients who underwent primary TKA for knee osteoarthritis through an image-based robotic system in a single center between October 2021 and February 2022. Whether modified KA or FA could achieve a balanced knee was evaluated by assessing the ligament balance in the medial and lateral compartments using a robotic system at extension and 90° flexion. Balance was defined as a difference of ≤2 mm between the compartments. Component positioning was adjusted within limits based on the functional positioning principles to achieve balance. Implant positioning and balance in extension and 90° flexion were compared between the modified KA plan (n = 100) and after FA adjustments (n = 100). Results: FA achieved significantly better balance in extension (FA, 99.0% vs. modified KA, 86.0%; p = 0.001) and flexion (98.0% vs. 43.0%; p < 0.001) than the modified KA plan. The mean difference in gap balance in extension (FA, 0.1 mm vs. modified KA, 0.6 mm; p = 0.001) and flexion (0.1 mm vs. 2.3 mm; p < 0.001) was also significant between the two techniques. The femoral component was positioned more externally rotated relative to the transepicondylar axis (FA, 2.5° vs. modified KA, 0.0°; p < 0.001) to obtain balanced targets. There were significant improvements in the patient-reported outcome measures between preoperative and postoperative assessments two years after TKA (all p < 0.05). Conclusions: FA consistently achieved superior balance in both extension and flexion following TKA compared with modified KA without altering the soft tissue envelope, leading to significant improvements in clinical outcomes at the two-year follow-up.
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Affiliation(s)
- Hong-Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro, Hwasun, Chonnam 58128, Republic of Korea; (H.-Y.Y.); (J.-K.S.)
| | - Jong-Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro, Hwasun, Chonnam 58128, Republic of Korea; (H.-Y.Y.); (J.-K.S.)
| | - Ji-Hyeon Yim
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Segyero Hospital, 77, Jangsin-ro, Gwangsan-gu, Gwangju 62224, Republic of Korea; (J.-H.Y.); (D.-H.L.)
| | - Dong-Hyun Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Segyero Hospital, 77, Jangsin-ro, Gwangsan-gu, Gwangju 62224, Republic of Korea; (J.-H.Y.); (D.-H.L.)
| | - Eun-Kyoo Song
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, 322, Seoyang-ro, Hwasun, Chonnam 58128, Republic of Korea; (H.-Y.Y.); (J.-K.S.)
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Segyero Hospital, 77, Jangsin-ro, Gwangsan-gu, Gwangju 62224, Republic of Korea; (J.-H.Y.); (D.-H.L.)
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13
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Kafelov M, Batailler C, Servien E, Lustig S. Restoration of the anterior compartment after robotic total knee arthroplasty significantly improves functional outcome and range of motion at 1 year. Knee Surg Sports Traumatol Arthrosc 2025; 33:319-328. [PMID: 38932605 PMCID: PMC11716350 DOI: 10.1002/ksa.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE This study aims to assess the functional outcomes based on restoring the anterior compartment after total knee arthroplasty (TKA). METHODS This retrospective study included 96 primary TKAs performed between 2021 and 2022. Functional positioning principles were applied using an image-based robotic-assisted system. The mean age was 69.2 ± 7.9 years. Knee Society Score (KSS), Kujala score, Forgotten Joint Score (FJS) and knee flexion were collected preoperatively and at 1 year. The depth difference between native and prosthetic trochlea was measured to assess anterior compartment restoration at full extension, 30°, 70° and 90° flexion. The global anterior compartment restoration combined the anterior compartment restoration and the patellar thickness restoration. RESULTS The trochlear offset was mostly understuffed after TKA compared to the native anatomy, mainly for medial and lateral condyles at 30° and 70° of flexion. The global anterior compartment restoration was understuffed in full extension (-0.7 mm ± 2), at 30° (-4.4 mm ± 2) and 70° of flexion (-3.6 mm ± 2.5). At 90°, the global anterior compartment restoration was overstuffed (2.2 mm ± 1.8). Functional scores were not significantly influenced by the anterior compartment stuffing at 0° and 30° (n.s.). The anterior compartment overstuffing at 70° and 90° was associated with decreased KSS function score (p = 0.009) and flexion (p = 0.04). CONCLUSION Moderate anterior understuffing was frequently observed after TKA performed with functional positioning and an image-based robotic-assisted system. This understuffing did not influence the functional outcomes. The overstuffing of the anterior compartment led to a reduction in KSS function score and flexion measurements at 1 year. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Moussa Kafelov
- Orthopaedics surgery and Sports Medicine DepartmentFIFA Medical Center of Excellence, Croix‐Rousse Hospital, Lyon University HospitalLyonFrance
- IFSTTAR, LBMC UMR_T9406Univ Lyon, Université Claude Bernard Lyon 1VilleurbanneFrance
- University Multiprofile Hospital for Active Treatment and Emergency Medicine ‘N. I. Pirogov’Bulgaria
| | - Cécile Batailler
- Orthopaedics surgery and Sports Medicine DepartmentFIFA Medical Center of Excellence, Croix‐Rousse Hospital, Lyon University HospitalLyonFrance
- IFSTTAR, LBMC UMR_T9406Univ Lyon, Université Claude Bernard Lyon 1VilleurbanneFrance
| | - Elvire Servien
- Orthopaedics surgery and Sports Medicine DepartmentFIFA Medical Center of Excellence, Croix‐Rousse Hospital, Lyon University HospitalLyonFrance
- Interuniversity Laboratory of Biology of Mobility, LIBM—EA 7424Claude Bernard Lyon 1 UniversityLyonFrance
| | - Sébastien Lustig
- Orthopaedics surgery and Sports Medicine DepartmentFIFA Medical Center of Excellence, Croix‐Rousse Hospital, Lyon University HospitalLyonFrance
- IFSTTAR, LBMC UMR_T9406Univ Lyon, Université Claude Bernard Lyon 1VilleurbanneFrance
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Vermorel PH, Ciccullo C, De Berardinis L, Gigante AP, Neri T, Philippot R. Does robotic arm-assisted total knee arthroplasty have a role to play in large deformities? SICOT J 2024; 10:50. [PMID: 39570039 PMCID: PMC11580621 DOI: 10.1051/sicotj/2024046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 10/11/2024] [Indexed: 11/22/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) for patients with a large preoperative deformity (more than 10° varus or valgus) remains a challenge leading to a high rate of outliers, unsatisfactory functional results, or early prosthetic loosening. Robotic arm-assisted TKA (RATKA) has shown improvements in implant positioning accuracy. This study aimed to assess RATKA implant positioning accuracy and functional results at one year postoperative for patients with a large preoperative deformity. METHODS From November 2019 to July 2022, 500 RATKA were performed. About 74 patients with more than 10° of varus or valgus global deformity were included. Each patient received a semi-constrained implant. The difference between the valgus or varus value planned intra-operatively and the varus or valgus measured on one-year postoperative X-rays has been assessed. Functional outcomes (VAS, range of motion, KOOS) have also been evaluated. RESULTS For varus, the mean difference was 0.54 ± 1.21°, all patients (100%) had a difference of less than 3° at one-year post-operative. For valgus, the mean difference was 0.63 ± 1.29°, most patients (92%) had a difference of less than 3° at one year postoperative. Overall, 98.6% (n = 73) of cases had a difference of less than 3° at one-year postoperative. The mean VAS was 1.6 ± 1.4 [1;4]. Mean flexion was 132 ± 7.6° [100;145]. A total of 69 patients (93%) had a good or excellent KOOS score (KOOS total > 70) at one year post-operative. CONCLUSION For large preoperative deformities, RATKA provides a high degree of accuracy in implant positioning, permitting it to fit the desired alignment without compromising knee stability, and giving the possibility of using semi-constrained implants. At one year postoperative, functional results are encouraging and most patients have recovered an optimal range of motions.
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Affiliation(s)
- Pierre-Henri Vermorel
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Department of Orthopaedic Surgery, University Hospital Centre (Saint Etienne) Avenue Albert Raimond 42270 Saint-Priest-en-Jarez France
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Inter-University Laboratory of Human Movement Science, University Lyon – University Jean-Monnet Saint-Étienne Saint-Étienne France
| | - Carlo Ciccullo
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Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche 60121 Ancona Italy
| | - Luca De Berardinis
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Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche 60121 Ancona Italy
| | - Antonio Pompilo Gigante
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Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche 60121 Ancona Italy
| | - Thomas Neri
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Department of Orthopaedic Surgery, University Hospital Centre (Saint Etienne) Avenue Albert Raimond 42270 Saint-Priest-en-Jarez France
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Inter-University Laboratory of Human Movement Science, University Lyon – University Jean-Monnet Saint-Étienne Saint-Étienne France
| | - Rémi Philippot
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Department of Orthopaedic Surgery, University Hospital Centre (Saint Etienne) Avenue Albert Raimond 42270 Saint-Priest-en-Jarez France
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15
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Baek JH, Lee SC, Kim T, Heo J, Lee DN, Ahn HS, Nam CH. Effectiveness of Periarticular Pin Tracker Placement Through a Single Main Incision in Robotic-Assisted Total Knee Arthroplasty: Technical Note and Short-Term Results. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1720. [PMID: 39459507 PMCID: PMC11509473 DOI: 10.3390/medicina60101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/14/2024] [Accepted: 10/18/2024] [Indexed: 10/28/2024]
Abstract
Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker-related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through a single main incision during robotic-assisted TKA over a minimum follow-up period of 6 months. Materials and Methods: A consecutive series of 149 TKAs was performed in 108 patients using the triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital from December 2023 to February 2024. Clinical outcomes and complications associated with pin tracker sites, including pin-site infection, neurovascular injury, hematoma, soft-tissue morbidity, and pin-site fracture, were assessed. Results: The mean Knee Society knee score improved from 42.5 preoperatively to 76.3 points at the final follow-up, whereas the mean Knee Society function score improved from 43.1 preoperatively to 78.1 points at the final follow-up (both p < 0.05). No patient experienced any minor or major complications related to the use of pin trackers in the distal femur and proximal tibia. Conclusions: This periarticular technique that uses pin trackers in the distal femur and proximal tibia through a single main incision could be a useful option for orthopedic surgeons while performing robotic-assisted TKA.
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Affiliation(s)
- Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (S.C.L.); (T.K.); (D.N.L.); (H.S.A.)
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (S.C.L.); (T.K.); (D.N.L.); (H.S.A.)
| | - Taehyeon Kim
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (S.C.L.); (T.K.); (D.N.L.); (H.S.A.)
| | - Juneyoung Heo
- Joint & Arthritis Research, Department of Neurosurgery, Himchan Hospital, Seoul 07999, Republic of Korea;
| | - Dong Nyoung Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (S.C.L.); (T.K.); (D.N.L.); (H.S.A.)
| | - Hye Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (S.C.L.); (T.K.); (D.N.L.); (H.S.A.)
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea; (J.-H.B.); (S.C.L.); (T.K.); (D.N.L.); (H.S.A.)
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16
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Baek JH, Lee SC, Ryu S, Lee DN, Kim T, Ahn HS, Nam CH. Surgical Technique for Complementing Robotic-Assisted Total Knee Arthroplasty in Middle-Aged Patients with Rigid Knee Bones. J Pers Med 2024; 14:945. [PMID: 39338199 PMCID: PMC11432815 DOI: 10.3390/jpm14090945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/19/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
This study reports 12 cases of inaccurate bone cutting from a single-surgeon series of 509 consecutively performed robotic-assisted total knee arthroplasty (TKA) for 1 year. In addition, a complementary technique with the combined benefits of robotic-assisted and manual techniques that address this issue is described. From June 2020 to May 2021, a consecutive series of 509 TKAs was performed on 338 patients using a posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital. The surgical records were reviewed to identify the causative bone locations and bone re-cutting events correlated with improper trial instrument positioning. The re-cutting rate was 2.4% (12/509). All re-cutting attempts occurred because of improper cutting of the femoral posterior chamfer. Re-cutting was attempted mostly on middle-aged male patients. This complementary technique can facilitate manual bone cutting while retaining the advantages of robotic surgery during robotic-assisted TKA. Additionally, the combined technique of manual bone cutting and robotic-assisted surgery can be a useful alternative for middle-aged male patients with rigid knee bones.
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Affiliation(s)
- Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
| | - Suengryol Ryu
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
| | - Dong Nyoung Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
| | - Taehyeon Kim
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
| | - Hye Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul 07999, Republic of Korea
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An HM, Wen JX, Gu W, Chen JY, Chai W, Li R. Discrepancies in Sagittal Alignment of the Lower Extremity Among Different Brands of Robotic Total Knee Arthroplasty Systems. J Arthroplasty 2024; 39:2248-2253. [PMID: 38508345 DOI: 10.1016/j.arth.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND There is an increasing number of different brands of robotic total knee arthroplasty (TKA) systems. Most robotic TKA systems share the same coronal alignment, while the definitions of sagittal alignment vary. The purpose of this study was to investigate whether these discrepancies impact the sagittal alignment of the lower extremity. METHODS A total of 72 lower extremity computed tomography scans were included in our study, and 3-dimensional models were obtained using software. A total of 7 brands of robotic TKA systems were included in the study. The lower extremity axes were defined based on the surgical guide for each implant. We also set the intramedullary axis as a reference to evaluate the discrepancies in sagittal alignment of each brand of robotic system. RESULTS On the femoral side, the axis definition was the same for all 7 robotic TKA systems. The robotic TKA axes showed a 2.41° (1.58°, 3.38°) deviation from the intramedullary axis. On the tibial side, the 7 robots had different axis definitions. The tibial mechanical axis of 6 of the TKA systems was more flexed than that of the intramedullary axis, which means the posterior tibial slope was decreased while the tibial mechanical axis of the remaining system was more extended. CONCLUSIONS The sagittal alignment of the lower extremity for 7 different brands of robotic TKA systems differed from each other and all deviated from the intramedullary axis. Surgeons should be aware of this discrepancy when using different brands of robotic TKA systems to avoid unexpected sagittal alignment and corresponding adverse clinical outcomes. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Hao-Ming An
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China; Chinese PLA Medical School, Beijing, China
| | - Jia-Xin Wen
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China; Chinese PLA Medical School, Beijing, China
| | - Wang Gu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Ji-Ying Chen
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Rui Li
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
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Ma N, Sun P, Xin P, Zhong S, Xie J, Xiao L. Comparison of the efficacy and safety of MAKO robot-assisted total knee arthroplasty versus conventional manual total knee arthroplasty in uncomplicated unilateral total knee arthroplasty a single-centre retrospective analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:2351-2358. [PMID: 38874668 PMCID: PMC11347482 DOI: 10.1007/s00264-024-06234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To compare the efficacy and safety of MAKO robot-assisted total knee arthroplasty (MA-TKA) with conventional manual total knee arthroplasty (CM-TKA) in patients with end-stage knee osteoarthritis (KOA) during the early postoperative period. METHOD A retrospective analysis was conducted on 22 patients with KOA who underwent MA-TKA and 26 patients who underwent CM-TKA from April 2023 to July 2023. Hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), American Knee Society Score (AKSS), Forgotten Joint Score-12 (FJS-12), visual analogue scale (VAS), and postoperative complications were recorded and compared between the two groups. RESULT Both groups successfully completed the surgeries. In terms of radiographic parameters, postoperative one month LDFA and HKA in the MA-TKA group were significantly lower than those in the CM-TKA group (P < 0.05). At the one month follow-up, 19 patients (86.4%) in the MA-TKA group had an HKA less than 3°, compared to 20 patients (76.9%) in the CM-TKA group. Clinically, VAS scores at 24 h, 48 h, and 72 h postoperatively were lower in the MA-TKA group both at rest and during activity. At one month and three months postoperatively, AKSS Function Scores and FJS-12 scores in the MA-TKA group were significantly higher than those in the CM-TKA group (P < 0.05). Regarding postoperative complications, no complications occurred in the MA-TKA group, while one patient in the CM-TKA group experienced postoperative knee stiffness, which resolved after physical therapy, with no statistically significant difference (P > 0.05). CONCLUSION Compared with conventional manual total knee arthroplasty, MAKO robot-assisted TKA demonstrates better short-term clinical efficacy, achieves better alignment planning, and maintains good safety.
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Affiliation(s)
- Nanshan Ma
- Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Pengfei Sun
- Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Pengfei Xin
- Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Sheng Zhong
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Jun Xie
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Lianbo Xiao
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China.
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19
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Pagan CA, Karasavvidis T, Cohen-Rosenblum AR, Hannon CP, Lombardi AV, Vigdorchik JM. Technology in Total Knee Arthroplasty in 2023. J Arthroplasty 2024; 39:S54-S59. [PMID: 39053667 DOI: 10.1016/j.arth.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
Over the past few decades, instrumentation and techniques for total knee arthroplasty have evolved from conventional manual tools to a wide range of technologies, including calibrated guides for accurate bone cuts and alignment, smart tools, dynamic intraoperative sensors for soft tissue balancing, patient-specific guides, computer navigation, and robotics. This review is intended to provide an overview of the latest advancements in total knee arthroplasty technology, address potential challenges and solutions related to the application of these technologies, and explore their limitations.
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Affiliation(s)
- Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Charles P Hannon
- Deparment of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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20
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Hepinstall MS, Di Gangi C, Oakley C, Sybert M, Meere PA, Meftah M. Variability in Alignment and Bone Resections in Robotically Balanced Total Knee Arthroplasties. Bioengineering (Basel) 2024; 11:845. [PMID: 39199803 PMCID: PMC11351558 DOI: 10.3390/bioengineering11080845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024] Open
Abstract
Image-based robotic-assisted total knee arthroplasty (RA-TKA) allows three-dimensional surgical planning informed by osseous anatomy, with intraoperative adjustment based on a dynamic assessment of ligament laxity and gap balance. The aim of this study was to identify ranges of implant alignment and bone resections with RA-TKA. We retrospectively reviewed 484 primary RA-TKA cases, stratified by preoperative coronal alignment. Demographics and intraoperative data were collected and compared using Chi-square and ANOVA tests. Planned limb, femoral, and tibial alignment became increasingly varus in a progressive order from valgus to neutral to the highest in varus knees (p < 0.001). Planned external transverse rotation relative to the TEA was lowest in the valgus cohort; relative to the PCA, whereas the varus cohort was highest (p < 0.001, both). Planned resections of the lateral distal femur and of the medial posterior femur were greater in the varus group compared to neutral and valgus (p < 0.001). There were significant differences between cohorts in planned tibia resections, laterally and medially. Varus knees demonstrated higher variability, while valgus and neutral had more metrics with low variability. This study demonstrated trends in intraoperative planned alignment and resection metrics across various preoperative coronal knee alignments. These findings contribute to the understanding of RA-TKA and may inform surgical decision-making.
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21
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Yang Q, Weng X, Xia C, Shi C, Liu J, Liang C, Liu Y, Wang Y. Comparison between guide plate navigation and virtual fixtures in robot-assisted osteotomy. Comput Methods Biomech Biomed Engin 2024; 27:1387-1397. [PMID: 37547946 DOI: 10.1080/10255842.2023.2243359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
To verify the advantages of Virtual Fixtures (VFs) by comparing the result of guide plate navigation (GPN) and VFs in robot-assisted osteotomy. Robot-assisted surgery has been extensively applied in traditional orthopedic surgeries. It fundamentally improves surgeries' cutting accuracy. In addition, many key techniques have been applied in bone cutting to increase the procedure's safety in various ways. In this paper, two robot-assisted osteotomy methods are proposed. Three operators with no osteotomy experience performed plane cutting with the assistance of a robot. GPN and VFs were applied to assist the Sawbones cutting. Each operator has five attempts using each method to perform bone cutting, distance errors and angular errors were recorded. The advantage of Sawbones is that there is no influence from soft tissues and blood. It can give a more precise measurement. The results show that both methods have high accuracy with the robot's assistance. VFs have higher accuracy in comparison with GPN. With GPN, the mean distance and angular error of the three operators were 2.974 ± 0.282 mm and 4.737 ± 0.254°. With VFs, the mean range and angular error of the three operators were 1.857 ± 0.349 mm and 2.24 ± 0.123°, respectively. VFs limited the robot's end in the planned area, increasing the accuracy and safety of robot-assisted osteotomy.
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Affiliation(s)
- Qing Yang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Chunjie Xia
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chao Shi
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jixuan Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Chendi Liang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yanzhen Liu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yu Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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22
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Adkar N, Patil M, Vaidya S, Kumbar R, Kerhalkar R, Mote G, Thareja S, Sadalagi P, Bajwa S. Correlation Between Planned and Executed Bone Cuts Using Robotics in Total Knee Arthroplasty: A Prospective Study of 500 Patients. Indian J Orthop 2024; 58:1103-1108. [PMID: 39087031 PMCID: PMC11286900 DOI: 10.1007/s43465-024-01196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 08/02/2024]
Abstract
Objective This study evaluated the precision of robotic-arm-assisted total knee arthroplasty (RATKA) in performing bone resection, predicting component size, managing soft tissue tension, and determining postoperative range of motion (ROM). Methods A total of 500 participants were enrolled in this prospective cohort research. The procedures were conducted at a single facility, with a uniform method and implant design. The Cuvis system, a fully automated robot, was utilized for the study. The precise removal of bone at both the tibial and femur sites, the positioning of the implant, and the release of soft tissue were documented and then compared to the preoperative plan. Results The distal (medial and lateral) femoral cuts had a mean absolute deviation from the plan of 0.23 mm, while the posterior (medial and lateral) femoral cuts had a mean absolute difference of 1 mm and 1.4 mm, respectively. The absolute discrepancies in the medial and lateral tibial cuts are 0.93 mm and - 0.06 mm, respectively. Out of 1000 bone resections, 980 (98%) were within < 1 mm from the preoperative plan. The predictions for the sizes of the tibial and femoral components had accuracies of 100% and 98.9%, respectively. Conclusion These findings collectively underscore the effectiveness of the fully automated Cuvis robotic system in achieving consistent and accurate results in bone resections and implant sizing, highlighting its potential as a valuable tool in orthopedic surgery.
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Affiliation(s)
- Neeraj Adkar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Mangesh Patil
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Swapnil Vaidya
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Rajendra Kumbar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Ravi Kerhalkar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Girish Mote
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Satwik Thareja
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Prajwal Sadalagi
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Supreet Bajwa
- Department of Orthopedics and Joint Replacement, Wockhardt Hospital, Mumbai Central, Maharashtra India
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Fu X, She Y, Jin G, Liu C, Liu Z, Li W, Jin R. Comparison of robotic-assisted total knee arthroplasty: an updated systematic review and meta-analysis. J Robot Surg 2024; 18:292. [PMID: 39052153 PMCID: PMC11272701 DOI: 10.1007/s11701-024-02045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
This study was conducted to compare the changes in different clinical scores and imaging indexes of patients who underwent robot-assisted total knee arthroplasty (RA-TKA) and manual total knee arthroplasty (M-TKA). PubMed, Web of Science, Cochrane Library and Embase were searched according to PRISMA guidelines in June 2024. Search terms included "robot-assisted", "manual" and "total knee arthroplasty". Outcome indicators included American Knee Society Score (KSS), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), range of motion (ROM), Hospital for Special Surgery (HSS) score, Forgotten Joint Score (FJS), 36-Item Short Form Health Survey (SF-36), operation duration (min), intraoperative blood loss (ml), pain score, patient's satisfaction scores, hip-knee-ankle (HKA) angle, frontal femoral component angle, frontal tibia component angle, lateral femoral component angle and lateral tibia component angle. A total of 1,033 articles were obtained after removing duplicates, and 12 studies involving 2,863 patients (1,449 RA-TKAs and 1,414 M-TKAs) were finally meta-analyzed (22-32). The baseline data of both groups were similar in all results. Meta-analysis suggested a better performance of the RA-TKA group than the M-TKA group regarding the HKA angle. The manual TKA reduced the operation time and significantly improved the range of motion. The results of > 6 months follow-up showed that M-TKA was better than RA-TKA in terms of KSS score and WOMAC. Compared with M-TKA, RA-TKA can produce more accurate prosthetic alignment, but it does not lead to better clinical results. Orthopedic surgeons should choose between two surgical procedures according to their own experience and patients' characteristics.
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Affiliation(s)
- Xinyu Fu
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Yiming She
- Department of Nephrology, Yanbian University Hospital, Yanji, Jilin, 133002, China
| | - Guangwen Jin
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Chengri Liu
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Ze Liu
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Wei Li
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Ri Jin
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China.
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Klasan A, Anelli-Monti V, Putnis SE, Neri T, Kammerlander C. The effect of different alignment strategies on trochlear orientation after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:1734-1742. [PMID: 38606595 DOI: 10.1002/ksa.12178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE When planning and delivering total knee arthroplasty (TKA), there are multiple coronal alignment strategies such as functional alignment (FA), kinematic alignment (KA), mechanical and adjusted mechanical alignment (MA, aMA). Recent three-dimensional and robotic-assisted surgery (RAS) studies have demonstrated that KA potentially better restores the trochlear anatomy than MA. The purpose of this study was to compare the restoration of the native trochlear orientation in patients undergoing RAS TKA using four different alignment strategies. It was hypothesised that FA would result in the lowest number of outliers. METHODS This is a prospective study of 200 patients undergoing RAS-TKA with a single implant. All patients were analysed for MA and KA prebalancing, and 157 patients received aMA and 43 patients FA with intraoperative balancing. Preoperative transverse computed tomography scans were used to determine the posterior condylar axis (PCA), lateral trochlear inclination (LTI) angle, sulcus angle (SA) and anterior trochlear line (ATL) angle. Implant measurements were obtained using a photographic analysis. Intraoperative software data combined with implant data and preoperative measurements were used to calculate the differences. Outliers were defined as ≥3° of alteration. Trochlea dysplasia was defined as LTI < 12°. RESULTS Native transepicondylar PCA had a median of 2°, LTI 18°, SA 137°, ATL 4°. LTI outliers were observed in 47%-60% of cases, with KA < FA < aMA < MA. For ATL, the range of outliers was 40.5%-85%, KA < FA < aMA < MA. SA produced 81% of outliers. Of all median angle values, only LTI when using KA was not significantly altered compared to the native knee. CONCLUSION There is a significant alteration of trochlear orientation after TKA, regardless of the alignment strategy used. KA produced the lowest, but a substantial, number of outliers. The uniform design of implants causes the surgeon to compromise on balance in flexion versus trochlear position. The clinical relevance of this compromise requires further clinical investigations. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Antonio Klasan
- Department of Orthropedics and Traumatology, AUVA UKH Steiermark, Graz, Austria
- Department of Orthropedics and Traumatology, Johannes Kepler University Linz, Linz, Austria
| | | | - Sven E Putnis
- Department of Orthropedics and Traumatology, University Hospital Bristol, Bristol, UK
| | - Thomas Neri
- Department of Orthropedics and Traumatology, University Hospital St. Etienne, St. Etienne, France
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Yi J, Gao Z, Huang Y, Liu Y, Zhang Y, Chai W. Evaluating the accuracy of a new robotically assisted system in cadaveric total knee arthroplasty procedures. J Orthop Surg Res 2024; 19:354. [PMID: 38879524 PMCID: PMC11179344 DOI: 10.1186/s13018-024-04788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/07/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (TKA) has been shown to facilitate high-precision bone resection, which is an important goal in TKA. The aim of this cadaveric study was to analyze the accuracy of the target angle and bone resection thickness of a recently introduced robotic TKA system. METHODS This study used 4 frozen cadaveric specimens (8 knees), 2 different implant designs, navigation, and a robotic system. The 4 surgeons who participated in this study were trained and familiar with the basic principles and operating procedures of this system. The angle of the bone cuts performed using the robotic system was compared with the target angles from the intraoperative plan. For each bone cut, the resection thickness was recorded and compared with the planned resection thickness. RESULTS The mean angular difference for all specimens was less than 1°, and the standard deviation was less than 2°. The mean difference between the planned and measured angles was close to 0 and not significantly different from 0 except for the difference in the frontal tibial component angle, which was 0.88°. The mean difference in the hip-knee-ankle axis angle was - 0.21°± 1.06°. The mean bone resection difference for all specimens was less than 1 mm, and the standard deviation was less than 0.5 mm. CONCLUSIONS The results of the cadaveric experimental study showed that the new TKA system can realize highly accurate bone cuts and achieve planned angles and resection thicknesses. Despite the limitations of small sample sizes and large differences between cadaveric and clinical patients, the accuracy of cadaveric experiments provides strong support for subsequent clinical trials.
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Affiliation(s)
- Jiafeng Yi
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
| | - Zhisen Gao
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
| | - Yijian Huang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co. Ltd, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China.
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Zambianchi F, Matveitchouk N, Pavesi M, Clemenza S, Cuoghi Costantini R, Marcovigi A, Seracchioli S, Catani F. Small deviations between planned and performed bone cuts using a CT-based robotic-arm-assisted total knee arthroplasty system. Knee Surg Sports Traumatol Arthrosc 2024; 32:1539-1547. [PMID: 38572678 DOI: 10.1002/ksa.12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Computed tomography (CT)-based robotic system for total knee arthroplasty (TKA) has shown improved accuracy compared to conventional. This study was designed to (1) confirm the accuracy of the robotic system in achieving the plan and (2) establish the alignment and positioning deviation between final components and planning, by measuring the discrepancy between final implant alignment and the corresponding planned cut. METHODS Ninety-six cementless robotic-arm assisted (RA) TKAs were assessed. Bone resections were performed using the haptically controlled robotic arm. Alignment in the coronal and sagittal plane and resection depth of the distal femoral and proximal tibial cuts were recorded with a navigation planar probe. After final components were impacted, the probe was positioned on each implant surface to determine its alignment and positioning. RESULTS The mean tibial resections and implanted tibial component's positioning were 0.4 mm (standard deviation, SD: 0.6) and 0.9 mm (SD: 0.8), respectively, higher than planned (p < 0.01). The tibial sagittal cut had 19/96 cases (19.8%) of ±1° outliers from plan. In 40/96 cases (41.7%), the tibial component was more prominent than planned of more than 1 mm. The mean femoral resections and impacted femoral component's positioning was 0.1 mm (SD: 0.8) and 0.2 mm (SD: 0.7), respectively, higher than planned. In 23/96 cases (24.0%), the femoral sagittal cut and femoral component coronal alignment deviated more than ±1° from plan. CONCLUSIONS The computed tomography-based robotic-assisted TKA system showed good accuracy regarding bone preparation and component's positioning relative to the planning. Cementless tibial component impaction resulted in the most deviation from plan, with a large proportion of cases resulting in being more prominent than planned. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Nikita Matveitchouk
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | | | - Sebastiano Clemenza
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Riccardo Cuoghi Costantini
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Stefano Seracchioli
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Lee JH, Kwon SC, Hwang JH, Lee JK, Kim JI. Functional alignment maximises advantages of robotic arm-assisted total knee arthroplasty with better patient-reported outcomes compared to mechanical alignment. Knee Surg Sports Traumatol Arthrosc 2024; 32:896-906. [PMID: 38454836 DOI: 10.1002/ksa.12120] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Robotic arm-assisted total knee arthroplasty (RTKA) enables adjustment of implant position to achieve the surgeon's preferred alignment. However, the alignment concept that most effectively enhances patient satisfaction remains unclear. This study compares the clinical outcomes of patients who underwent functionally aligned RTKA (FA-RTKA), mechanically aligned conventional TKA (MA-CTKA) and mechanically aligned RTKA (MA-RTKA). METHODS A prospectively collected database was retrospectively reviewed for patients who underwent primary TKA for knee osteoarthritis. One hundred and forty-seven knees were performed with MA-CTKA, followed by 72 consecutive knees performed with MA-RTKA, and subsequently, 70 consecutive knees performed with FA-RTKA were enrolled. After 1:1 propensity score matching of patient demographics, 70 knees were finally included in each group. The extent of additional soft tissue release during surgery was identified, and the Coronal Plane Alignment of the Knee classification was utilised to categorise the alignment. At the 1-year follow-up, patient-reported outcomes, including the pain Visual Analogue Scale, Knee Society Score, Western Ontario and McMaster Universities Arthritis Index and Forgotten Joint Score-12, were also compared among the groups. RESULTS The FA-RTKA group showed significantly less additional soft tissue release than the MA-CTKA and MA-RTKA groups (15.7%, 38.6% and 35.7%, respectively; p = 0.006). Statistically significant differences in functional scores were observed in the postoperative 1-year clinical outcomes in favour of the FA-RTKA group, which had a significantly larger percentage of knees that maintained constitutional alignment and joint line obliquity than those of the other groups. CONCLUSIONS Functionally aligned TKA showed superior 1-year postoperative patient-reported outcomes compared with those of conventional and robotic arm-assisted mechanically aligned TKA. Therefore, the advantage of RTKA is maximised when the implant positioning is based on functional alignment. The application of RTKA with mechanical alignment has been proven ineffective in improving the clinical outcomes of patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seung Cheol Kwon
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Kim SE, Han HS. Robotic arm-assisted total knee arthroplasty in a patient with osteopetrosis: a case report and review of literature. Orthop Rev (Pavia) 2024; 16:94238. [PMID: 38435436 PMCID: PMC10908595 DOI: 10.52965/001c.94238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Osteopetrosis, a rare condition arising from osteoclast dysfunction, is characterised by increased bony density and obliteration of the intramedullary canal. While total knee arthroplasty (TKA) is preferred for osteoarthritic patients with osteopetrosis, inherent disease characteristics pose surgical challenges. This article presents a patient with osteopetrosis treated with robotic arm-assisted TKA (RA-TKA). This approach provided precise bone resection, obviates the need for intramedullary guides, minimizes saw disposal, and reduces surgical duration, with satisfactory short-term outcomes. RA-TKA may be an effective treatment for osteoarthritis in patients with osteopetrosis.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopaedic Surgery Seoul National University College of Medicine
- Department of Orthopaedic Surgery Seoul National University Hospital
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery Seoul National University College of Medicine
- Department of Orthopaedic Surgery Seoul National University Hospital
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29
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Tone S, Hasegawa M, Naito Y, Wakabayashi H, Sudo A. Two- and three-dimensional evaluations following handheld robot-assisted total knee arthroplasty. J Robot Surg 2024; 18:70. [PMID: 38340201 DOI: 10.1007/s11701-024-01827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/14/2024] [Indexed: 02/12/2024]
Abstract
Robot-assisted total knee arthroplasty (TKA) has proven to be successful in improving the accuracy of component positioning and reducing radiographic outliers. This study aimed to evaluate and compare the alignment of the components using two- and three-dimensional (2D and 3D) measurements following handheld imageless robot-assisted TKA. Seventy consecutive patients underwent primary TKA at our institution using a handheld robot-assisted system. Full-length standing anteroposterior and lateral radiographs were obtained 2 weeks after surgery for assessment of 2D component alignments. Pre- and postoperative computed tomography (CT) images were obtained to assess 3D component alignment. The reference points defined on preoperative CT images were transferred to the postoperative CT images. The absolute errors in the 2D and 3D component alignments from the planned, validated cutting, and validated implantation angles were calculated. Outliers of > ± 3° of femoral and tibial component alignments in the coronal and sagittal planes were also investigated. All absolute errors in the 2D and 3D component alignments were < 1°, except for the planned and validated cutting angles of the femoral sagittal alignment. No outliers were observed in the femoral or tibial component in the coronal plane. Significant differences between the 2D and 3D measurements were observed for the mean absolute value from the planned and validated cutting angles in the femoral sagittal plane and from the validated implantation angle in the tibial coronal plane. The handheld robot-assisted system demonstrated a high accuracy for component alignment using 2D and 3D evaluations.
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Affiliation(s)
- Shine Tone
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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MacAskill M, Peluso R, Lash J, Hewett TE, Bullock M, Caughran A. A Three-dimensional Comparison of Pre- and Post-component Position in a Series of Off-label Robotic-assisted Revision Total Knee Arthroplasties. Arthroplast Today 2024; 25:101310. [PMID: 38229867 PMCID: PMC10788208 DOI: 10.1016/j.artd.2023.101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/09/2023] [Accepted: 11/19/2023] [Indexed: 01/18/2024] Open
Abstract
Background The application of robotic-assisted arthroplasty in revision knee scenarios continues to evolve. This study compares the pre- and post-revision implant positions in series of revision total knee arthroplasties (TKA) using a robotic arm system. Methods Twenty-five consecutive off-label robotic-assisted revision TKA were performed. After virtual revision femoral and tibial components were positioned to achieve "balanced" medial and lateral flexion and extension gaps, the existing primary implants (PI) were removed, and bone cuts were executed with the robotic arm system. Preoperative coronal, sagittal, and axial position of the PI was compared to the final planned positions of the robotic revision implants (RRI) for each subject. A repeated measures ANOVA using the absolute difference in millimeters and degrees between the PI and RRI orientation was completed. Results Intra-operatively, the virtual gaps were balanced within the planning software followed by successful execution of the plan. There was a statistically significant difference between posterior condylar offset and tibial component positioning for RRI compared to PI. There was no difference between the distal femoral component values between PI and RRI. Conclusions The sagittal alignment of the revision implants, specifically the femoral posterior condylar offset and tibial component slope, are statistically significant considerations for a stable revision TKA with off-label use of a robotic-arm system. Other potential benefits may include appropriate implant sizing which can affect the resultant ligamentous tension important for a functional revision TKA. Future research and software iterations will be needed to determine the overall accuracy and utility of robotic-assisted revision TKA.
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Affiliation(s)
- Micah MacAskill
- Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Richard Peluso
- Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Jonathan Lash
- Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Timothy E. Hewett
- Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Matthew Bullock
- Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Alexander Caughran
- Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
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Yang Y, Jiang L, Zhou X, Zhou X, Chen H, Chen Z. Robotic-assisted total knee arthroplasty improves implant position and early functional recovery for the knee with severe varus/valgus deformity. BMC Musculoskelet Disord 2024; 25:92. [PMID: 38267884 PMCID: PMC10809628 DOI: 10.1186/s12891-024-07203-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE Robotic-assisted total knee arthroplasty (r-TKA) facilitates precise bone resection and lower limb alignment, yet accuracy and functional recovery for severe varus/valgus deformity is not well-documented. The aim of study was to investigate whether r-TKA improves implant alignment in the coronal and sagittal view and early functional recovery compared to conventional TKA(c-TKA). METHODS This comparative study included 86 patients with symptomatic knee arthritis who underwent primary TKA at our institution between 1st May and 31th November 2021. Radiological parameters evaluated included hip-knee-ankle angle (HKAA), femoral varus-valgus angle (FVVA), tibial varus-valgus angle (TVVA), posterior tibial slope angle (PTSA), femoral sagittal angle (FSA), posterior condylar offset ratio, and Insall-Salvati index. Operative time, stay length, and complications were reviewed from patient records. The hospital for special surgery (HSS), Visual Analogue Scale (VAS) and knee joint motion range were evaluated at the six-month follow-up. RESULTS The c-TKA and r-TKA groups had no significant differences in HKAA (179.73 ± 3.76°, range: 172.10-188.90° vs. 180.53 ± 2.91°, range: 173.30-188.32°, p = 0.277), FVVA (96.13 ± 2.61°, range: 90.27-101.52° vs. 96.38 ± 2.23°, range: 90.98-100.95°, p = 0.636), and TVVA (88.74 ± 2.03°, range: 83.75-92.74° vs. 89.43 ± 1.83°, range: 85.32-94.15°, p = 1.000). Outlier of mechanical alignment incidence (> 3°) was significantly lower in r-TKA compared with c-TKA, 17.50% (7/40) vs. 41.30% (19/46), (p = 0.017). PTSA of r-TKA remained significantly lower than c-TKA (p = 0.009) in mild-deformity patients. For severe varus/valgus deformity, r-TKA had a significantly lesser HKAA-outlier incidence (p = 0.025), PTSA-outlier incidence (p = 0.019), and lower PTSA (p < 0.001) compared with c-TKA. The r-TKA functional outcome was better than c-TKA regarding HSS (93.12 ± 1.97, range: 90-95, 95%CI:92.11-94.13 vs. 91.33 ± 2.50, range: 85-95, 95%CI:90.20-92.69, p = 0.036), and VAS (0.24 ± 0.44, range:0-1 vs. 0.72 ± 0.75, range:0-2, p = 0.026), knee joint flexion (118.53° ± 8.06, range: 105-130°, 95%CI:114.39-122.67° vs. 112.22 ± 8.09°, range: 100-130°, 95%CI:108.20-116.24° ,p = 0.027) for severe varus/valgus deformity. CONCLUSION r-TKA improved lower-limb coronal alignment, sagittal implant position, and early functional recovery for patients with severe varus/valgus deformity of the knee. r-TKA did not confer substantial advantages over c-TKA in both radiological and clinical outcomes for the mild varus/valgus deformity.
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Affiliation(s)
- Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China
| | - Lingjun Jiang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China
| | - Xiaoxiao Zhou
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu hospital, Shanghai, China
| | - Xiaobo Zhou
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China
| | - Haixiao Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China.
| | - Zhongyi Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, No. 150 Ximen Street, Linhai City, 317000, Zhejiang Province, China.
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Rajgor HD, Mayne A, Munasinghe C, Pagkalos J, Agrawal Y, Davis ET, Sharma AD. Mako versus ROSA: comparing surgical accuracy in robotic total knee arthroplasty. J Robot Surg 2024; 18:33. [PMID: 38231299 DOI: 10.1007/s11701-023-01786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/14/2023] [Indexed: 01/18/2024]
Abstract
There is increasing adoption of robotic surgical technology in Total Knee Arthroplasty. The ROSA® knee system can be used in either image-based mode (using pre-operative calibrated radiographs) or imageless modes (using intra-operative bony registration). The Mako knee system is an image-based system (using a pre-operative CT scan). This study aimed to compare surgical accuracy between the ROSA and Mako systems with specific reference to joint line height, patella height, posterior condylar offset and tibial slope. This was a retrospective review of a prospectively collected data of the initial 50 consecutive ROSA TKAs and the initial 50 consecutive Mako TKAs performed by two high-volume surgeons. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to joint line height (JLH), patella height (PH), tibial slope (TS) and posterior condylar offset (PCO). Mean difference between pre- and post-operative radiographs using the ROSA knee system of joint line height was 0.47 mm (SD 0.95) posterior condylar offset 0.16 mm (SD 0.76), tibial slope 0.9 degrees (SD 1.6) and patella height 0.01 (SD 0.05). Mean difference using the MAKO knee system of joint line height was 0.26 (SD 1.08), posterior condylar offset -0.26 mm (SD 0.78), tibial slope 1.8 degrees and patella height 0.03. No significant difference was demonstrated between the accuracy of component positioning of the ROSA or MAKO knee systems. Our study is the first study to compare the accuracy of the ROSA and MAKO knee systems in total knee arthroplasty. Both systems are highly accurate in restoring native posterior condylar offset, joint line height, tibial slope and patella height in TKA with no significant difference demonstrated between the two groups.
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Affiliation(s)
- Harshadkumar D Rajgor
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK.
| | - Alistair Mayne
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | | | - Joseph Pagkalos
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | - Yuvraj Agrawal
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | - Edward T Davis
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Akash D Sharma
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
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Klasan A, Anelli-Monti V, Huber S, Zacherl M, Hofstaetter J, Kammerlander C, Sadoghi P. No Benefit of Robotic-Assisted over Computer-Assisted Surgery for Achieving Neutral Coronal Alignment in Total Knee Arthroplasty. J Knee Surg 2024; 37:8-13. [PMID: 37734406 DOI: 10.1055/a-2179-8456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The use of robotic-assisted surgery (RAS) in total knee arthroplasty (TKA) is becoming increasingly popular due to better precision, potentially superior outcomes and the ability to achieve alternative alignment strategies. The most commonly used alignment strategy with RAS is a modification of mechanical alignment (MA), labeled adjusted MA (aMA). This strategy allows slight joint line obliquity of the tibial component to achieve superior balancing. In the present study, we compared coronal alignment after TKA using RAS with aMA and computer-assisted surgery (CAS) with MA that has been the standard in the center for more than 10 years. We analyzed a prospectively collected database of patients undergoing TKA in a single center. Lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were compared for both techniques. In 140 patients, 68 CASs and 72 RASs, we observed no difference in postoperative measurements (median 90 degrees for all, LDFA p = 0.676, MPTA p = 0.947) and no difference in outliers <2 degrees (LDFA p = 0.540, MPTA p = 0.250). The present study demonstrates no benefit in eliminating outliers or achieving neutral alignment of both the femoral and the tibial components in robotic-assisted versus computer-assisted TKA if MA is the target. To utilize the precision of RAS, it is recommended to aim for more personalized alignment strategies. The level of evidence is level III retrospective study.
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Affiliation(s)
- Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria
- Johannes Kepler University, Linz, Austria
| | | | - Stephanie Huber
- Orthopedic Hospital Speising, Vienna, Austria
- Michael Ogon Institute, Vienna, Austria
| | | | - Jochen Hofstaetter
- Orthopedic Hospital Speising, Vienna, Austria
- Michael Ogon Institute, Vienna, Austria
| | | | - Patrick Sadoghi
- Department for Orthopedics and Traumatology, Medical University of Graz, Graz, Austria
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Lee HJ, Park KK, Park YB, Choi SW, Kim BO, Kim SH. Accuracy of Advanced Active Robot for Total Knee Arthroplasty: A Cadaveric Study. J Knee Surg 2024; 37:135-141. [PMID: 36638805 DOI: 10.1055/s-0042-1760391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although the accuracy of other types of robotic systems for total knee arthroplasty (TKA) has been assessed in cadaveric studies, no investigations have been performed to evaluate this newly advanced active robotic system. Therefore, the authors aimed to analyze the accuracy of bone resection in terms of thickness and alignment in a cadaveric study. Three cadaveric specimens (six knees) and an active robotic system (CUVIS Joint, CUREXO) were used in the study. Three surgeons with different experiences in robotic TKAs performed this cadaveric study using the same robotic protocol with two different implant designs. The thickness and angle of bone resection planes obtained from the optical tracking system and the difference between resection planes and the planning data were assessed to determine accuracy. With respect to the overall resection accuracy compared to the plan, the cutting depth accuracy was within 1.0 mm mean of root mean square (RMS), and the resection angle accuracy in terms of sagittal, coronal, and axial planes was within 1.0 degree mean RMS. In contrast, no significant differences were observed between the planned and measured values in terms of the resection angles and cutting thickness. The hip-knee-ankle angle at postoperative evaluation was 0.7 degrees ± 0.7 degrees (RMS 1.0 degrees). This in vivo study suggests that the use of this newly advanced active robotic system for TKA demonstrates a high degree of accuracy in terms of resection thickness and alignment. This finding supports the clinical application of this advanced robotic system. LEVEL OF EVIDENCE: Cadaveric study, Level V.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Gyeonggi-do, South Korea
| | - Sung Wook Choi
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Bong-Oh Kim
- R & D center, Curexo Inc., Seoul, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Li M, Zhang Y, Shao Z, Zhu H. Robotic-assisted total knee arthroplasty results in decreased incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty. J Orthop Surg (Hong Kong) 2024; 32:10225536241241122. [PMID: 38518261 DOI: 10.1177/10225536241241122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE Periprosthetic fracture (PPF) is an uncommon but devastating complication after total knee arthroplasty (TKA). Anterior femoral notching (AFN) is one of a perioperative risk factor for PPF. The main purpose of this study was to compare between the rates of anterior femoral notching (AFN) and supracondylar periprosthetic femoral fracture (sPPF) of manual TKA and robotic arm-assisted TKA (RATKA). Meanwhile, blood loss, transfusion rates, inflammatory responses, complications, early clinical and radiological outcomes were also assessed. METHODS This retrospective study included 330 patients (133 RATKA and 197 manual TKA). Differences in risks of inflammatory, blood loss, complications (periprosthetic fracture and periprosthetic joint infection), pre-operative and post-operative distal lateral femoral angle (LDFA), distal femoral width (DFW), prosthesis-distal femoral width (PDFW) ratio, AFN, femoral component flexion angle (FCFA), peri-operative and post-operative functional outcomes between the RATKA and manual TKA groups were compared. RESULTS The operation time and postoperative CRP level in the RATKA group was significantly longer and higher than that in the manual TKA group (p < .001). However, there was no significant difference in postoperative WBC level (p = .217), hemoglobin loss (p = .362), postoperative drainage (p = .836), and periprosthetic fracture (p = 1.000). There was no significant difference in LDFA (p > .05), DFW(p = .834), PDFW ratio (p = .089) and FCFA (p = .315) between the two groups, but the rate of AFN in the RATKA group was significantly lower than that in the manual TKA group (p < .05). There was no significant difference in ROM between the two groups on POD3, POD 90 and 1 year (p < .05), but the FJS-12 score in the RATKA group was higher than that in the manual TKA group on 1 year (p = .001). CONCLUSION Robotic-assisted total knee arthroplasty can decrease the incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty.
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Affiliation(s)
- MingYang Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - YongTao Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - ZhenShuai Shao
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - HaoXiang Zhu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Sappey-Marinier E, Bini S. Unrestricted kinematic alignment corrects fixed flexion contracture in robotically aligned total knees without raising the joint line in extension. J Exp Orthop 2023; 10:114. [PMID: 37950808 PMCID: PMC10640542 DOI: 10.1186/s40634-023-00670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/09/2023] [Indexed: 11/13/2023] Open
Abstract
PURPOSE Mechanically Aligned Total Knee Arthroplasty (MA TKA) typically addresses fixed flexion contractures (FFC) by raising the joint line during extension. However, in unrestricted Kinematically Aligned TKA (KA TKA) utilizing a caliper-based resection technique, the joint line is not raised. This study aims to determine the efficacy of KA TKA in restoring full extension in patients with FFC without increasing distal femoral resection, considering tibial bone resection and sagittal component positioning. METHODS A retrospective study was conducted by a single surgeon, involving patients who underwent primary robotically assisted cruciate retaining unrestricted KA TKA between June 1, 2021, and December 1, 2022. Complete intraoperative resection and alignment data were recorded, including the thickness of distal femoral and proximal tibial bone cuts. Patients with a preoperative FFC ≥ 5° (study group) were compared to those with FFC < 5° (control group). The impact of variations in tibial resection and sagittal component positioning was assessed by comparing the heights of medial and lateral resections, sagittal femoral component flexion, and tibial slope. Group comparisons were analyzed using the Wilcoxon Signed Rank Test, with a significance level set at p < 0.05. RESULTS A total of 48 KA TKA procedures met the inclusion criteria, with 24 performed on women. The mean preoperative FFC in the study group was 11.2° (range: 5-25°), while the control group exhibited 1° (range: 0-4°) (p < 0.001). There were no statistically significant differences observed between the study and control groups in terms of distal femoral resections, both medially (p = 0.14) and laterally (p = 0.23), as well as tibial resection heights, both medially (p = 0.66) and laterally (p = 0.74). The alignment of the femoral component flexion and tibial slope was comparable between the two groups (p = 0.31 and p = 0.54, respectively). All patients achieved within 5 degrees of full extension at closure. CONCLUSION Robotic arm-assisted unrestricted KA TKA effectively restores full extension without raising the joint line during extension for patients with a preoperative fixed flexion contracture. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, 69008, France.
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
| | - Stefano Bini
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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Lee JH, Jung HJ, Lee JK, Hwang JH, Kim JI. Large Osteophytes over 10 mm at Posterior Medial Femoral Condyle Can Lead to Asymmetric Extension Gap Following Bony Resection in Robotic Arm-Assisted Total Knee Arthroplasty with Pre-Resection Gap Balancing. J Clin Med 2023; 12:5980. [PMID: 37762920 PMCID: PMC10531677 DOI: 10.3390/jcm12185980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Robotic arm-assisted total knee arthroplasty (TKA) involves a pre-resection gap balancing technique to obtain the desired gap. However, the expected gap may change owing to the soft-tissue release effect of unreachable osteophytes. This study evaluated the effect of unreachable osteophytes of the posterior medial femoral condyle on gap changes following bony resection. We retrospectively analysed 129 robotic arm-assisted TKAs performed for varus knee osteoarthritis. Knees were classified according to the size of osteophytes on the posterior medial femoral condyle using preoperative computed tomography measurement. After the removal of reachable osteophytes, the robotic system measured pre- and post-resection medial extension (ME), lateral extension (LE), medial flexion (MF), and lateral flexion (LF) gaps. No extension gap changes were observed for 25 (19.4%), and no flexion gap changes were observed 41 (31.8%) knees, following bone cuts. ME, LE, MF, and LF gaps increased with the osteophyte size (p < 0.05). For osteophytes <10 mm, all the gaps increased symmetrically. However, for osteophytes >10 mm, the ME gap increased asymmetrically more than LE, MF, and LF gaps (p < 0.05). The gap changes due to bony resection were correlated to the osteophyte sizes of the posterior medial femoral condyle. Surgeons should plan a slightly tight medial extension gap to attain the desired gaps for >10 mm osteophytes.
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Affiliation(s)
- Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.H.L.); (J.H.H.)
| | - Ho Jung Jung
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea;
| | - Ji Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.H.L.); (J.H.H.)
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea; (J.H.L.); (J.H.H.)
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Glowalla C, Langer S, Lenze U, Lazic I, Hirschmann MT, Hinterwimmer F, von Eisenhart-Rothe R, Pohlig F. Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system. Knee Surg Sports Traumatol Arthrosc 2023; 31:3912-3918. [PMID: 36964782 PMCID: PMC10435414 DOI: 10.1007/s00167-023-07386-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Robotic arm-assisted total knee arthroplasty (raTKA), currently a major trend in knee arthroplasty, aims to improve the accuracy of implant positioning and limb alignment. However, it is unclear whether and to what extent manual radiographic and navigation measurements with the MAKO™ system correlate. Nonetheless, a high agreement would be crucial to reliably achieve the desired limb alignment. METHODS Thirty-six consecutive patients with osteoarthritis and a slight-to-moderate varus deformity undergoing raTKA were prospectively included in this study. Prior to surgery and at follow-up, a full leg radiograph (FLR) under weight-bearing conditions was performed. In addition, a computed tomography (CT) scan was conducted for preoperative planning. The hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were measured in the preoperative and follow-up FLR as well as in the CT scout (without weight-bearing) by three independent raters. Furthermore, the HKA was intraoperatively assessed with the MAKO™ system before and after raTKA. RESULTS Significantly higher HKA values were identified for intraoperative deformity assessment using the MAKO system compared to the preoperative FLR and CT scouts (p = 0.006; p = 0.05). Intraoperative assessment of the HKA with final implants showed a mean residual varus deformity of 3.2° ± 1.9°, whereas a significantly lower residual varus deformity of 1.4° ± 1.9° was identified in the postoperative FLR (p < 0.001). The mMPTA was significantly higher in the preoperative FLR than in the CT scouts (p < 0.001). Intraoperatively, the mMPTA was adjusted to a mean of 87.5° ± 0.9° with final implants, while significantly higher values were measured in postoperative FLRs (p < 0.001). Concerning the mLDFA, no significant differences could be identified. CONCLUSION The clinical importance of this study lies in the finding that there is a difference between residual varus deformity measured intraoperatively with the MAKO™ system and those measured in postoperative FLRs. This has implications for preoperative planning as well as intraoperative fine-tuning of the implant position during raTKA to avoid overcorrection of knees with slight-to-moderate varus osteoarthritis. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Claudio Glowalla
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Severin Langer
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Igor Lazic
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), 4101, Bruderholz, Switzerland
| | - Florian Hinterwimmer
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany.
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Loomans L, Leirs G, Vandenneucker H. Operating room efficiency after the implementation of MAKO robotic-assisted total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:5501-5506. [PMID: 36943503 DOI: 10.1007/s00402-023-04834-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION The aim of this study was to examine if robotic-assisted total knee arthroplasty (RATKA) is cost- and time-effective in terms of implant stock and perioperative parameters, as optimizing perioperative efficiency may contribute to value-based care. MATERIALS AND METHODS Four hundred thirty-two consecutive patients who received primary total knee arthroplasties (TKAs) from May 2017 to March 2020 in a regional hospital were included in this study. Operating room time (OR time), surgical time, number of trays, insert thickness, and length of stay (LOS) were assessed and compared for a cohort group with navigation-assisted procedures to a group with robotic-assisted procedures (MAKO, Stryker, USA). Prediction of implant size was assessed for the robotic-assisted group. The Mann-Whitney U test was used for comparisons between groups when the normality assumption was not met. Categorical variables were assessed using the Fisher's exact test. p < 0.05 was considered statistically significant. RESULTS In the RATKA group, we noticed a significant mean reduction of 11 min in total OR time (p < 0.001), the use of thinner insert (p < 0.001), and a shorter mean length of stay of 1 day (p < 0.001). Compared to the navigation group, surgical time was not significantly longer, nor clinically relevant (0.238). In 76.9% of the robotic-assisted cases, the estimated implant size was equal to the final size and in all other cases, the preoperative implant size was oversized. CONCLUSION The introduction of the MAKO robotic-assisted total knee arthroplasty resulted in a gain in operating room time, a thinner and more predictable insert thickness, a shorter length of stay in hospital, and less instrumentation compared to navigation-assisted procedures. Level of evidence Level III, Retrospective cohort study.
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Affiliation(s)
- Laura Loomans
- Orthopaedic Surgery, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Geert Leirs
- Orthopaedic Surgeon, Noorderhart, 3900, Pelt, Belgium
| | - Hilde Vandenneucker
- Orthopaedic Surgeon, Department of Orthopaedics, University Hospital Leuven, Department of Development and Regeneration, Institute for Orthopaedic Research and Training (IORT), KU Leuven, 3000, Leuven, Belgium
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Boddu SP, Moore ML, Rodgers BM, Brinkman JC, Verhey JT, Bingham JS. A Bibliometric Analysis of the Top 100 Most Influential Studies on Robotic Arthroplasty. Arthroplast Today 2023; 22:101153. [PMID: 37342364 PMCID: PMC10277458 DOI: 10.1016/j.artd.2023.101153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 06/22/2023] Open
Abstract
Background The use of robotics in arthroplasty surgery has increased substantially in recent years. The purpose of this study was to objectively identify the 100 most influential studies in the robotic arthroplasty literature and to conduct a bibliometric analysis of these studies to describe their key characteristics. Methods The Clarivate Analytics Web of Knowledge database was used to gather data and metrics for robotic arthroplasty research using Boolean queries. The search list was sorted in descending order by the number of citations, and articles were included or excluded based on clinical relevance to robotic arthroplasty. Results The top 100 studies were cited a total of 5770 times from 1997 to 2021, with rapid growth in both citation generation and the number of articles published occurring in the past 5 years. The top 100 robotic arthroplasty articles originated from 12 countries, with the United States being responsible for almost half of the top 100. The most common study types were comparative studies (36) followed by case series (20), and the most common levels of evidence were III (23) and IV (33). Conclusions Research on robotic arthroplasty is rapidly growing and originates from a wide variety of countries, academic institutions, and with significant industry influence. This article serves as a reference to direct orthopaedic practitioners to the 100 most influential studies in robotic arthroplasty. We hope that these 100 studies and the analysis we provide aid healthcare professionals in efficiently assessing consensus, trends, and needs within the field.
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Affiliation(s)
- Sayi P. Boddu
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | | | - Jens T. Verhey
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
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Danoff JR, Heimroth J, Willinger M, Trout S, Sodhi N. Surgical Technique: Robotic-Assisted 1.5-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infection. Arthroplast Today 2023; 21:101126. [PMID: 37234598 PMCID: PMC10205596 DOI: 10.1016/j.artd.2023.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023] Open
Abstract
A 1.5-stage exchange total knee arthroplasty for periprosthetic joint infection has been described; however, achieving a balanced and well-aligned construct can sometimes be difficult given the bony defects often encountered in these cases. The use of robotic navigation technologies allows for accurate and precise implant placement. This technique report details the utilization of robotic navigation in a 1.5-stage exchange total knee arthroplasty for periprosthetic joint infection and describes the outcome of 6 patients. This technique guide highlights how robotic technology can account for many commonly encountered bone voids, joint line identification, and component orientation, while achieving a balanced and well-aligned knee.
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Affiliation(s)
- Jonathan R. Danoff
- Corresponding author: Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, 611 Northern Blvd, Suite 200 Great Neck, NY 11021, USA. Tel.: +1 516 325 7013.
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Tzanetis P, Fluit R, de Souza K, Robertson S, Koopman B, Verdonschot N. Pre-Planning the Surgical Target for Optimal Implant Positioning in Robotic-Assisted Total Knee Arthroplasty. Bioengineering (Basel) 2023; 10:543. [PMID: 37237613 PMCID: PMC10215074 DOI: 10.3390/bioengineering10050543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Robotic-assisted total knee arthroplasty can attain highly accurate implantation. However, the target for optimal positioning of the components remains debatable. One of the proposed targets is to recreate the functional status of the pre-diseased knee. The aim of this study was to demonstrate the feasibility of reproducing the pre-diseased kinematics and strains of the ligaments and, subsequently, use that information to optimize the position of the femoral and tibial components. For this purpose, we segmented the pre-operative computed tomography of one patient with knee osteoarthritis using an image-based statistical shape model and built a patient-specific musculoskeletal model of the pre-diseased knee. This model was initially implanted with a cruciate-retaining total knee system according to mechanical alignment principles; and an optimization algorithm was then configured seeking the optimal position of the components that minimized the root-mean-square deviation between the pre-diseased and post-operative kinematics and/or ligament strains. With concurrent optimization for kinematics and ligament strains, we managed to reduce the deviations from 2.4 ± 1.4 mm (translations) and 2.7 ± 0.7° (rotations) with mechanical alignment to 1.1 ± 0.5 mm and 1.1 ± 0.6°, and the strains from 6.5% to lower than 3.2% over all the ligaments. These findings confirm that adjusting the implant position from the initial plan allows for a closer match with the pre-diseased biomechanical situation, which can be utilized to optimize the pre-planning of robotic-assisted surgery.
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Affiliation(s)
- Periklis Tzanetis
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
| | - René Fluit
- Faculty of Science and Engineering, University of Groningen, 9747 AG Groningen, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | | | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Wang J, Hall TAG, Musbahi O, Jones GG, van Arkel RJ. Predicting hip-knee-ankle and femorotibial angles from knee radiographs with deep learning. Knee 2023; 42:281-288. [PMID: 37119601 DOI: 10.1016/j.knee.2023.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 03/09/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Knee alignment affects the development and surgical treatment of knee osteoarthritis. Automating femorotibial angle (FTA) and hip-knee-ankle angle (HKA) measurement from radiographs could improve reliability and save time. Further, if HKA could be predicted from knee-only radiographs then radiation exposure could be reduced and the need for specialist equipment and personnel avoided. The aim of this research was to assess if deep learning methods could predict FTA and HKA angle from posteroanterior (PA) knee radiographs. METHODS Convolutional neural networks with densely connected final layers were trained to analyse PA knee radiographs from the Osteoarthritis Initiative (OAI) database. The FTA dataset with 6149 radiographs and HKA dataset with 2351 radiographs were split into training, validation, and test datasets in a 70:15:15 ratio. Separate models were developed for the prediction of FTA and HKA and their accuracy was quantified using mean squared error as loss function. Heat maps were used to identify the anatomical features within each image that most contributed to the predicted angles. RESULTS High accuracy was achieved for both FTA (mean absolute error 0.8°) and HKA (mean absolute error 1.7°). Heat maps for both models were concentrated on the knee anatomy and could prove a valuable tool for assessing prediction reliability in clinical application. CONCLUSION Deep learning techniques enable fast, reliable and accurate predictions of both FTA and HKA from plain knee radiographs and could lead to cost savings for healthcare providers and reduced radiation exposure for patients.
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Affiliation(s)
- Jinhong Wang
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Thomas A G Hall
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Omar Musbahi
- Department of Surgery and Cancer, Imperial College London, White City Campus, London W12 0BZ, United Kingdom
| | - Gareth G Jones
- Department of Surgery and Cancer, Imperial College London, White City Campus, London W12 0BZ, United Kingdom
| | - Richard J van Arkel
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom.
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Nedopil AJ, Hernandez AM, Boone JM, Howell SM, Hull ML. Correcting for distal femoral asymmetry is necessary to determine postoperative alignment deviations from planned alignment of the femoral component. Knee 2023; 42:193-199. [PMID: 37054496 DOI: 10.1016/j.knee.2023.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/07/2022] [Accepted: 01/26/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND One method for assessing the accuracy of manual, patient-specific, navigational, and robotic-assisted total knee arthroplasty (TKA) instrumentation is to use a post-operative computer tomogram and determine the deviation of the femoral component alignment relative to the planned alignment in the native (i.e. healthy) contralateral distal femoral epiphysis. However, side-to-side asymmetry might introduce errors which inflate alignment deviations. This study quantified asymmetry in the distal femoral epiphysis. METHODS High resolution CT images (0.5 mm slice thickness) were acquired from bilateral lower limb specimens of 13 skeletally mature subjects with no skeletal abnormalities. Images were segmented to generate 3D femur models. Asymmetry was quantified by differences in positions and orientations required to shape-match the distal epiphysis of the mirror 3D femur model to the distal epiphysis of the contralateral 3D femur model. RESULTS Asymmetry was due to random rather than systematic differences. Random differences (i.e. standard deviations) in proximal-distal (P-D) and anterior-posterior (A-P) positions were 1.1 mm and in varus-valgus (V-V) and internal-external (I-E) orientations were 0.9° and 1.3°, respectively. These represented substantial relative errors of up to 50 % in previously reported overall alignment deviations. CONCLUSIONS Although small in an absolute sense, asymmetry of the distal femur epiphysis introduced substantial relative errors when assessing accuracy of femoral component alignment in TKA. When post-operative computer tomograms are used to assess the accuracy of manual, patient specific, navigational, and robotic-assisted TKA instrumentation, the overall deviation should be corrected for asymmetry to better indicate the accuracy of the surgical technique.
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Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97074 Würzburg, Germany.
| | - Andrew M Hernandez
- Department of Radiology, University of California at Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - John M Boone
- Department of Radiology, University of California at Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California at Davis, 451 E. Health Sciences Drive, Room 2303, Davis, CA 95616, United States.
| | - Maury L Hull
- Department of Biomedical Engineering, University of California at Davis, 451 E. Health Sciences Drive, Room 2303, Davis, CA 95616, United States; Department of Mechanical Engineering, University of California at Davis, One Shields Avenue, Davis, CA 95616 USA; Department of Orthopaedic Surgery, University of California at Davis Medical Center, Sacramento, CA 95817 USA.
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Fabrizio M, Edoardo B, Niccolò G, Roberto C, Bernardo I. How reproducible are clinical measurements in robotic knee surgery? J Exp Orthop 2023; 10:32. [PMID: 36961581 PMCID: PMC10039133 DOI: 10.1186/s40634-023-00582-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/30/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Robotic-assisted surgery has been recently introduced to improve biomechanical restoration, and thus better clinical and functional outcomes, after knee joint arthroplasty operations. Robotic-assisted uni-compartmental knee arthroplasty (UKA) aims indeed to improve surgical bone resection and alignment accuracy, optimized component positioning and knee balancing, relying on a series of calibration measurements performed during the surgery. These advantages focus therefore on improving the reproducibility of UKA surgeries, reducing (if not eliminating) eventual differences among high- and low-volume surgeons. The purpose of this study is to investigate and quantify the reproducibility of in-vivo measurements performed with a robotic system: the intra- and inter-observer variability of a series of measurements was therefore analyzed and compared among differently experienced operators. METHODS Five patients were analyzed and underwent robotic-assisted UKA using a semi-active robotic system. Three different observers with different experience levels were involved to independently perform the measurements of two parameters of the preoperative knee (Hip-Knee-Ankle angle [HKAa], Internal-External Rotation) at different degrees of knee flexion. Inter-observer and intra-observer comparisons were performed. RESULTS The average variability in the measurements obtained from the intra-observer and inter-observer comparisons were always < 0.68° for HKAa and < 2.59° for internal-external rotation, and the ICCs showed excellent agreement (> 0.75) for most cases and good agreement (> 0.60) in the remaining ones. CONCLUSION This study demonstrated high reproducibility of the measurements obtainable in clinical environment with the robotic system. The inter-observer results furthermore showed that the level of confidence with the robotic system is not significantly influencing the measurement.
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Affiliation(s)
- Matassi Fabrizio
- Orthopedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Bori Edoardo
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Giabbani Niccolò
- Orthopedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Civinini Roberto
- Orthopedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Innocenti Bernardo
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
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Functional alignment with robotic‑arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1072-1080. [PMID: 36378291 DOI: 10.1007/s00167-022-07227-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion-extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA). METHODS A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups. RESULTS Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P < 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively). CONCLUSIONS Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments. LEVEL OF EVIDENCE III.
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Is the femoral intramedullary alignment already actual in total knee arthroplasty? J Exp Orthop 2023; 10:16. [PMID: 36786874 PMCID: PMC9929006 DOI: 10.1186/s40634-022-00563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient-specific instrumentation (PSI) and robotic and computer-assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion.
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Shatrov J, Coulin B, Batailler C, Servien E, Walter B, Lustig S. Alignment philosophy influences trochlea recreation in total knee arthroplasty: a comparative study using image-based robotic technology. INTERNATIONAL ORTHOPAEDICS 2023; 47:329-341. [PMID: 36112197 PMCID: PMC9877070 DOI: 10.1007/s00264-022-05570-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/28/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove. METHODS One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial-lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°-40°) and deep flexion (70°-80°). RESULTS Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion. CONCLUSION Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.
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Affiliation(s)
- Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
- Sydney Orthopaedic Research Institute at Landmark Orthopaedics, St. Leonards, Sydney, Australia
| | - Benoit Coulin
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Bill Walter
- University of Sydney, St Leonards, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Sebastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
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Tuecking LR, Savov P, Ettinger M, Windhagen H. [Kinematic Alignment of Total Knee Arthroplasty]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:93-107. [PMID: 36796373 DOI: 10.1055/a-1689-5118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Nowadays, kinematic alignment is a widely used alignment philosophy in total knee arthroplasty. The concept of kinematic alignment respects the patient's individual prearthrotic anatomy and is based on the reconstruction of the femoral anatomy and thus the axes of motion of the knee joint. Only then the alignment of the tibial component is adapted to the femoral component. By means of this technique soft tissue balancing is reduced to a minimum. Due to the risk of excessive outlier alignment technical assistance or calipered techniques are recommended for precise implementation. This article attempts to provide an understanding of the fundamentals of kinematic alignment, and it focusses on how it differs from alternative alignment strategies and the way the philosophy is implemented in different surgical techniques.
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Shatrov J, Foissey C, Batailler C, Gunst S, Servien E, Lustig S. How long does image based robotic total knee arthroplasty take during the learning phase? Analysis of the key steps from the first fifty cases. INTERNATIONAL ORTHOPAEDICS 2023; 47:437-446. [PMID: 36355082 DOI: 10.1007/s00264-022-05618-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Robotically assisted total knee arthroplasty (RA-TKA) is an emerging surgical tool. The purpose of this study was to analyze the length of time taken to perform the key steps of a RA-TKA for a surgeon and centre new to the MAKO robotic system. METHOD This was a prospective cohort study of the first 50 patients undergoing TKA using a robotic platform (Mako, Stryker, Kalamazoo, MI, USA) performed by a single surgeon. Each key surgical step was recorded. The first 50 patients were chronologically allocated into five groups of ten and compared. RESULTS Mean operation length was 59.4 ± 7.4 min with significant improvement after 30 cases. A significant effect on certain steps of the surgery also occurred over 50 cases: after 30 cases for pre-operative planning (3.8 min in group 1 versus 1.2 min in group 4, p < 0.005), ten cases for registration time (5.2 min in group 1 versus 3.8 in group 2, p = 0.039) and ten cases for tibial cutting time (1.6 min in group 1 versus 1.3 in group 2, p < 0.005). Nurse setup, femur cutting, and intraoperative planning did not demonstrate a significant improvement in time over 50 cases. CONCLUSION A significant decrease in total operating length occurred after the 30th case. Anatomical registration and tibial cutting time demonstrated the largest improvements. MAKO image-based robotically assisted TKA is not a time-intensive intervention for both the surgeon and scrub nursing staff, and significant improvements in total surgical time occurs early in the learning phase.
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Affiliation(s)
- Jobe Shatrov
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France. .,Sydney Orthopaedic Research Institute (SORI) at Landmark Orthopaedics- St. Leonards, Sydney, Australia.
| | - Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Stanislas Gunst
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.,Interuniversity Laboratory of Human Movement Science, Université Lyon 1, 7424, Lyon, EA, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, FIFA Medical Centre of Excellence, Hôpital de La Croix Rousse - Lyon University, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.,UMR_T9406, Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, 69622, Lyon, LBMC, France
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