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Girod MM, Mulford KL, Kaji ES, Grove AF, Saniei S, Ulrich MN, Taunton MJ, Hannon CP, Trousdale RT, Perry KI, Wyles CC. Influence of Robotic versus Manual Technology for Achieving Sagittal Targets in Total Knee Arthroplasty Using a Cruciate Retaining and Medial Stabilized Implant. J Arthroplasty 2025:S0883-5403(25)00570-4. [PMID: 40398583 DOI: 10.1016/j.arth.2025.05.052] [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: 12/04/2024] [Revised: 05/12/2025] [Accepted: 05/13/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Most of the focus regarding total knee arthroplasty (TKA) implant positioning and alignment has been centered on the coronal plane. Posterior condylar offset (PCO) and tibial slope (TS) are sagittal parameters that are measured on radiographs, managed intraoperatively, and are crucial to a stable TKA. We sought to compare whether robotic-assisted TKA (raTKA) versus manual TKA (mTKA) are different with regard to achieving a surgeon's preoperative sagittal targets. METHODS We trained a deep learning model based on a U-Net architecture that calculates PCO and TS on lateral knee radiographs. We deployed this model on a consecutive cohort of 280 patients who underwent either mTKA (n = 132) or raTKA (n = 148), with the same medial stabilized knee implant at a tertiary referral center. Measured resection was the technique for mTKA, and either calipered kinematic alignment or gap balancing for raTKA. RESULTS Mean absolute error between the algorithm and human measurements was 1.3 ± 1.6° for TS and 1.7 ± 1.4 mm for PCO, which was less than the difference between the human annotators (2.0 ± 1.9° and 2.2 ± 2.6 mm, respectively). Mean difference between goal and postoperative TS was less in raTKA than mTKA (0.3 versus 1.3°; P = 0.03). However, the opposite was observed regarding restoration of native PCO, favoring mTKA (-1.7 versus 3.3 mm; P < 0.001). Overall, despite increased diversity in alignment philosophies and proportion of cementless fixation, there was less variability in raTKA postoperative data, suggesting increased precision. CONCLUSION We developed a deep learning algorithm to calculate PCO and TS on lateral knee radiographs. We observed significant differences between raTKA and mTKA in achieving sagittal plane targets, with raTKA being more precise than mTKA. Future studies are warranted to determine whether these differences are clinically relevant.
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Affiliation(s)
- Miguel M Girod
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellen L Mulford
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth S Kaji
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Austin F Grove
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sami Saniei
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Marisa N Ulrich
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J Taunton
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charles P Hannon
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert T Trousdale
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kevin I Perry
- Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cody C Wyles
- Orthopedic Surgery Artificial Intelligence Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Pascal A, Guignard A, Tostain O, Cottebrune T, Migaud H, Pasquier G, Dartus J, Putman S. Comparative study of a single design of total knee arthroplasty inserted with or without a robotic system based on control of ligament balance: Accuracy and functional outcome at 1 year. Orthop Traumatol Surg Res 2025:104292. [PMID: 40348182 DOI: 10.1016/j.otsr.2025.104292] [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: 10/26/2024] [Revised: 02/25/2025] [Accepted: 04/17/2025] [Indexed: 05/14/2025]
Abstract
INTRODUCTION Robotic systems are helping to improve surgical precision with the aim of improving the functional outcome of total knee arthroplasty (TKAs). The OMNIBotics system is a semi-autonomous robotic system combining a dynamic ligament tensor and a robotic cutting guide for personalized ligament balancing. To our knowledge, there is no single-operator comparative series evaluating the contribution of this system. A retrospective comparative study was therefore carried out to compare, for the same prosthesis and operator: (1) the precision of the OMNIBotics system versus conventional ancillary equipment, (2) the functional results at 1 year postoperative for each groups. HYPOTHESIS The OMNIBotics system would be more accurate than the mechanical ancillary for performing planned alignments by reducing the number of outliers and would allow a significant improvement in functional scores at 1 year postoperative. MATERIAL AND METHODS A total of 106 patients were retrospectively included between October 2017 and December 2021; 53 patients (34 women, 19 men) underwent TKA using the OMNIBotics system (OMNI group) and 53 patients (41 women, 12 men) underwent TKA using conventional mechanical ancillary (Non OMNI group). The two groups were comparable (gender, Body Mass Index (BMI), American Society of Anesthesiologist (ASA) score, deformity, preoperative Oxford score) except for age. All patients underwent a full length X-ray of the lower limbs at 3 months post-operatively to calculate the postoperative Hip Knee Ankle (HKA) angle. This was compared with the planned HKA angle, which was different for the two groups (defined by the software for the OMNI group, equal to 180 ° for the Non OMNI group). All patients responded to an Oxford score preoperatively and then to an Oxford score and Forgotten Joint Score (FJS) at 1 year postoperative. RESULTS The number of patients with a difference ≤1 ° between measured and planned HKA angle was significantly higher (p = 0.032) in the OMNI group (60%, n = 32) than in the non-OMNI group (40%, n = 21). The OMNI group also had significantly fewer outliers (measured HKA angle >3° of the planned HKA angle) than the non-OMNI group (94%, n = 50 versus 81%, n = 43, p = 0.038). Postoperative Oxford and Forgotten Knee scores were significantly better in the OMNI group with a mean value of 38.4 ± 6.7 [range, 24-48] and 70.7 ± 22.5 [range 9-100] for Oxford and FJS scores in the OMNI group versus 33.5 ± 10.1 [range 8-45] and 56.9 ± 22.7 [range 8-100] for the Non OMNI group (p = 0.004 and 0.002 respectively). CONCLUSION The OMNIBotics is a non-imaging robotic assistance system which, after analysis of the ligament balance, enables accurate reproduction of the planning carried out, improving the patient's functional result at one year compared to a conventional ancillary system. LEVEL OF EVIDENCE III; Retrospective comparative study.
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Affiliation(s)
- Adrien Pascal
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France.
| | - Arthur Guignard
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
| | - Olivier Tostain
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
| | - Thibault Cottebrune
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
| | - Henri Migaud
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
| | - Gilles Pasquier
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
| | - Julien Dartus
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
| | - Sophie Putman
- Université Lille-Hauts de France, 59000 Lille, France; Department of Orthopaedic and Traumatology, Lille University Hospital, 2 avenue Émile Laine, 59000 Lille, France
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Mert Ü, Khasawneh MY, Ghandour M, Al Zuabi A, Horst K, Hildebrand F, Bouillon B, Mahmoud MA, Kabir K. Comparative Efficacy and Precision of Robot-Assisted vs. Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2025; 14:3249. [PMID: 40364281 PMCID: PMC12072899 DOI: 10.3390/jcm14093249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 04/24/2025] [Accepted: 05/03/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though RA-TKA had a higher risk of conversion to open surgery (10% vs. 2%). Meta-regression identified robotic system and surgeon experience as key predictors of outcome variability. Conclusions: RA-TKA offers advantages in implant alignment and postoperative pain reduction. However, benefits are inconsistent across settings, and some robotic systems may not provide improvements over C-TKA.
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Affiliation(s)
- Ümit Mert
- Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten/Herdecke, 42283 Wuppertal, Germany; (M.Y.K.); (M.G.); (K.K.)
| | - Moh’d Yazan Khasawneh
- Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten/Herdecke, 42283 Wuppertal, Germany; (M.Y.K.); (M.G.); (K.K.)
| | - Maher Ghandour
- Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten/Herdecke, 42283 Wuppertal, Germany; (M.Y.K.); (M.G.); (K.K.)
| | - Ahmad Al Zuabi
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52056 Aachen, Germany; (A.A.Z.); (K.H.); (F.H.); (M.A.M.)
| | - Klemens Horst
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52056 Aachen, Germany; (A.A.Z.); (K.H.); (F.H.); (M.A.M.)
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52056 Aachen, Germany; (A.A.Z.); (K.H.); (F.H.); (M.A.M.)
| | - Bertil Bouillon
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 51109 Cologne, Germany;
| | - Mohamad Agha Mahmoud
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52056 Aachen, Germany; (A.A.Z.); (K.H.); (F.H.); (M.A.M.)
| | - Koroush Kabir
- Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten/Herdecke, 42283 Wuppertal, Germany; (M.Y.K.); (M.G.); (K.K.)
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Ong MTY, LaCour MT, Yung PSH, Dessinger GM, Komistek RD. In Vivo Kinematics for Various Robotically Performed Total Knee Arthroplasty Implant Designs. J Orthop Res 2025. [PMID: 40325355 DOI: 10.1002/jor.26091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 03/28/2025] [Accepted: 04/13/2025] [Indexed: 05/07/2025]
Abstract
Although it is well-documented that robotic-assisted total knee arthroplasty (TKA) can improve surgical precision, evaluations of the postoperative kinematics of patients implanted using robotics remain less common. The objective of this study is to analyze the weight-bearing kinematics for multiple TKAs implanted using two different surgical robots. In vivo knee kinematics were assessed using fluoroscopy for 28 subjects implanted with a Bi-Cruciate Stabilized (BCS) TKA, 23 with a Bi-Cruciate Retaining (BCR) TKA, 13 with a posterior stabilized (PS) TKA, and 22 with a cruciate retaining (CR) TKA. All subjects were implanted by the same surgeon using the respective company's surgical robot. All subjects performed a weight-bearing deep knee bend. Parameters of interest include the femoral condylar anterior/posterior motion, femorotibial axial rotation, and weight-bearing range-of-motion. The BCS TKA experienced the most posterior rollback, 13.4 ± 4.4 mm for the lateral condyle and 5.8 ± 2.5 mm for the medial condyle. These subjects also experienced the most femorotibial axial rotation, +9.3 ± 5.3°. Conversely, CR subjects experienced the least overall rollback and most anterior sliding, 0.4 ± 3.8 mm of lateral rollback and 1.9 ± 4.1 mm of medial anterior sliding. Implant design appears to play a significant role in postoperative kinematics. Improved stability is evident in TKAs that account for the ACL. However, no system behaved significantly better nor worse than previously published literature evaluating standard instrumentation. Level of Evidence: Level 3, retrospective cohort study.
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Affiliation(s)
- Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Michael T LaCour
- Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Garett M Dessinger
- Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Richard D Komistek
- Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
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De Smet A, Truijen J, Vanlommel L. Is limb overcorrection following total knee arthroplasty compromising functional outcome? J Orthop 2025; 63:101-108. [PMID: 39564090 PMCID: PMC11570690 DOI: 10.1016/j.jor.2024.10.050] [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: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 11/21/2024] Open
Abstract
Purpose Many patients remain unsatisfied after total knee arthroplasty (TKA). Personalized alignment strategies have gained popularity in the search to improve patient satisfaction and function. This study aimed to examine the impact of limb overcorrection in the coronal plane on patient satisfaction and functional outcome. The secondary aim was to investigate how a change in knee phenotype following TKA affects clinical outcome. Methods A retrospective matched case-control study was designed between patients with limb overcorrection (N = 37) and a control group (N = 104). Mean follow-up was 68 months. Satisfaction and function were compared by means of the new 2011 Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological evaluation was performed on weight-bearing full-leg radiographs. Overcorrection was defined as a mechanical HKA (mHKA) angle of 2° or more and opposite to the preoperative alignment. The control group consisted of TKAs that were corrected to neutral or left in slight undercorrection. Finally, component alignment (lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA)) and Coronal Plane Alignment of the knee (CPAK) phenotypes were evaluated. Results The overcorrection group performed better than the control group in terms of KSS subscores satisfaction and functional activities, total KSS score, all KOOS subcategories, and total KOOS score. Subdivision of the control group into a neutral and undercorrection group, and the overcorrection group into mild and severe overcorrection, revealed similar findings.A chance in knee phenotype as per aHKA, JLO or CPAK did not result in worse clinical outcomes. Conclusion Accidental limb overcorrection after TKA does not result in inferior clinical outcomes or patient satisfaction at midterm follow-up.The present study could not identify an optimal coronal alignment target. This suggests that coronal alignment as a predictor of patient satisfaction and function is likely less important than previously believed. Level of evidence Level III, retrospective case-control study.
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Affiliation(s)
- Arne De Smet
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
- Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jan Truijen
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
- Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Luc Vanlommel
- Department of Orthopaedic Surgery and Traumatology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
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Bosco J, Wixted CM, Gangi CD, Waren D, Meftah M. Prediction of coronal alignment in robotic-assisted total knee arthroplasty with artificial intelligence. Knee 2025; 55:126-132. [PMID: 40286441 DOI: 10.1016/j.knee.2025.04.011] [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: 01/17/2025] [Revised: 04/06/2025] [Accepted: 04/09/2025] [Indexed: 04/29/2025]
Abstract
INTRODUCTION Robotic-assisted technologies provide the ability to avoid soft tissue release by utilizing more accurate bony cuts during total knee arthroplasty (TKA). However, the ideal limb alignment is not yet established. The aim of this study was to predict postoperative Coronal Plane Alignment of the Knee (CPAK) using corresponding native bony measurements. METHODS This study analyzed a retrospective cohort of 530 primary robotic-assisted TKAs. Machine learning was utilized to predict appropriate target lateral distal femoral angles (LDFA) and medial proximal tibial angles (MPTA). Normalization of LDFA and MPTA alignments was performed using the min-max scaler operation on the training set with feature range [-1, 1] and repeated separately for the input and target distributions. A neural network of hidden dimensions (16, 8, 4) was trained via supervised learning to predict planned LDFA and MPTA values from preoperative LDFA and MPTA measurements. RESULTS The model converged after 104 epochs and batch size 4 with mean squared error ±1.82°. The model's regression agrees with the hypothesized change in preoperative to planned coronal alignment: valgus measurements are translated to neutral/aligned targets while varus alignments are translated to varus alignment of lesser severity. Evaluative statistics demonstrate this method for planning knee morphologies is significantly more accurate than making predictions about the mean (RMSE 1.440; R-squared 0.444; Nash Sutcliffe 0.579). CONCLUSION This study's model provides accurate predictions for target knee alignment morphologies. Future work is warranted to evaluate this method's usefulness for planning robotic TKA.
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Affiliation(s)
- Joseph Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
| | - Colleen M Wixted
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States.
| | - Catherine Di Gangi
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
| | - Daniel Waren
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, United States
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Ziedas AC, Michaelson J, Knesek D, Laker M, Frush T, Markel DC. Cemented and Cementless Robotic-Assisted versus Manual Total Knee Arthroplasty Outcomes: A Single Center Michigan Arthroplasty Registry Collaborative Quality Initiative-Based Study. J Arthroplasty 2025:S0883-5403(25)00380-8. [PMID: 40280209 DOI: 10.1016/j.arth.2025.04.043] [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: 12/04/2024] [Revised: 04/14/2025] [Accepted: 04/15/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND The purpose of our study was to determine whether a difference existed between cemented and cementless robotic-assisted total knee arthroplasty (RA-TKA) and manual TKA with regard to revision rates and 90-day outcomes. We hypothesized these techniques would have similar results. METHODS A single center's data from the Michigan Arthroplasty Registry Collaborative Quality Initiative were queried for all primary TKAs from January 2012 to July 2023. The RA-TKA and manual cohorts were compared for revisions and 90-day complications, including emergency department (ED) visits, readmissions, and returns to the operating room Chi-square and Fisher's exact tests were used for categorical data, and t-tests for continuous data. Of the 7,417 cemented TKAs (mean age 67 ± 9.6 years, 70% women), 273 were RA-TKA and 7,144 were manual. Of the 2,407 cementless TKAs (mean age 65 ± 8.6 years, 53% women), 730 were RA-TKA and 1,677 were manual. RESULTS Cemented RA-TKA had more periprosthetic joint infection revisions, more 90-day ED visits, and readmissions for wound complications compared to cemented manual TKA. Cementless RA-TKA had more 90-day readmissions for wound complications, while manual TKA had more 90-day ED visits for postoperative pain. Cemented and cementless RA-TKA had longer surgical time, shorter length of stay, and shorter time to revision. There were 283 revisions performed on cemented manual TKA (nine RA-TKAs, 3.2%, 274 manual, 3.8%, (P = 0.87)). There were 56 revisions performed on cementless knees (13 RA-TKAs, 1.7%, 43 manual 2.5% (P = 0.303)). Cumulative percent revision at 5 years was 3.9% for cemented RA-TKA, 3.5% for cemented manual TKA, 1.8% for cementless RA-TKA, and 2.8% for cementless manual TKA. CONCLUSIONS Both RA-TKA and manual TKA have similar revision rates, while RA-TKA had more wound complications. Cementless RA-TKA may be beneficial in reducing postoperative pain.
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Affiliation(s)
- Alexander C Ziedas
- Henry Ford Providence Orthopaedic Residency Program, Southfield, Michigan
| | | | - David Knesek
- Henry Ford Providence Orthopaedic Residency Program, Southfield, Michigan
| | - Michael Laker
- Henry Ford Providence Orthopaedic Residency Program, Southfield, Michigan
| | - Todd Frush
- Henry Ford Providence Orthopaedic Residency Program, Southfield, Michigan
| | - David C Markel
- Henry Ford Providence Orthopaedic Residency Program, Southfield, Michigan
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García-Sanz F, Sosa-Reina MD, Jaén-Crespo G, González-de-la-Flor Á, Villafañe JH, Romero-Morales C. Redefining Knee Arthroplasty: Does Robotic Assistance Improve Outcomes Beyond Alignment? An Evidence-Based Umbrella Review. J Clin Med 2025; 14:2588. [PMID: 40283417 PMCID: PMC12028302 DOI: 10.3390/jcm14082588] [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: 03/10/2025] [Revised: 04/03/2025] [Accepted: 04/06/2025] [Indexed: 04/29/2025] Open
Abstract
Background: Robotic-assisted total knee arthroplasty (rTKA) has been introduced to improve surgical precision and alignment in knee replacement procedures. However, its impact on clinical outcomes, pain relief, and cost-effectiveness remains debated. This umbrella review synthesizes evidence from systematic reviews and meta-analyses comparing rTKA to conventional TKA. Methods: An umbrella review was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Database of Systematic Reviews. Systematic reviews and meta-analyses comparing rTKA with conventional TKA were included. Methodological quality was assessed using AMSTAR 2 and ROBIS tools. Primary outcomes included hospital stay, radiographic alignment, postoperative pain, functional outcomes, and patient satisfaction. Results: Ten systematic reviews were included. rTKA demonstrated superior alignment accuracy and a reduction in alignment outliers. Some studies reported shorter hospital stays and lower early postoperative pain scores for rTKA. However, these benefits did not consistently translate into improved long-term functional outcomes, patient satisfaction, or reduced revision rates. Cost-effectiveness analyses indicated that rTKA remains an expensive option, with benefits largely dependent on surgical volume and healthcare system resources. Conclusions: While rTKA improves surgical precision and may offer short-term advantages, its long-term superiority over conventional TKA remains unproven. Higher costs and longer operative times limit its widespread adoption. Further high-quality, long-term studies are needed to determine its clinical and economic value.
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Affiliation(s)
- Fernando García-Sanz
- Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (F.G.-S.); (M.D.S.-R.); (G.J.-C.); (Á.G.-d.-l.-F.); (J.H.V.)
- Clínica CEMTRO, 28035 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (F.G.-S.); (M.D.S.-R.); (G.J.-C.); (Á.G.-d.-l.-F.); (J.H.V.)
| | - Gonzalo Jaén-Crespo
- Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (F.G.-S.); (M.D.S.-R.); (G.J.-C.); (Á.G.-d.-l.-F.); (J.H.V.)
| | - Ángel González-de-la-Flor
- Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (F.G.-S.); (M.D.S.-R.); (G.J.-C.); (Á.G.-d.-l.-F.); (J.H.V.)
| | - Jorge Hugo Villafañe
- Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (F.G.-S.); (M.D.S.-R.); (G.J.-C.); (Á.G.-d.-l.-F.); (J.H.V.)
| | - Carlos Romero-Morales
- Faculty of Medicine, Health and Sports, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (F.G.-S.); (M.D.S.-R.); (G.J.-C.); (Á.G.-d.-l.-F.); (J.H.V.)
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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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10
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Hiraoka A, Swinnen B, Vandeputte A, Franssen W, Leirs G. Optimizing operating room efficiency in robotic-assisted total knee arthroplasty through manufacturing efficiency principles. J Exp Orthop 2025; 12:e70283. [PMID: 40421405 PMCID: PMC12104826 DOI: 10.1002/jeo2.70283] [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: 02/28/2025] [Accepted: 04/07/2025] [Indexed: 05/28/2025] Open
Abstract
Purpose Recent studies have explored the application of manufacturing efficiency principles as a framework for improving operating room (OR) throughput, quality of care and patient outcomes. However, these principles have not yet been validated with real-world research data. In this study, we investigated whether applying these principles has an impact on the operational excellence and teams' consistency of robotic-assisted total knee arthroplasty (RATKA) procedures. Methods A total of 31 patients, divided over eight surgery days, were included in the study. The aim of the study was to answer the research question: 'Does applying efficiency principles have an impact on the operational excellence of RATKA surgery?' The efficiency of the procedures was monitored using the artificial intelligence (AI)-enabled camera application and analyzed utilizing an AI-backed process digital twin platform. Normally distributed continuous variables were compared using the independent t test. Equality of variances was assumed using the Levene's test for equality of variances. Non-normally distributed continuous variables were analyzed using the Mann-Whitney U test. Results After analyzing the baseline group, four procedural modifications were implemented according to the lean principles. There was a significant difference in preparation time (mean difference = 4.3, 95% confidence interval = 1.3-7.3, p = 0.007), showing the efficiency gain during preparation after efficiency implementation. The number of sets opened per case was reduced from ten to seven sets. Conclusions Findings indicate that better OR preparation, consistent staff allocation and effective staff training can reduce surgical times, minimize waste and improve OR throughput. Addressing primary constraints, parallelizing flows and breaking down processes decreases surgical wait times, enhances patient flow and streamlines OR operations. Level of Evidence Level III.
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Affiliation(s)
- Akito Hiraoka
- Department of Orthopaedics and TraumatologyNoorderhart HospitalPeltBelgium
- Department of Orthopaedics and TraumatologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Bart Swinnen
- Department of Orthopaedics and TraumatologyNoorderhart HospitalPeltBelgium
| | | | | | - Geert Leirs
- Department of Orthopaedics and TraumatologyUniversity Hospitals LeuvenLeuvenBelgium
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11
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Pius AK, Sporer SM, Sterling O, De M, Jahan M, Browne JA, Springer BD, Huddleston JI. Navigated and Robotic Total Knee Arthroplasty Do Not Confer Improved 5-Year Survivorship Compared to Conventional Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry. J Arthroplasty 2025:S0883-5403(25)00259-1. [PMID: 40139479 DOI: 10.1016/j.arth.2025.03.047] [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: 03/14/2025] [Accepted: 03/17/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Computer-assisted navigation and/or the use of robotics at the time of the primary total knee arthroplasty (TKA) have been shown to improve implant position, minimize alignment outliers, and possibly improve patient outcomes compared to conventional instrumentation. The purpose of this study was to use the linked Medicare dataset from the American Joint Replacement Registry to compare the midterm (5-year) outcomes of navigated TKA and robotic TKA to those of conventional TKA. METHODS All primary TKA procedures submitted to the American Joint Replacement Registry between January 2017 and December 2022 among patients aged 65 years and older were included in the analysis. The data were stratified into patients who underwent navigated TKA, robotic TKA, or conventional TKA at the time of their index procedure. The all-cause revision rate, mechanical loosening rate, and the other mechanical complication rate were determined at five years postoperatively. The survival model was adjusted for age, sex, fixation type, and year. RESULTS At five years postoperatively, the survival model found computer navigation use to not be significant in TKA all-cause revision (P = 0.32) or mechanical loosening (P = 0.91), but was significant for other mechanical complications (P = 0.004). Robotic use was not found to be significant in TKA all-cause revision (P = 0.75), mechanical loosening (P = 0.42), or other mechanical complications (P = 0.46). CONCLUSIONS Navigation and/or the use of robotics at the time of primary TKA did not demonstrate a decrease in the need for revision at five years follow-up among Medicare beneficiaries. Although this study was unable to assess other important clinical outcomes following TKA with advanced technology, the purported benefits of using this technology to improve component survival are not supported.
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Affiliation(s)
- Alexa K Pius
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
| | | | - Oliva Sterling
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Mita De
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Mahveen Jahan
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Bryan D Springer
- Department of Orthopaedic Surgery, Mayo Clinic Jacksonville, Jacksonville, Florida
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford University, Stanford, California
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12
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Stauss R, Savov P, Ettinger M. [New technologies in total knee arthroplasty : Current concepts and personalized treatment strategies]. ORTHOPADIE (HEIDELBERG, GERMANY) 2025; 54:190-198. [PMID: 39961906 DOI: 10.1007/s00132-025-04618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND In total knee arthroplasty (TKA), there is a trend towards personalized concepts. This includes the implementation of new technologies and the increasing popularity of individualized alignment strategies. TARGETS The purpose of personalized TKA is to restore the patient's bony anatomy and constitutional alignment, as well as the physiological soft tissue balance and joint kinematics. Modern technologies facilitate a thorough, three-dimensional analysis of the bony structures and the patient's constitutional alignment. Virtual planning enables a simulation component placement, gap balancing and postoperative alignment. After approval of the surgical plan, the technology-aided execution shows a greater accuracy, precision and reproducibility of implant alignment compared to conventional manual instrumentation. OVERVIEW This article focuses on novel technologies in total knee arthroplasty, including patient-specific instrumentation (PSI), custom implants, navigation and robotics. The purpose of this article is to summarize current evidence, including radiological and functional outcomes, as well as economic aspects. Furthermore, the implementation of novel technologies in the context of personalized alignment strategies will be discussed.
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Affiliation(s)
- Ricarda Stauss
- Universitätsklinik für Orthopädie im Pius Hospital, Carl von Ossietzky Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland.
| | - Peter Savov
- Universitätsklinik für Orthopädie im Pius Hospital, Carl von Ossietzky Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
| | - Max Ettinger
- Universitätsklinik für Orthopädie im Pius Hospital, Carl von Ossietzky Universität Oldenburg, Georgstraße 12, 26121, Oldenburg, Deutschland
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13
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Haikal ER, Katchis CS, Ang BK, Bass RD, Reinhardt KR, Germano JA, Danoff JR, Slover JD. Analysis of Femoral Flexion Angle Distribution and Range of Motion in Total Knee Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00166-4. [PMID: 40074599 DOI: 10.1016/j.arth.2025.02.038] [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: 12/10/2024] [Revised: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Optimal coronal and rotational alignment in total knee arthroplasty is essential for satisfactory outcomes. There has been limited focus on sagittal alignment in assessing outcomes. This study investigated the impact of femoral implant flexion (FF) angle on knee kinematics and postoperative outcomes. METHODS In this multicenter, prospective case series, we analyzed demographics, preoperative and postoperative range of motion (ROM), and implant alignment in patients undergoing total knee arthroplasty with a computed tomography-based robotic system. The study included 976 patients (age 66 years [range, 38 to 90]; body mass index 32.6 [range, 14.3 to 50.2]; 56.6% women). The ROM was assessed at four intervals: preoperative, early postoperative, middle postoperative, and late postoperative. Patients were divided into "high FF" and "low FF" groups based on mean FF. Comparisons were made using t-tests and Pearson's Chi-square tests. RESULTS The average FF was 4.05° ± 2.10 (range, 0 to 9). The low FF group (n = 528) had a mean FF of 2.45° ± 1.28. The high FF group (n = 448) had a mean of 5.93° ± 1.06. No differences were found in patient height, weight, or body mass index. No differences were noted in preoperative knee alignment or ROM between groups. The high FF patients were more frequently women (62.5 versus 53.0%; P = 0.006), had more cemented implants (20.4 versus 14.4%; P = 0.020), and had smaller implants (P < 0.001). At the latest follow-up, a nonclinically significant difference in extension ROM was noted (low FF 0°, high FF 0.1°; P = 0.050). No differences in flexion ROM were observed at any visit. CONCLUSIONS The FF angles showed a normal distribution, with higher angles associated with cemented implants, smaller implants, and women. No clinically meaningful differences in ROM were found between the high and the low FF groups across all visits.
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Affiliation(s)
- Emil R Haikal
- Department of Orthopaedic Surgery, Northwell Orthopaedic Institute, Lenox Hill Hospital, New York, New York
| | - Christopher S Katchis
- Department of Orthopaedic Surgery, Northwell Orthopaedic Institute, Lenox Hill Hospital, New York, New York
| | - Bryan K Ang
- Department of Orthopaedic Surgery, Northwell Orthopaedic Institute, Lenox Hill Hospital, New York, New York
| | - Robert D Bass
- Department of Orthopaedic Surgery, Northwell Orthopaedic Institute, Lenox Hill Hospital, New York, New York
| | - Keith R Reinhardt
- Department of Orthopaedic Surgery, South Shore University Hospital, Northwell Health, Bay Shore, New York
| | - James A Germano
- Department of Orthopaedic Surgery, Long Island Valley Stream Hospital Northwell Health, Valley Stream, New York
| | - Jonathan R Danoff
- Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, Manhasset, New York
| | - James D Slover
- Department of Orthopaedic Surgery, Northwell Orthopaedic Institute, Lenox Hill Hospital, New York, New York
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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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15
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Deckey DG, Stein MK, Atkins LM, Richards AE, Wu KA, Wyles CC, Seyler TM. Fitting the Knee to the Patient, Not the Other Way Around: A Three-Dimensional Analysis of Total Knee Arthroplasty Implant Fit. J Arthroplasty 2025:S0883-5403(25)00158-5. [PMID: 39956490 DOI: 10.1016/j.arth.2025.02.030] [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: 11/12/2024] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND Despite the growing interest in alternative alignment strategies, advancement in surgical technique, and implant design, several studies have demonstrated that a large number of patients continue to be dissatisfied following total knee arthroplasty (TKA). The purpose of this study was to outline differences in three-dimensional (3D) knee morphology associated with sex and deformity of the arthritic knee and compare these to available off-the-shelf (OTS) and patient-specific implants. METHODS A total of 85,604 preoperative computed tomography scans of patients undergoing TKA were analyzed. Distal femoral geometry was quantified via 11 measurements taken from 3D models and landmarks. These values were then compared to the geometries of 12 common TKA implants from the American Joint Replacement Registry. RESULTS The average overall alignment of the studied population was found to be 3.3° varus with the average hip-knee-ankle angle being smaller in men than women. Femoral distal offset was found to play an important role in driving both varus and valgus deformities. Nearly 40% of knees in the cohort had a distal condylar offset and 25.6% had a posterior condylar offset that would require beyond the traditionally acceptable 3° varus or valgus or require internal rotation when using the most common OTS implants on the market. The range of adequate coverage across the evaluated implant systems ranged from 20 to 63%. On average, less than half (41%) of the patient population fell within the bounds considered to be a proper fit for the 12 OTS implant systems evaluated. CONCLUSIONS To our knowledge, this study is the largest 3D analysis of osteoarthritic knees to date and identified crucial differences in knee morphology among patients undergoing TKA. These data demonstrate a consistent asymmetry of femoral geometry, despite most OTS femoral implants being symmetric. In addition, there was a larger posterior condylar offset and smaller distal condylar offset, questioning the utility of a single-radius femoral design in all patients.
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Affiliation(s)
- David G Deckey
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew K Stein
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Alexandra E Richards
- Anne Burnett Marion School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Kevin A Wu
- Duke University School of Medicine, Durham, North Carolina
| | - Cody C Wyles
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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16
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T RK, Bhat AKK, Biradar N, Patil AR, Mangsuli K, Patil A. Gap Balancing Technique With Functional Alignment in Total Knee Arthroplasty Using the Cuvis Joint Robotic System: Surgical Technique and Functional Outcome. Cureus 2025; 17:e78914. [PMID: 40091934 PMCID: PMC11908966 DOI: 10.7759/cureus.78914] [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] [Accepted: 02/12/2025] [Indexed: 03/19/2025] Open
Abstract
Introduction The application of robotic technologies in total knee arthroplasty (TKA) has widely grown in the past few years. The preoperative CT (computed tomography) scan planning of the knee along with the quantitative soft tissue information recorded and assessed by the robot can be utilized in achieving functional alignment and aid in gap balancing. Gap tension is an important factor influencing the clinical outcome after TKA. This paper describes our technique for gap balancing and functional alignment using a fully autonomous Cuvis joint robotic system. Methods A total of 624 knees underwent primary TKA using Cuvis robotic assistance in the time period between November 2023 to April 2024. A total of 360 patients that included 100 males and 260 females were included in the study. All the surgeries were performed by the same surgeon and the same posterior-stabilized (PS)-design prosthesis was implanted. The medial and lateral gaps were balanced using our technique intraoperatively. The patients were followed up at one, three, and six months duration postoperatively, and their knee functional outcomes were analyzed using the Oxford Knee Score (OKS). Results A total of 360 patients with a mean age of 64.36 were part of this study. The study shows significant improvement in knee function post surgery. The average preoperative OKS recorded was 15.82, which improved at the postoperative sixth-month follow-up to a mean value of 42.07. There were no patients with poor results as per OKS scores, and no patients required any revision procedures. Conclusion The gap balancing technique with functional knee alignment using the Cuvis joint robotic system improved short-term outcomes, with balanced gaps, controlled alignment, and preserved soft tissue tension. No complications were reported, but further long-term, multicenter studies are needed for definitive conclusions.
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Affiliation(s)
| | - Adarsh Krishna K Bhat
- Orthopaedic Surgery, Apollo Hospitals, Bangalore, IND
- Trauma and Orthopaedics, The University of Edinburgh, Edinburgh, GBR
| | - Naveen Biradar
- Orthopaedic Surgery, Apollo Hospitals, Bangalore, IND
- Orthopaedics, Khaja Bandanawaz Institute of Medical Sciences, Gulbarga, IND
| | | | | | - Amar Patil
- Orthopaedic Surgery, Apollo Hospitals, Bangalore, IND
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Andriollo L, Picchi A, Iademarco G, Fidanza A, Perticarini L, Rossi SMP, Logroscino G, Benazzo F. The Role of Artificial Intelligence and Emerging Technologies in Advancing Total Hip Arthroplasty. J Pers Med 2025; 15:21. [PMID: 39852213 PMCID: PMC11767033 DOI: 10.3390/jpm15010021] [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: 12/03/2024] [Revised: 01/05/2025] [Accepted: 01/07/2025] [Indexed: 01/26/2025] Open
Abstract
Total hip arthroplasty (THA) is a widely performed surgical procedure that has evolved significantly due to advancements in artificial intelligence (AI) and robotics. As demand for THA grows, reliable tools are essential to enhance diagnosis, preoperative planning, surgical precision, and postoperative rehabilitation. AI applications in orthopedic surgery offer innovative solutions, including automated hip osteoarthritis (OA) diagnosis, precise implant positioning, and personalized risk stratification, thereby improving patient outcomes. Deep learning models have transformed OA severity grading and implant identification by automating traditionally manual processes with high accuracy. Additionally, AI-powered systems optimize preoperative planning by predicting the hip joint center and identifying complications using multimodal data. Robotic-assisted THA enhances surgical precision with real-time feedback, reducing complications such as dislocations and leg length discrepancies while accelerating recovery. Despite these advancements, barriers such as cost, accessibility, and the steep learning curve for surgeons hinder widespread adoption. Postoperative rehabilitation benefits from technologies like virtual and augmented reality and telemedicine, which enhance patient engagement and adherence. However, limitations, particularly among elderly populations with lower adaptability to technology, underscore the need for user-friendly platforms. To ensure comprehensiveness, a structured literature search was conducted using PubMed, Scopus, and Web of Science. Keywords included "artificial intelligence", "machine learning", "robotics", and "total hip arthroplasty". Inclusion criteria emphasized peer-reviewed studies published in English within the last decade focusing on technological advancements and clinical outcomes. This review evaluates AI and robotics' role in THA, highlighting opportunities and challenges and emphasizing further research and real-world validation to integrate these technologies into clinical practice effectively.
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Affiliation(s)
- Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico—Unità di Traumatologia dello Sport, Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy
- Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Artificial Intelligence Center, Alma Mater Europaea University, 1010 Vienna, Austria
| | - Aurelio Picchi
- Unit of Orthopedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giulio Iademarco
- Unit of Orthopedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Fidanza
- Unit of Orthopedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Loris Perticarini
- Sezione di Chirurgia Protesica ad Indirizzo Robotico—Unità di Traumatologia dello Sport, Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico—Unità di Traumatologia dello Sport, Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy
- Department of Life Science, Health, and Health Professions, Università degli Studi Link, Link Campus University, 00165 Rome, Italy
- Biomedical Sciences Area, IUSS University School for Advanced Studies, 27100 Pavia, Italy
| | - Giandomenico Logroscino
- Unit of Orthopedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico—Unità di Traumatologia dello Sport, Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy
- Biomedical Sciences Area, IUSS University School for Advanced Studies, 27100 Pavia, Italy
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Chan KCA, Cheung A, Chan PK, Luk MH, Chiu KY, Fu H. Robotic total knee arthroplasty safely reduces length of stay in an Asian public healthcare system. Bone Jt Open 2025; 6:12-20. [PMID: 39746375 PMCID: PMC11695079 DOI: 10.1302/2633-1462.61.bjo-2024-0184.r1] [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] [Indexed: 01/04/2025] Open
Abstract
Aims Around the world, the emergence of robotic technology has improved surgical precision and accuracy in total knee arthroplasty (TKA). This territory-wide study compares the results of various robotic TKA (R-TKA) systems with those of conventional TKA (C-TKA) and computer-navigated TKA (N-TKA). Methods This is a retrospective study utilizing territory-wide data from the Clinical Data Analysis and Reporting System (CDARS). All patients who underwent primary TKA in all 47 public hospitals in Hong Kong between January 2021 and December 2023 were analyzed. Primary outcomes were the percentage use of various robotic and navigation platforms. Secondary outcomes were: 1) mean length of stay (LOS); 2) 30-day emergency department (ED) attendance rate; 3) 90-day ED attendance rate; 4) 90-day reoperation rate; 5) 90-day mortality rate; and 6) surgical time. Results A total of 8,492 knees from 7,746 patients were included in the study. Overall robotic use had risen to 20.4% (2023 Q3 to Q4: 355/1,738) by the end of 2023, with Mako being the most popular at 10.3% (179/1,738). R-TKA had the shortest mean LOS compared with N-TKA and C-TKA (5.5 vs 6.3 and 7.1 days, respectively; p < 0.001). Only Mako (9.7%) demonstrated reduced 90-day ED attendance compared to C-TKA (13.1%; p = 0.009), Cori/Navio (15.0%; p = 0.005), and Rosa (16.4%; p < 0.001). No differences in 90-day reoperation rate and mortality were observed between all groups. Mean surgical times were longer in R-TKA groups by 20.6 minutes (p < 0.001). Conclusion R-TKA use has increased in recent years, and has been shown to reduce hospital stay despite having a slightly longer surgical time, proving a promising candidate to alleviate the burden on healthcare systems. Individual differences between R-TKA systems contributed to variable clinical outcomes.
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Affiliation(s)
- Kai C. A. Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Cheung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Ping-Keung Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Michelle H. Luk
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Kwong Y. Chiu
- Department of Orthopaedics and Traumatology, Hong Kong Sanatorium Hospital, Hong Kong SAR, China
| | - Henry Fu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Bourgeault-Gagnon Y, Salmon LJ, Lyons MC. Robotic-Assisted Total Knee Arthroplasty Improves Accuracy and Reproducibility of the Polyethylene Insert Thickness Compared to Manual Instrumentation or Navigation: A Retrospective Cohort Study. Arthroplast Today 2024; 30:101489. [PMID: 39492997 PMCID: PMC11530840 DOI: 10.1016/j.artd.2024.101489] [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: 03/07/2024] [Accepted: 07/23/2024] [Indexed: 11/05/2024] Open
Abstract
Background Increased accuracy and lower rates of component positioning outliers have been associated with better long-term survival and functional outcomes of total knee arthroplasty (TKA). This study investigates the accuracy of robotic-assisted TKA compared to navigation-assisted and manual instrumentation techniques, using polyethylene tibial insert thickness as a surrogate. Methods Consecutive primary TKA by a single surgeon were retrospectively reviewed and divided in 3 groups: manual instrumentation, navigation-assisted, and robotic-assisted (RA-TKA). Polyethylene insert thickness, deviation from planned thickness, and rate of outliers were compared between the 3 groups using nonparametric analysis of variance, Kruskal-Wallis tests, and Bonferroni corrections. Logistic regression analysis was performed to identify predictors of polyethylene thickness ≥9 mm. The learning curve for RA-TKA was evaluated with a box plot graph of groups of 10 consecutive cases. Results There were 474 patients in manual instrumentation TKA, 257 in navigation-assisted TKA and 225 in RA-TKA, with median polyethylene thicknesses of 6.0 (interquartile range 5.0-7.0), 6.0 (interquartile range 5.0-7.0), and 5.0 (interquartile range 5.0-6.0) millimeters, respectively (P˂0.001 RA-TKA compared to both other groups). Polyethylene inserts with a thickness ≥9 mm were used in 28 (5.9%) manual instrumentation TKA, 13 (5.1%) navigation-assisted TKA, and 1 (0.4%) RA-TKA (P = .004). Independent predictors for polyethylene thickness ≥9 mm included surgical technique, left side, and male sex. A learning curve of <30 cases was observed before consistent polyethylene thickness was achieved in RA-TKA. Conclusions Tibial polyethylene insert thickness, as a surrogate of surgical accuracy, is more reproducible in robotic-assisted than in navigation-assisted or manual-instrumentation TKA. The learning curve to reach high levels of reproducibility with this technique is relatively short.
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Affiliation(s)
| | - Lucy J. Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, NSW, Australia
- University of Notre Dame Medical School, Sydney, NSW, Australia
| | - Matthew C. Lyons
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, NSW, Australia
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20
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Lambrechts J, Vansintjan P, Lapierre C, Sinnaeve F, Van Lysebettens W, Van Overschelde P. Accuracy of a New Augmented Reality Assisted Technique for Total Knee Arthroplasty: An In Vivo Study. Arthroplast Today 2024; 30:101565. [PMID: 39524992 PMCID: PMC11550726 DOI: 10.1016/j.artd.2024.101565] [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: 05/30/2024] [Revised: 09/12/2024] [Accepted: 09/24/2024] [Indexed: 11/16/2024] Open
Abstract
Background Total knee arthroplasty (TKA) remains the standard of care for treating end-stage osteoarthritis of the knee. Approximately 15%-20% of the patients are dissatisfied following surgery. To improve accuracy and outcomes of TKA, various assistive technologies have been introduced. For this study, an augmented reality (AR) system was explored and tested. Methods The Knee + system (Pixee Medical, Besancon, France) was used to guide TKA. It uses a combination of quick response-code labeled instruments and AR glasses to guide tibial and femoral cuts. The primary research goal was to evaluate its accuracy by direct comparing the planned angular values for lateral distal femoral angle, medial proximal tibial angle, hip-knee-ankle axis, and tibial slope to the intraoperative obtained values and the measured angles on postoperative full leg radiographs. The secondary research goal was to assess its feasibility. Results This retrospective study evaluated 124 patients, with a follow-up of at least 1 year. The average absolute difference between planned and measured postop values were 1.39° for lateral distal femoral angle, 1.03° for medial proximal tibial angle, 2.16° for tibial slope, and 1.51° for hip-knee-ankle axis. Within the follow-up period, 8 complications were observed. The average surgical time was 83 minutes. Conclusions This study has demonstrated a high accuracy, comparable to robotic-assisted total knee arthroplasty, of the Knee + AR system. It has shown to be a safe, cheap and time-efficient assistive technology for patients undergoing medial pivot TKA.
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Affiliation(s)
- Jasper Lambrechts
- Department of Orthopedic Surgery, AZ Sint-Jan Bruges, Bruges, Belgium
| | - Pieter Vansintjan
- Hip and Knee Unit Ghent, Sint-Martens-Latem, Belgium
- Department of Orthopedic Surgery, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Cynthia Lapierre
- Hip and Knee Unit Ghent, Sint-Martens-Latem, Belgium
- Department of Orthopedic Surgery, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Farah Sinnaeve
- Hip and Knee Unit Ghent, Sint-Martens-Latem, Belgium
- Department of Orthopedic Surgery, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Wouter Van Lysebettens
- Hip and Knee Unit Ghent, Sint-Martens-Latem, Belgium
- Department of Orthopedic Surgery, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Philippe Van Overschelde
- Hip and Knee Unit Ghent, Sint-Martens-Latem, Belgium
- Department of Orthopedic Surgery, AZ Maria Middelares Ghent, Ghent, Belgium
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21
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Woelfle CA, Geller JA, Neuwirth AL, Sarpong NO, Shah RP, John Cooper H. Robotic assistance improves success of cementless component fixation in one total knee arthroplasty system. Knee 2024; 51:240-248. [PMID: 39396419 DOI: 10.1016/j.knee.2024.09.012] [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: 02/27/2024] [Revised: 08/13/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION New cementless implant designs in total knee arthroplasty (TKA) have begun to shift the longstanding practice of cemented fixation. With aseptic loosening a leading cause for revision of cementless implants, initial osteointegration is critical for component survivorship. Robotic-assisted TKA (RA-TKA) has shown promising results in recent literature at improving component accuracy. The current study aims to evaluate if robotic assistance affects the success of cementless fixation in primary TKA. METHODS 445 cementless primary TKA components from one manufacturer implanted by five surgeons between June 2018 and October 2022 were retrospectively reviewed. Those with minimum one-year follow-up were analyzed. Femoral and tibial components were reviewed separately and grouped based on whether manual or RA-TKA from the same manufacturer was performed. Fisher's exact test was used to analyze if aseptic loosening rates were different between the two techniques. RESULTS 373 (82%) cementless components from a single knee system were included. 146 femoral and 103 tibial components were implanted using RA-TKA, while 63 femoral and 61 tibial components were implanted manually. At a mean follow-up of 18 months (range, 12 to 51 months), successful fixation was achieved in 96.2% of all components. No femoral components from either group were revised due to aseptic loosening. Four manually implanted vs. no robotically assisted tibial components were revised due to aseptic loosening (6.6% vs 0.0%; P = 0.038). CONCLUSION The performance of modern cementless femoral components was excellent with or without robotic assistance, however RA-TKA improved the survivorship of the same system's cementless tibial component. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Catelyn A Woelfle
- Department of Orthopedic Surgery Columbia University Irving Medical Center New York, NY, USA
| | - Jeffrey A Geller
- Department of Orthopedic Surgery Columbia University Irving Medical Center New York, NY, USA.
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery Columbia University Irving Medical Center New York, NY, USA.
| | - Nana O Sarpong
- Department of Orthopedic Surgery Columbia University Irving Medical Center New York, NY, USA.
| | - Roshan P Shah
- Department of Orthopedic Surgery Columbia University Irving Medical Center New York, NY, USA.
| | - H John Cooper
- Department of Orthopedic Surgery Columbia University Irving Medical Center New York, NY, USA.
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22
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Giordano JR, Bartlett L, Huyke F, Sadh P, Thompson K, Ajah O, Danoff J. Is Immediate Postoperative Radiograph Necessary Following Robotic-Assisted Total Knee Arthroplasty? J Knee Surg 2024; 37:851-855. [PMID: 38788783 DOI: 10.1055/a-2333-1619] [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: 05/26/2024]
Abstract
The necessity of immediate postoperative radiographs following total knee arthroplasty (TKA) has long been debated. With the increasing use of robotic-assisted TKA (RTKA), and thus more precise implant placement, the need for immediate postoperative radiographs to determine implant positioning may be unnecessary. We sought to evaluate implant position on the immediate postoperative radiographs following RTKA to determine their necessity. A retrospective review of 150 RTKAs was performed. The posterior slopes for all TKAs were recorded based on the preoperative three-dimensional template. Additionally, two independent trained researchers (J.G./L.B.) each measured the posterior slope of the postoperative day 0 (POD0) radiograph and postoperative week 2 radiograph. The difference in posterior slope measurement between template and POD0, between template and postoperative week 2, and between POD0 and postoperative week 2 was calculated. Of the 150 TKAs performed, there were no periprosthetic fractures found on the POD0 radiograph. The mean difference between the templated posterior slope and measured posterior slope on POD0 was 0.04 degrees (standard deviation [SD], 1.01; p = 0.615). There was a weak correlation between the two values (rs [95% confidence interval (CI)], 0.38 [0.21, 0.53]). When comparing the template to the postoperative week 2 radiographs, there was a mean difference of 0.02 degrees (SD, 0.48; p = 0.556). However, a moderate to strong correlation was noted (rs [95% CI], 0.71 [0.61, 0.79]). Comparison of the mean posterior slope from POD0 radiograph to that of postoperative week 2 radiograph showed a mean difference of 0.06 degrees (SD, 1.0; p = 0.427). A weak correlation was found between these two values (rs [95% CI], 0.43 [0.26, 0.56]). Given the accuracy and precision of RTKA, along with the ability to decrease cost and radiation, immediate postoperative radiograph may be unnecessary, when pertaining to the uncomplicated RTKA. However, if there is concern for intraoperative fracture, long stems placed in a revision arthroplasty, or other intraoperative complications, then postoperative radiographs are encouraged.
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Affiliation(s)
- Joshua R Giordano
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
| | - Lucas Bartlett
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
| | - Fernando Huyke
- Department of Orthopaedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntington, New York
| | - Puru Sadh
- Zucker School of Medicine at Hofstra, Hempstead, New York
| | - Kiara Thompson
- Zucker School of Medicine at Hofstra, Hempstead, New York
| | - Obinnah Ajah
- Zucker School of Medicine at Hofstra, Hempstead, New York
| | - Jonathan Danoff
- Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, Manhasset, New York
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23
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Mancino F, Fontalis A, Kayani B, Magan A, Plastow R, Haddad FS. The current role of CT in total knee arthroplasty. Bone Joint J 2024; 106-B:892-897. [PMID: 39216858 DOI: 10.1302/0301-620x.106b9.bjj-2023-1303.r1] [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: 09/04/2024]
Abstract
Advanced 3D imaging and CT-based navigation have emerged as valuable tools to use in total knee arthroplasty (TKA), for both preoperative planning and the intraoperative execution of different philosophies of alignment. Preoperative planning using CT-based 3D imaging enables more accurate prediction of the size of components, enhancing surgical workflow and optimizing the precision of the positioning of components. Surgeons can assess alignment, osteophytes, and arthritic changes better. These scans provide improved insights into the patellofemoral joint and facilitate tibial sizing and the evaluation of implant-bone contact area in cementless TKA. Preoperative CT imaging is also required for the development of patient-specific instrumentation cutting guides, aiming to reduce intraoperative blood loss and improve the surgical technique in complex cases. Intraoperative CT-based navigation and haptic guidance facilitates precise execution of the preoperative plan, aiming for optimal positioning of the components and accurate alignment, as determined by the surgeon's philosophy. It also helps reduce iatrogenic injury to the periarticular soft-tissue structures with subsequent reduction in the local and systemic inflammatory response, enhancing early outcomes. Despite the increased costs and radiation exposure associated with CT-based navigation, these many benefits have facilitated the adoption of imaged based robotic surgery into routine practice. Further research on ultra-low-dose CT scans and exploration of the possible translation of the use of 3D imaging into improved clinical outcomes are required to justify its broader implementation.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
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24
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Tsai HK, Bao Z, Wu D, Han J, Jiang Q, Xu Z. A new gap balancing technique with functional alignment in total knee arthroplasty using the MAKO robotic arm system: a preliminary study. BMC Surg 2024; 24:232. [PMID: 39143535 PMCID: PMC11323490 DOI: 10.1186/s12893-024-02524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Gap tension is an important factor influencing the clinical outcomes of total knee arthroplasty (TKA). Traditional mechanical alignment (MA) places importance on neutral alignment and often requires additional soft tissue releases, which may be related to patient dissatisfaction. Conversely, the functional alignment requires less soft tissue release to achieve gap balance. Conventional gap tension instruments present several shortcomings in practice. The aim of this study is to introduce a new gap balancing technique with FA using the modified spacer-based gap tool and the MAKO robotic arm system. METHODS A total of 22 consecutive patients underwent primary TKA using the MAKO robotic arm system. The gap tension was assessed and adjusted with the modified spacer-based gap tool during the operation. Patient satisfaction was evaluated post-operatively with a 5-point Likert scale. Clinical outcomes including lower limb alignment, Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were recorded before surgery, 3 months and 1 year after surgery. RESULTS The range of motion (ROM) was significantly increased (p < 0.001) and no patients presented flexion contracture after the surgery. KSS and WOMAC score were significantly improved at 3 months and 1 year follow-up (p < 0.001 for all). During the surgery, the adjusted tibial cut showed more varus than planned and the adjusted femoral cut presented more external rotation than planned (p < 0.05 for both). The final hip-knee-ankle angle (HKA) was also more varus than planned (p < 0.05). CONCLUSIONS This kind of spacer-based gap balancing technique accompanied with the MAKO robotic arm system could promise controlled lower limb alignment and improved functional outcomes after TKA.
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Affiliation(s)
- Hung-Kang Tsai
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Zhengyuan Bao
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Dengxian Wu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
| | - Jing Han
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China.
| | - Zhihong Xu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China.
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25
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Miao H, Zhu Z, Wang H, Bai X, Li X. Predictive Accuracy Analysis of a Novel Robotic-Assisted System for Total Knee Arthroplasty:A Prospective Observational Study. Ther Clin Risk Manag 2024; 20:473-482. [PMID: 39135983 PMCID: PMC11318605 DOI: 10.2147/tcrm.s468598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024] Open
Abstract
Background Robotic-assisted total knee arthroplasty (RATKA) has been reported to enhance operative decision-making. The purpose of this study was intended to assess the predictive accuracy of bone cuts, lower limb alignment, and component size of a novel system for RATKA preoperatively and intraoperatively. Methods Preoperatively planned bone cuts, limb alignment, and component size were projected using a reconstructed 3D model. Intraoperative bone cuts and postoperative limb alignment were measured. Errors between planned and real bone cuts, limb alignment, and component size were compared. Results The mean absolute errors for bone cuts and alignment were within 1.40mm/1.30° with a standard deviation (SD) of 0.96mm/1.12°. For all errors of bone cuts and alignment compared with the plan, there were no statistically significant differences except for the lateral distal of femoral cuts (P=0.004). The accuracy for predicting the femoral, tibial, and polyethylene component sizes was 100% (48/48), 90% (43/48), and 88% (42/48), respectively. Regarding all mean absolute errors of bone cuts and alignments, no significant differences were observed among surgeons. Conclusion The novel robotically-assisted system for RATKA donated reliable operative decision-making based on the predictive accuracy regardless of the surgeon's level of experience.
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Affiliation(s)
- Haichuan Miao
- Dalian Medical University, Dalian, 116044, People’s Republic of China
- Department of Sports Medicine and Joint Surgery, The People’s Hospital of Liaoning Province, The People’s Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Zhiyong Zhu
- Department of Sports Medicine and Joint Surgery, The People’s Hospital of Liaoning Province, The People’s Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Huisheng Wang
- Department of Sports Medicine and Joint Surgery, The People’s Hospital of Liaoning Province, The People’s Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xizhuang Bai
- Department of Sports Medicine and Joint Surgery, The People’s Hospital of Liaoning Province, The People’s Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
| | - Xi Li
- Department of Sports Medicine and Joint Surgery, The People’s Hospital of Liaoning Province, The People’s Hospital of China Medical University, Shenyang, 110000, People’s Republic of China
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26
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Borsinger TM, Quevedo Gonzalez FJ, Pagan CA, Karasavvidis T, Sculco PK, Wright TM, Kahlenberg CA, Lipman JD, Debbi EM, Vigdorchik JM, Mayman DJ. Is Tibial Bone Mineral Density Related to Sex, Age, Preoperative Alignment, or Fixation Method in Primary Total Knee Arthroplasty? J Arthroplasty 2024; 39:S108-S114. [PMID: 38548236 DOI: 10.1016/j.arth.2024.03.056] [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: 11/15/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Cementless total knee arthroplasty (TKA) has regained interest for its potential for long-term biologic fixation. The density of the bone is related to its ability to resist static and cyclic loading and can affect long-term implant fixation; however, little is known about the density distribution of periarticular bone in TKA patients. Thus, we sought to characterize the bone mineral density (BMD) of the proximal tibia in TKA patients. METHODS We included 42 women and 50 men (mean age 63 years, range: 50 to 87; mean body mass index 31.6, range: 20.5 to 49.1) who underwent robotic-assisted TKA and had preoperative computed tomography scans with a BMD calibration phantom. Using the robotic surgical plan, we computed the BMD distribution at 1 mm-spaced cross-sections parallel to the tibial cut from 2 mm above the cut to 10 mm below. The BMD was analyzed with respect to patient sex, age, preoperative alignment, and type of fixation. RESULTS The BMD decreased from proximal to distal. The greatest changes occurred within ± 2 mm of the tibial cut. Age did not affect BMD for men; however, women between 60 and 70 years had higher BMD than women ≥ 70 years for the total cut (P = .03) and the medial half of the cut (P = .03). Cemented implants were used in 1 86-year-old man and 18 women (seven < 60 years, seven 60 to 70 years, and four ≥ 70 year old). We found only BMD differences between cemented or cementless fixation for women < 60 years. CONCLUSIONS To our knowledge, this is the first study to characterize the preoperative BMD distribution in TKA patients relative to the intraoperative tibial cut. Our results indicate that while sex and age may be useful surrogates of BMD, the clinically relevant thresholds for cementless knees remain unclear, offering an area for future studies.
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Affiliation(s)
- Tracy M Borsinger
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | | | - Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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27
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Weaver DJ, Deshmukh S, Bashyal R, Bagaria V. Complications and Learning Curve Associated with an Imageless Burr-Based (CORI) Robotic-Assisted Total Knee Arthroplasty System: Results from First 500 Cases. Indian J Orthop 2024; 58:1109-1117. [PMID: 39087033 PMCID: PMC11286604 DOI: 10.1007/s43465-024-01200-9] [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: 03/12/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024]
Abstract
Background The use of robotic-assisted total knee arthroplasty (RA-TKA) is gaining traction. There is evidence to suggest that RA-TKA can help to optimize the precision and accuracy of implant positioning and that there may be protective effects on surrounding bony and soft tissues. Yet, there are important differences between the various RA-TKA systems currently on the market. One such newly introduced RA-TKA system uses imageless technology and performs bony cuts with the use of a burr-based device. The learning curve and complications unique to this system have yet to be assessed. Methods We evaluated 500 consecutive RA-TKA cases using a newly developed burr-based and imageless system which were done by a single surgeon between the months of October 2021 and February 2023. Operative times were recorded and compared to the previous 150 conventional TKA cases allowing for the learning curve to be calculated using the CUSUM method. Intraoperative and postoperative complications were categorically profiled. Results The learning curve of this RA-TKA system was found to be 6 cases. Intraoperative complications included unintended bony over resection (n = 3), soft tissue injury (n = 2), and robotic system hardware (n = 2) or software (n = 2) malfunction. Postoperative complications consisted of superficial pin site infection (n = 1) and periprosthetic fracture near the pin sites (n = 1). There were no identified cases of prosthetic joint infection, instability events, or wound complications. Conclusions The learning curve and the complication profile of a newly introduced imageless and burr-based RA-TKA system were described. This information serves to guide surgeons in adopting this technology and can counsel them regarding the potential pitfalls and challenges associated with its integration into practice. The work sheds light on the complexity and learning curve of the recently released imageless burr-based RA-TKA system. This important information is intended to help surgeons accept this cutting-edge technology by providing advice on any errors and difficulties that can occur when integrating it into clinical practice. This information can help surgeons navigate the complexities of integrating this new burr-based robotic technology into knee replacement procedures, enabling them to make well-informed decisions and receive guidance.
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Affiliation(s)
- Douglas J. Weaver
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, USA
| | - Shobit Deshmukh
- Department of Orthopaedic Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Mumbai, 400004 India
| | - Ravi Bashyal
- North Shore University Health System Orthopaedic and Spine Institute, Evanston, USA
| | - Vaibhav Bagaria
- Department of Orthopaedic Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Mumbai, 400004 India
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28
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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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Woelfle CA, Weiner TR, Sculco PK, Sarpong NO, Shah RP, Cooper HJ. Surgeon-Applied Stress and a Ligament Tensor Instrument Provide a Similar Assessment of Preresection Flexion Laxity During Robotic Total Knee Arthroplasty. Arthroplast Today 2024; 28:101450. [PMID: 39071093 PMCID: PMC11283011 DOI: 10.1016/j.artd.2024.101450] [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: 02/13/2024] [Revised: 03/28/2024] [Accepted: 06/03/2024] [Indexed: 07/30/2024] Open
Abstract
Background Robotic-assisted total knee arthroplasty (RA-TKA) allows surgeons to perform intraoperative soft tissue laxity assessments prior to bone resections and is used to alter resections to achieve gap balance. This study compared 2 techniques for flexion gap laxity assessment during RA-TKA. Methods A prospective study of 50 primary RA-TKAs performed by a single surgeon was conducted between February and October 2023. Following full exposure, anterior tibial dislocation, and osteophyte removal, maximal medial and lateral compartment flexion laxity was quantified to the nearest 0.5 mm by the robotic system using a dynamic, surgeon-applied stress (SURGEON). This data was used to plan a balanced flexion gap by adjusting the femoral component size, rotation, and anterior-posterior translation. Flexion laxity was quantified again after distal femoral and proximal tibial resections using a ligament tensor instrument (TENSOR). These new data were used to plan for the same desired flexion gap using the same variables. Paired-samples t-tests and a simple linear regression were used for analysis. Results Both methods produced near-identical recommendations for femoral component sizing (mean deviation 0.06 sizes, range -1 to +1 size; P = .569), rotation (deviation mean 1.0°, range -3.0° to +3.0°; P = .741), and anterior-posterior translation (deviation mean 0.13 mm, range -0.5 to +0.5 mm, P = .785). SURGEON femoral component rotation predicted TENSOR rotation (R2 = 0.157; 95% confidence interval = 0.124, 0.633; P = .004). Conclusions Assessing flexion laxity with a surgeon-applied stress vs a ligament tensor produced near-identical laxity data in RA-TKA, suggesting surgeons may comfortably choose either technique as a reliable method. Level of Evidence Level III.
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Affiliation(s)
- Catelyn A. Woelfle
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - Travis R. Weiner
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - Peter K. Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Nana O. Sarpong
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P. Shah
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
| | - H. John Cooper
- Department of Orthopedic Surgery, New York Presbyterian Hospital - Columbia University Irving Medical Center, New York, NY, USA
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Russell SP, Keyes S, Hirschmann MT, Harty JA. Conventionally instrumented inverse kinematic alignment for total knee arthroplasty: How is it done? J Exp Orthop 2024; 11:e12055. [PMID: 38868128 PMCID: PMC11167404 DOI: 10.1002/jeo2.12055] [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: 01/09/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose For primary total knee arthroplasty (TKA), there is an increasing trend towards patient-specific alignment strategies such as kinematic alignment (KA) and inverse kinematic alignment (iKA), which by restoring native joint mechanics may yield higher patient satisfaction rates. Second, the most recent Australian joint registry report describes favourable revision rates for conventionally instrumented TKA compared to technology-assisted techniques such as those using navigation, robotics or custom-cutting blocks. The aim of this technique article is to describe in detail a surgical technique for TKA that: (1) utilises the principles of iKA and (2) uses conventionally instrumented guided resections thereby avoiding the use of navigation, robotics or custom blocks. Methods A TKA technique is described, whereby inverse kinematic principles are utilised and patient-specific alignment is achieved. Additionally, the patellofemoral compartment of the knee is restored to the native patellofemoral joint line. The sequenced technical note provided may be utilised for cemented or cementless components; cruciate retaining or sacrificing designs and for fixed or rotating platforms. Results An uncomplicated, robust and reproducible technique for TKA is described. Discussion Knee arthroplasty surgeons may wish to harness the emerging benefits of both a conventionally instrumented technique and a patient-specific alignment strategy. Level of Evidence Level V.
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Affiliation(s)
- Shane P. Russell
- Department of Orthopaedic SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Department of Orthopaedic SurgeryBon Secours Hospital CorkCorkIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
- Department of Orthopaedic SurgeryRoyal College of Surgeons in IrelandDublinIreland
| | - Sara Keyes
- Department of Orthopaedic SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Department of Orthopaedic SurgeryBon Secours Hospital CorkCorkIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
| | - Michael T. Hirschmann
- Department of Orthopedic Surgery and TraumatologyKantonsspital BasellandBruderholzSwitzerland
- Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine & BiomechanicsUniversity of BaselBaselSwitzerland
| | - James A. Harty
- Department of Orthopaedic SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Department of Orthopaedic SurgeryBon Secours Hospital CorkCorkIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
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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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Koucheki R, Wolfstadt JI, Chang JS, Backstein DJ, Lex JR. Total Knee Arthroplasty With Robotic and Augmented Reality Guidance: A Hierarchical Task Analysis. Arthroplast Today 2024; 27:101389. [PMID: 39071834 PMCID: PMC11282423 DOI: 10.1016/j.artd.2024.101389] [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: 09/03/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 07/30/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility. The objective of this study was to develop and validate HTAs for conventional, robotic-assisted, and AR-navigated TKA. Methods The development of HTAs for conventional TKA involved an iterative review process that incorporated the input of 4 experienced arthroplasty surgeons. The HTAs were then adapted for robotic-assisted and AR-navigated TKA by incorporating specific steps associated with the use of these systems. The accuracy and completeness of the HTAs were validated by observing 10 conventional and 10 robotic-assisted TKA procedures. Results HTAs for conventional, robotic-assisted, and AR-navigated TKA were developed and validated. The resulting HTAs provide a comprehensive and standardized plan for each procedure and can aid in the identification of potential areas of inefficiency and risk. Robotic-assisted and AR-navigated approaches require additional steps, and there are an increased number of instances where complications may occur. Conclusions The HTAs developed in this study can provide valuable insights into the potential pitfalls of robotic-assisted and AR-navigated TKA procedures. As AR-navigation systems are developed, they should be optimized by critical analysis using the developed HTAs to ensure maximum efficiency, reliability, accessibility, reduction of human error, and costs.
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Affiliation(s)
- Robert Koucheki
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jesse I. Wolfstadt
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Justin S. Chang
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Humber River Hospital, Toronto, ON, Canada
| | - David J. Backstein
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Johnathan R. Lex
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Molho D, Vaidya S, O’Sullivan D, Vye D, Nelson S, Bernstein J. Cemented vs Cementless Robotic-Assisted Total Knee Arthroplasty Yield Similar Short-Term Clinical Outcomes. Arthroplast Today 2024; 27:101360. [PMID: 38690095 PMCID: PMC11058072 DOI: 10.1016/j.artd.2024.101360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/04/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background In primary total knee arthroplasty (TKA), there is ongoing controversy about optimal fixation (cemented vs cementless). Cemented TKA remains the gold standard, with the largest body of long-term evidence available to support it. However, cementless TKA implants are gaining popularity due to potential biomechanical advantages and a growing body of literature supporting survivorship. Due to paucity of literature investigating fixation methods in robotic-assisted TKA (Ra-TKA), we aim to compare clinical outcomes of cementless Ra-TKA with those of cemented Ra-TKA. Methods This is a retrospective cohort study of patients who underwent Ra-TKA by 19 surgeons comparing results of cases using cementless vs cemented fixation. We observed short-term complications, emergency room visits, and readmissions. We collected patient-reported outcomes measurement information system and knee injury and osteoarthritis outcome scores preoperatively and 12 weeks after surgery. Results A total of 582 TKA cases were included: 335 cementless and 247 cemented. The patients in the cementless group were younger and had a higher body mass index. The cemented group had a higher rate of return to the operating room, with manipulation under anesthesia for stiffness being the most common indication in both groups. There were no statistically significant differences in 30-day readmissions, 90-day emergency room visits, or patient-reported outcomes. Conclusions Our retrospective study demonstrated higher return to operating room in the cemented group vs the cementless group. We reported no differences in any other short-term outcomes between the cementless and cemented Ra-TKA. Our data support efficacy and safety of cementless Ra-TKA at 3-month follow-up.
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Affiliation(s)
- David Molho
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Swaroopa Vaidya
- Connecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - David O’Sullivan
- Hartford HealthCare Research Program, Hartford Healthcare, Hartford, CT, USA
| | - Dianne Vye
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Stephen Nelson
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Bridgeport, CT, USA
| | - Jenna Bernstein
- Connecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USA
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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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Rinehart DB, Stambough JB, Mears SC, Barnes CL, Stronach B. Robotic Total Knee Arthroplasty Surgeon Marketing: Do Claims Align With the Literature? Arthroplast Today 2024; 27:101357. [PMID: 38524152 PMCID: PMC10958061 DOI: 10.1016/j.artd.2024.101357] [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: 10/09/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Background Robotic total knee arthroplasty (R-TKA) utilization and marketing continue to rise. We examined the marketing on surgeon websites regarding R-TKA benefits and sought to determine if the claims were supported by existing literature. Methods A Google search identified 10 physician websites from each of the 5 largest U.S. markets by population with the term "robotic total knee arthroplasty city, state." Claims on websites about R-TKA were categorized. Literature from 2012-2022 was reviewed for data "for" or "against" each claim. Level of evidence for each publication was collected. Results Fifty websites were captured that included 59 surgeons. A specific R-TKA platform was mentioned on 68% of websites. Website claims about robotics were placed into 8 major categories. Literature review supported the claims of more precise/accurate, reduced injury to tissue, and less pain with more literature "for" than "against" the claims. Conclusions Claims made on physician websites regarding the benefits of R-TKA are variable and not definitively supported by existing literature. Most available data can be categorized into levels of evidence III, IV, and V. There is a paucity of level I evidence to support the various marketing statements. Physicians should be cognizant of both the claims made on their websites and the literature that could be used to support or refute those specific claims.
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Affiliation(s)
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Lychagin AV, Gritsyuk AA, Elizarov MP, Rukin YA, Gritsyuk AA, Gavlovsky MY, Elizarov PM, Berdiyev M, Kalinsky EB, Vyazankin IA, Rosenberg N. Short-Term Outcomes of Total Knee Arthroplasty Using a Conventional, Computer-Assisted, and Robotic Technique: A Pilot Clinical Trial. J Clin Med 2024; 13:3125. [PMID: 38892836 PMCID: PMC11172941 DOI: 10.3390/jcm13113125] [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: 04/20/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. Methods: This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan-Meier curves, with revision surgery as the endpoint. Results: While all three groups showed significant improvements in knee function postoperatively (p < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, p = 0.011). Conclusion: The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis's long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA.
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Affiliation(s)
- Alexey Vladimirovich Lychagin
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Andrey Anatolyevich Gritsyuk
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Mikhail Pavlovich Elizarov
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Yaroslav Alekseevich Rukin
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Andrey Andreevich Gritsyuk
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Maxim Yaroslavovich Gavlovsky
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Pavel Mihailovich Elizarov
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Murat Berdiyev
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Eugene Borisovich Kalinsky
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Ivan Antonovich Vyazankin
- Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia; (A.V.L.); (A.A.G.); (M.P.E.); (Y.A.R.); (A.A.G.); (M.Y.G.); (P.M.E.); (M.B.); (E.B.K.); (I.A.V.)
| | - Nahum Rosenberg
- Specialists Center, National Insurance Institute, Haifa 3109601, Israel
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Rajasekaran S, Soundarrajan D, Singh R, Shiferaw BA, Rajasekaran RB, Dhanasekararaja P, Rajkumar N. Comparison of imageless robotic assisted total knee arthroplasty and conventional total knee arthroplasty: early clinical and radiological outcomes of 200 knees. J Robot Surg 2024; 18:151. [PMID: 38564044 DOI: 10.1007/s11701-024-01905-x] [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: 01/10/2024] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
The aim of this study was to compare the short term clinical and radiological outcomes of imageless robotic and conventional total knee arthroplasty (TKA) and to estimate the accuracy of the two techniques by analysing the outliers after TKA. We have evaluated 200 consecutive knees (158 patients), 100 knees undergoing robotic TKA, and 100 knees treated with conventional TKA. Demographic parameters like age, gender, body mass index, diagnosis and range of motion were obtained. Knee society score (KSS) and Knee society functional score (KSS-F) were used for clinical evaluation. Mechanical alignment (Hip-knee-ankle angle), proximal tibial angle (MPTA), distal femoral angle (LDFA) and tibial slope were analysed for radiological results and outliers were compared between both groups. Outliers were defined when the measured angle exceeded ± 3° from the neutral alignment in each radiological measurement on the final follow-up radiograph.The minimum follow-up was 6 months (range, 6 to 18 months). The preoperative mean HKA angle was 169.7 ± 11.3° in robotic group and 169.3 ± 7.3° in conventional group. There was significant improvement in HKA, LDFA, MPTA and tibial slope compared to the preoperative values in both the groups (p < 0.01). The number of HKA, LDFA and tibial slope outliers were 31, 29 and 37, respectively, in the conventional group compared to 13, 23 and 17 in the robotic group (p < 0.01). There was a significant improvement in the KSS and KSS-F functional scores postoperatively in both the groups (p < 0.01). However, there was no significant difference in the functional scores between the groups postoperatively (p = 0.08). This study showed excellent improvement with both imageless robotic and conventional TKA, with similar clinical outcomes between both groups. However, radiologically robotic TKA showed better accuracy and consistency with fewer outliers compared with conventional TKA.
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Affiliation(s)
| | | | - Rithika Singh
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Bahru Atnafu Shiferaw
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | | | | | - Natesan Rajkumar
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Liu G, Liu Q, Tian R, Wang K, Yang P. Associations of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial. Int J Surg 2024; 110:2115-2121. [PMID: 38241323 PMCID: PMC11019982 DOI: 10.1097/js9.0000000000001048] [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: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The association between postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) and nutrition status among elderly adults remained unclear. The authors aimed to evaluate these associations and provide a nutrition status reference for the surgical technique selection of TKA. METHODS In the present study, the authors used data from a multicenter, prospective, randomized controlled project, which recruited patients underwent TKA therapy. A total of 88 elderly adults (age ≥65 years old) were included in this study. Their preoperative and postoperative demographic data and radiographic parameters were collected. Clinical outcomes, including postoperative hip-knee-ankle (HKA) angle deviation, knee society score (KSS), 10 cm visual analog scale, and so on, were observed and compared between the RA-TKA group and the conventional TKA group. Logistic regression was performed to adjust several covariates. In addition, according to the results of restricted cubic splines analyses, all participants were categorized into two groups with GNRI≤100 and GNRI >100 for further subgroup analyses. RESULTS Our results showed despite having a lower postoperative HKA angle deviation, the RA-TKA group had a similar postoperative KSS score compared with the conventional TKA group in elderly adults. Among elderly patients with GNRI>100, RA-TKA group achieved significantly more accurate alignment (HKA deviation, P =0.039), but did not obtain more advanced postoperative KSS scores because of the compensatory effect of good nutrition status. However, among elderly patients with GNRI≤100, RA-TKA group had significantly higher postoperative KSS scores compared to the conventional TKA group ( P =0.025) and this association were not altered after adjustment for other covariates. CONCLUSION Considering the clinical outcomes of conventional TKA may be more susceptible to the impact of nutrition status, elderly patients with GNRI≤100 seem to be an applicable population for RA-TKA, which is more stable and would gain significantly more clinical benefits compared with conventional TKA.
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Affiliation(s)
- Guanzhi Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Qimeng Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Reading L, Brown C, Pasqualini I, Huffman N, Piuzzi NS. 24-Year-Old Patient with Klippel-Trenaunay Syndrome Underwent Cementless Robotic Cruciate-Retaining TKA: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00008. [PMID: 38608129 DOI: 10.2106/jbjs.cc.23.00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
CASE A 24-year-old man with Klippel-Trenaunay syndrome (KTS) presented with severe knee osteoarthritis unresponsive to conservative measures. Owing to end-stage, debilitating arthritic symptoms, surgery was pursued. Careful preoperative, multidisciplinary planning/treatment included magnetic resonance imaging to characterize the venous malformations throughout the right lower extremity, preoperative sclerotherapy, sirolimus, and robotic-assisted cementless total knee arthroplasty (TKA). CONCLUSION Cementless robotic-assisted TKA with selective patellar resurfacing can be a viable option for young KTS patients with severe osteoarthritis when a meticulous multidisciplinary approach, including sclerotherapy and advanced imaging, is undertaken to analyze vascular abnormalities, minimize surgical risks, preserve bone stock, and optimize outcomes.
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Affiliation(s)
- Landon Reading
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Colin Brown
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | | | - Nickelas Huffman
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Peterman NJ, Pagani N, Mann R, Li RL, Gasienica J, Naik A, Sun D. Disparities in Access to Robotic Knee Arthroplasty: A Geospatial Analysis. J Arthroplasty 2024; 39:864-870. [PMID: 37852446 DOI: 10.1016/j.arth.2023.10.012] [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: 04/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The utilization of robotic knee arthroplasty (RKA) continues to increase across the United States. The aim of this geospatial analysis was to elucidate if RKA is distributed uniformly across the United States or if disparities exist in patient access. METHODS Publicly available provider-finding functions for 5 major manufacturers of RKA systems were used to obtain the practice locations of surgeons performing RKA along with their associated RKA system manufacturer. The average travel distance for each county to the nearest RKA surgeon was calculated and Moran's index clustering analysis was used to find hotspots and coldspots of RKA access. A logistic regression model was used to identify the predictive odds ratios between robotic hotspots and coldspots with county-level sociodemographic variables. Of the 34,216 currently practicing orthopedic surgeons in 2022, 2,571 have access to robotic assistance for knee arthroplasty. RESULTS Hotspots of increased travel time were predominantly in West South Central and West North Central census regions. Hotspots were significantly more rural and consisted of predominantly White populations, with lower median income and health insurance coverage. CONCLUSIONS The results of the current study align with existing literature, demonstrating absolute geographic access disparities for rural and economically disadvantaged populations. Additionally, relative access disparities persist for minority populations and individuals with high comorbidity burdens residing in urban areas.
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Affiliation(s)
- Nicholas J Peterman
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Nicholas Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Rachel Mann
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Richard L Li
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Jacob Gasienica
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Daniel Sun
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
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Diquattro E, Prill R, Salzmann M, Traina F, Becker R. High three-dimensional accuracy of component placement and lower limb alignment using a robotic arm-assisted system and gap-balancing instrument in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:685-692. [PMID: 38415872 DOI: 10.1002/ksa.12088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE It was hypothesized that robotic arm-assisted total knee arthroplasty (RA-TKA) using additionally a gap-balancing instrumentation will show high accuracy in executing the planning in femoral and tibial component placement throughout the range of knee motion (ROM) during TKA surgery. METHODS Prospectively collected data were analysed for patients undergoing RA-TKA. A cruciate retaining cemented design was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded at the beginning of surgery and finally after implantation of the components. A ligament tensioner was inserted after tibial precut to measure the extension and flexion gap, and final component placement was planned based on 3D CT images. Femoral and tibial component placement was measured in all three planes. RESULTS A total of 104 patients were included (mean age 69.4 ± 9 years; 44 male, 60 female). The difference in component placement after planning and final implantation showed less valgus of 0.7° ± 1.4° (p < 0.001), less external rotation of 0.6° ± 1.9° (p = 0.001) and less flexion of 0.9° ± 1.8° (p < 0.001) for the femoral component. The tibial component was placed in more varus of 0.2° ± 0.9° (p = 0.056) and more posterior slope of 0.5° ± 0.9° (p < 0.001). The lower limb alignment in extension was 4.4° ± 5.2° of varus of the native knee and changed to 1.2° ± 1.9° of varus after TKA (p < 0.01). CONCLUSION Robotic-assisted TKA helps to achieve the target of alignment and component placement very close to the planning. It allows optimal component placement of off-the-shelf implants respecting patient's specific anatomy. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Emanuele Diquattro
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Robert Prill
- Department of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Mikhail Salzmann
- Department of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roland Becker
- Department of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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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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43
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Dretakis K, Koutserimpas C. Pitfalls with the MAKO Robotic-Arm-Assisted Total Knee Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:262. [PMID: 38399549 PMCID: PMC10890000 DOI: 10.3390/medicina60020262] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
Robotic-arm-assisted total knee arthroplasty (RATKA) with the MAKO system minimizes deviations in implant alignment and yields superior precision in implant position compared to a manual total knee arthroplasty. In this comprehensive commentary, we present and categorize the limitations and pitfalls of the procedure and we also provide recommendations for avoiding each limitation. The main surgeon-related limitations include prolonged operation duration, loose insertion of the checkpoints and pins, wrong registration and mapping, and damage to soft tissues during bone cutting. The system-related issues include the interruptions of the saw-cutting due to vibrations, specifications for the operating room floor and power supply, the high cost of the system, as well as the cost of each operation due to the extra implants, inability to use the system with various prostheses, wireless connection interruptions between the system's components, and hardware issues with the six joints of the robotic device. In order to circumvent the potential challenges in this surgical procedure, it is essential to possess sufficient experience and undergo comprehensive training. Maintaining continuous awareness of the additional implants throughout the entire operation and prioritizing the preservation of soft tissues are of paramount significance. A profound comprehension of the system and its inherent constraints can also prove to be pivotal in certain situations.
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Affiliation(s)
- Konstantinos Dretakis
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 15123 Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av 3, 11525 Athens, Greece
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Haddad FS. Time to challenge some entrenched practice. Bone Joint J 2024; 106-B:108-110. [PMID: 38295851 DOI: 10.1302/0301-620x.106b2.bjj-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
- The Bone & Joint Journal , London, UK
- The NIHR Biomedical Research Centre, UCLH, London, UK
- The Princess Grace Hospital, London, UK
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45
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Khatri C, Metcalfe A, Wall P, Underwood M, Haddad FS, Davis ET. Robotic trials in arthroplasty surgery. Bone Joint J 2024; 106-B:114-120. [PMID: 38295854 DOI: 10.1302/0301-620x.106b2.bjj-2023-0711.r1] [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: 02/08/2024]
Abstract
Total hip and knee arthroplasty (THA, TKA) are largely successful procedures; however, both have variable outcomes, resulting in some patients being dissatisfied with the outcome. Surgeons are turning to technologies such as robotic-assisted surgery in an attempt to improve outcomes. Robust studies are needed to find out if these innovations are really benefitting patients. The Robotic Arthroplasty Clinical and Cost Effectiveness Randomised Controlled Trials (RACER) trials are multicentre, patient-blinded randomized controlled trials. The patients have primary osteoarthritis of the hip or knee. The operation is Mako-assisted THA or TKA and the control groups have operations using conventional instruments. The primary clinical outcome is the Forgotten Joint Score at 12 months, and there is a built-in analysis of cost-effectiveness. Secondary outcomes include early pain, the alignment of the components, and medium- to long-term outcomes. This annotation outlines the need to assess these technologies and discusses the design and challenges when conducting such trials, including surgical workflows, isolating the effect of the operation, blinding, and assessing the learning curve. Finally, the future of robotic surgery is discussed, including the need to contemporaneously introduce and evaluate such technologies.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Warwick Orthopaedics Specialist Training Programme, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Andrew Metcalfe
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Warwick Orthopaedics Specialist Training Programme, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Peter Wall
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Warwick Orthopaedics Specialist Training Programme, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Bone & Joint Journal , London, UK
| | - Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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46
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Sershon R. CORR Insights®: Robotic-assisted TKA is Not Associated With Decreased Odds of Early Revision: An Analysis of the American Joint Replacement Registry. Clin Orthop Relat Res 2024; 482:311-312. [PMID: 38112613 PMCID: PMC10776142 DOI: 10.1097/corr.0000000000002863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Robert Sershon
- Orthopaedic Surgeon, Anderson Orthopaedic Research Institute, Alexandria, VA, USA
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47
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Chen JB, Borsinger TM, Chalmers BP, Debbi EM. Joint Replacement Technology in the Ambulatory Surgery Center: Current and Future Applications. HSS J 2024; 20:18-21. [PMID: 38356759 PMCID: PMC10863591 DOI: 10.1177/15563316231209500] [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: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 02/16/2024]
Abstract
Total joint replacement (TJR) surgery in the ambulatory surgery centers (ASCs) has grown significantly over the past several years, along with the ability to improve the value of care. Standardization of high-quality, perioperative care is pivotal to the success of a TJR ASC program. As surgeons are experiencing increasing overhead with decreasing reimbursement, technology integration can provide major advantages. In this article, we will therefore highlight several examples of technologies that are changing the field and improving care in the preoperative, intraoperative, and postoperative settings.
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Affiliation(s)
- James B Chen
- Mission Orthopedic Institute, Providence Mission Hospital, Mission Viejo, CA, USA
| | - Tracy M Borsinger
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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48
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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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Howell SM, Sappey-Marinier E, Niesen AE, Nedopil AJ, Hull ML. Better forgotten joint scores when the angle of the prosthetic trochlea is lateral to the quadriceps vector in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5438-5445. [PMID: 37792084 DOI: 10.1007/s00167-023-07598-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The primary aim was to analyze unrestricted kinematic alignment (unKA) total knee arthroplasty (TKA) and determine the frequency of medial deviation of the prosthetic trochlear angle (PTA) of the femoral component relative to the quadriceps vector (QV) that terminates at the anterior inferior iliac spine (AIIS), and whether patients with medial deviation had a worse Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) relative to those with lateral deviation. The secondary aim was to determine the frequency of medial deviation for mechanical alignment (MA) TKA simulations. METHODS From a database of a single surgeon, the study extracted de-identified data on 147 patients with a CT scanogram showing the pelvis and AIIS, a limb with an unKA TKA, and a native (i.e., healthy) opposite limb. On the scanogram, an examiner, blinded to the PROMs, measured the PTA-QV angle on the unKA TKA and on the opposite limb simulated MA TKA by drawing the PTA at 6° valgus relative to the femoral mechanical axis and measuring the PTA-QV angle. RESULTS Medial deviation of the PTA occurred in 86% of patients with unKA TKA, and the 126 with medial deviation had a 17/1 point worse median FJS/OKS than the 21 with lateral deviation at a mean follow-up of 47 ± 8 months, respectively (p < 0.0001, p = 0.0053). In addition, 21%, 17%, and 8% of MA TKA had medial deviation after radiographic simulation using reported surgical errors for manual, patient-specific, and robotic instrumentation, respectively. CONCLUSION In most patients with unKA TKA and a smaller proportion with MA TKA, a PTA of 6° valgus was medial to the QV, which, by excluding the patient's Q-angle, might alter patellofemoral kinematics like an incorrectly oriented trochleoplasty. The 17-point worse FJS in the patients with an unKA TKA and medial deviation of the PTA suggests the surgical target should be to orient the PTA lateral to the QV. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
| | - Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, 94143, USA.
- Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 69008, Lyon, France.
| | - Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
| | - Alexander J Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074, Würzburg, Germany
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
- Department of Orthopedic Surgery, University of California, Davis Medical Center, Sacramento, CA, 95817, USA
- Department of Mechanical Engineering, University of California, Davis, CA, 95616, USA
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50
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Sinno E, Panegrossi G, Rovere G, Cavallo AU, Falez F. Influence of posterior tibial slope on postoperative outcomes after postero-stabilized and condylar-stabilized total knee arthroplasty. Musculoskelet Surg 2023; 107:385-390. [PMID: 36370251 DOI: 10.1007/s12306-022-00768-5] [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: 01/21/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To compare clinical outcomes and surgical times of two different types of total knee arthroplasty(TKA), postero-stabilized(PS) and condylar-stabilized(CS), in relation to posterior tibial slope(PTS) values and the deviation of these values from the surgical technique. METHODS 168 patients undergoing TKA surgery between 2016 and 2020 met our inclusion criteria. For each case, gender, age at surgery, operating time, type of implant and preoperative PTS(preop-PTS) and postoperative PTS(postop-PTS) measurements were collected; difference(∆PTS) between preop-PTS and postop-PTS was also calculated. Short Form 12 Mental and Physical scores(SF-12 M and P) and functional Knee Society Score(fKSS) were collected preoperatively and at a minimum of 12 months postoperatively. Four subgroups were thus created in relation to PS or CS system and postop-PTS value(≤ 5°and > 5°). RESULTS Of the 168 patients, 96 had a PS system and 72 CS system. Performing a CS-TKA took less time than a PS-TKA(p < 0.05). SF-12P showed better results(p < 0.05) in CS-TKA group than PS-TKA, probably because of the younger age of CS-TKA patients(p < 0.05). In the PS > 5° all examined postoperative scores were better(p < 0.05) than PS ≤ 5°, while only fKSS was better(p < 0.05) in CS > 5° than CS ≤ 5°. No significant difference(p > 0.05) in terms of postoperative outcomes between the PS > 5° and CS > 5° was noted, whereas only SF-12P was better in the CS ≤ 5° compared with PS ≤ 5°. Highest values of SF-12 M and fKSS were obtained in the PS ≤ 5°, in which postop-PTS was closer to technique. CONCLUSION When performing a PS-TKA, the best result was obtained with a postop-PTS > 5°, but comparable outcomes between the two systems were evident with postop-PTS > 5°. It is crucial to come as close as possible to the indications reported in surgical technique regardless ∆PTS.
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Affiliation(s)
- E Sinno
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy.
| | - G Panegrossi
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy
| | - G Rovere
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia 1, 00193, Rome, Italy
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - A U Cavallo
- Department of Biomedicine and Prevention, University "Tor Vergata", Rome, Italy
- Division of Radiology, San Carlo Di Nancy Hospital", GVM Care and Research, Rome, Italy
| | - F Falez
- Department of Orthopaedics and Traumatology, S. Filippo Neri Hospital, ASL Roma 1 Martinotti 20, 00135, Rome, Via G, Italy
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