1
|
An HM, Cao Z, Zhang S, Yang MZ, Kong XP, Chai W. Why robot-assisted total hip arthroplasty aborted: Chinese experience of four hundred and twenty nine consecutive cases. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06250-0. [PMID: 39012414 DOI: 10.1007/s00264-024-06250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Robot-assisted total hip arthroplasty (RA-THA) helps with precise orientation of the prosthesis, but some RA-THA procedures are aborted intraoperatively and are converted to manual total hip arthroplasty (THA). This study aimed to analyse why RA-THA is sometimes aborted intraoperatively and to make recommendations accordingly. METHODS A total of 429 consecutive Mako THA cases in our prospective database from August 2018 to June 2021 were included in our study. All robotic procedures aborted intraoperatively for any reason were recorded. The patients' demographics, diagnoses, and surgeons' information were included in the statistical analysis to pinpoint the risk factors for intraoperative robot to manual conversion. RESULTS Intraoperative RA-THA abortions occurred in 17 cases (3.96%) and the patients had to be converted to manual THA. The adverse events leading to intraoperative abortions included pelvic array loosening or malposition (5, 1.17%), inaccurate bone mapping or construction (6, 1.40%), inaccurate initial registration (4, 0.93%), and other reasons (2, 0.47%). CONCLUSION Robot-related adverse events could be found in all perioperative steps of RA-THA, and some of these events might result in intraoperative abortion. Complex hip disease was a statistically significant factor for an increased risk of intraoperative abortion of RA-THA. Standardized surgical procedures and preoperative assessments can be helpful in reducing the rate of RA-THA abortions.
Collapse
Affiliation(s)
- Hao-Ming An
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Zheng Cao
- School of Medicine, Nankai University, Tianjin, China
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Shuai Zhang
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- Department of Orthopedics, 969th Hospital of Joint Logistics Support Force of PLA, Hohhot, 010051, China
| | - Min-Zhi Yang
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Xiang-Peng Kong
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| |
Collapse
|
2
|
Carrino JA, Ibad H, Lin Y, Ghotbi E, Klein J, Demehri S, Del Grande F, Bogner E, Boesen MP, Siewerdsen JH. CT in musculoskeletal imaging: still helpful and for what? Skeletal Radiol 2024:10.1007/s00256-024-04737-w. [PMID: 38969781 DOI: 10.1007/s00256-024-04737-w] [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: 03/25/2024] [Revised: 06/17/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
Computed tomography (CT) is a common modality employed for musculoskeletal imaging. Conventional CT techniques are useful for the assessment of trauma in detection, characterization and surgical planning of complex fractures. CT arthrography can depict internal derangement lesions and impact medical decision making of orthopedic providers. In oncology, CT can have a role in the characterization of bone tumors and may elucidate soft tissue mineralization patterns. Several advances in CT technology have led to a variety of acquisition techniques with distinct clinical applications. These include four-dimensional CT, which allows examination of joints during motion; cone-beam CT, which allows examination during physiological weight-bearing conditions; dual-energy CT, which allows material decomposition useful in musculoskeletal deposition disorders (e.g., gout) and bone marrow edema detection; and photon-counting CT, which provides increased spatial resolution, decreased radiation, and material decomposition compared to standard multi-detector CT systems due to its ability to directly translate X-ray photon energies into electrical signals. Advanced acquisition techniques provide higher spatial resolution scans capable of enhanced bony microarchitecture and bone mineral density assessment. Together, these CT acquisition techniques will continue to play a substantial role in the practices of orthopedics, rheumatology, metabolic bone, oncology, and interventional radiology.
Collapse
Affiliation(s)
- John A Carrino
- Weill Cornell Medicine, New York, NY, USA.
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Hamza Ibad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Elena Ghotbi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joshua Klein
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Shadpour Demehri
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 5165, Baltimore, MD, 21287, USA
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
| | - Eric Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mikael P Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, Entrance 7A, 3Rd Floor, 2400, Copenhagen, NV, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey H Siewerdsen
- Department of Imaging Physics, Institute for Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
3
|
Kokubu Y, Kawahara S, Mizu‐Uchi H, Hamai S, Akasaki Y, Sato T, Ishibashi S, Konishi T, Nakashima Y. Component rotational mismatch in the standing position is a potential risk factor for unfavourable functional outcomes after total knee arthroplasty. J Exp Orthop 2024; 11:e12069. [PMID: 38957227 PMCID: PMC11217670 DOI: 10.1002/jeo2.12069] [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: 04/19/2024] [Revised: 05/20/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose This study assessed rotational mismatch between components after total knee arthroplasty (TKA) in the supine and standing positions and aimed to investigate the effect of rotational mismatch in the standing position on postoperative patient-reported outcome measures (PROMs). Methods Seventy-one patients (71 knees) who underwent TKA for medial knee osteoarthritis were used to investigate rotational mismatches between components. Rotational mismatches between components were examined on postoperative standing whole-leg and supine knee radiographs using a three-dimensional-to-two-dimensional model image registration technique, and the angles between the reference axes of the components were measured. Component alignment was evaluated using postoperative computed tomography images, and a questionnaire (2011 version of the Knee Society Score: [KSS 2011]) was mailed to investigate postoperative PROMs. Results In the entire cohort, rotational mismatches in the supine and standing positions were similar (p = 0.9315). In 15% of patients, the mismatch was large (>5°) in the supine position but small (<5°) in the standing position (overestimated group). However, in 23% of patients, the mismatch was small (<5°) in the supine position and large (>5°) in the standing position (underestimated group). The underestimated group had severe preoperative varus deformity, resulting in external rotation of both femoral and tibial components. Rotational mismatch in the standing position (p = 0.0032) was a significant risk factor for unfavourable PROMs. Patients with a mismatch in the standing position had significantly lower scores than those without a mismatch (p = 0.0215), exceeding the minimal clinically important difference values. Conclusions The underestimated group is clinically important because the surgical procedure and intraoperative assessment of component placement are performed in the supine position. In cases of severe preoperative varus deformity, care should be taken not to place the component in malrotation to avoid rotational mismatch in the standing position. Level of Evidence Ⅳ, Case series.
Collapse
Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hideki Mizu‐Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yukio Akasaki
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Department of Orthopaedic SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
| | - Toshiki Konishi
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| |
Collapse
|
4
|
Levin JM, Lorentz SG, Hurley ET, Lee J, Throckmorton TW, Garrigues GE, MacDonald P, Anakwenze O, Schoch BS, Klifto C. Artificial intelligence in shoulder and elbow surgery: overview of current and future applications. J Shoulder Elbow Surg 2024; 33:1633-1641. [PMID: 38430978 DOI: 10.1016/j.jse.2024.01.033] [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: 11/22/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 03/05/2024]
Abstract
Artificial intelligence (AI) is amongst the most rapidly growing technologies in orthopedic surgery. With the exponential growth in healthcare data, computing power, and complex predictive algorithms, this technology is poised to aid providers in data processing and clinical decision support throughout the continuum of orthopedic care. Understanding the utility and limitations of this technology is vital to practicing orthopedic surgeons, as these applications will become more common place in everyday practice. AI has already demonstrated its utility in shoulder and elbow surgery for imaging-based diagnosis, predictive modeling of clinical outcomes, implant identification, and automated image segmentation. The future integration of AI and robotic surgery represents the largest potential application of AI in shoulder and elbow surgery with the potential for significant clinical and financial impact. This editorial's purpose is to summarize common AI terms, provide a framework to understand and interpret AI model results, and discuss current applications and future directions within shoulder and elbow surgery.
Collapse
Affiliation(s)
- Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Samuel G Lorentz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Julia Lee
- Department of Orthopedic Surgery, Sierra Pacific Orthopedics, Fresno, CA, USA
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Germantown, TN, USA
| | | | - Peter MacDonald
- Section of Orthopaedic Surgery & The Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
5
|
Mancino F, Fontalis A, Grandhi TSP, Magan A, Plastow R, Kayani B, Haddad FS. Robotic arm-assisted conversion of unicompartmental knee arthroplasty to total knee arthroplasty. Bone Joint J 2024; 106-B:680-687. [PMID: 38945538 DOI: 10.1302/0301-620x.106b7.bjj-2023-0943.r2] [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: 07/02/2024]
Abstract
Aims Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up. Methods This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36). Results There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439). Conclusion Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
Collapse
Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Tarani S P Grandhi
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
| |
Collapse
|
6
|
Zhang X, Shen X, Zhang R, Chen M, Ma R, Zhang Z, Zhang H, Yang B, Zhu C. Radiographic evaluation of robot-assisted versus manual total hip arthroplasty: a multicenter randomized controlled trial. J Orthop Traumatol 2024; 25:33. [PMID: 38926175 PMCID: PMC11208392 DOI: 10.1186/s10195-024-00773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The effectiveness of robot-assisted surgery remains contentious due to the lack of high-quality randomized controlled trials (RCTs) to elevate the level of evidence. We aimed to evaluate the postoperative radiographic outcomes of robot-assisted (RAS-THA) versus manual (M-THA) total hip arthroplasty. METHODS This multicenter RCT was performed from March 1, 2021 to December 1, 2021. Patients were randomly assigned to routine M-THA or to RAS-THA that used the TRex-RS orthopedic joint surgical navigation system. The primary outcome was to compare the acetabular component orientation, femoral stem alignment, femoral canal fill ratio, and leg length discrepancy between RAS-THA and M-THA using postoperative radiography. Subgroup analyses of the two groups stratified by surgical approach, gender, and BMI were also conducted. RESULTS Seventy-three participants were randomly allocated to the RAS-THA group, while seventy-two participants were assigned to the M-THA group. Compared to the M-THA group, the RAS-THA group exhibited less variability in the preoperative planning of the vertical center of rotation (VCOR; P < 0.001), demonstrated a significant advantage in femoral stem alignment (P = 0.004), and showed pronounced decreases in inequality and in the variability in leg length discrepancy (P < 0.001). There was no significant difference in the Lewinnek safe-zone ratio (P = 0.081) and the femoral canal fill ratio (P > 0.05) between the two groups. Further subgroup analysis also showed that the RAS-THA group had fewer horizontal center of rotation (HCOR) and leg length differences when stratified by surgical approach, gender, and overweight status. CONCLUSION This RCT found that, regardless of the surgical approach, gender, or body mass index, RAS-THA can effectively improve the postoperative VCOR and significantly reduce the variability of leg length difference. RAS-THA should be considered an effective method to enhance surgical precision by achieving less variability in challenging patients with leg length discrepancies. TRIAL REGISTRATION ChiCTR2100044124.
Collapse
Affiliation(s)
- Xianzuo Zhang
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xianyue Shen
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Rongwei Zhang
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Mo Chen
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Ruixiang Ma
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Bo Yang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, 261000, People's Republic of China.
| | - Chen Zhu
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
| |
Collapse
|
7
|
Ma N, Sun P, Xin P, Zhong S, Xie J, Xiao L. Comparison of the efficacy and safety of MAKO robot-assisted total knee arthroplasty versus conventional manual total knee arthroplasty in uncomplicated unilateral total knee arthroplasty a single-centre retrospective analysis. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06234-0. [PMID: 38874668 DOI: 10.1007/s00264-024-06234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To compare the efficacy and safety of MAKO robot-assisted total knee arthroplasty (MA-TKA) with conventional manual total knee arthroplasty (CM-TKA) in patients with end-stage knee osteoarthritis (KOA) during the early postoperative period. METHOD A retrospective analysis was conducted on 22 patients with KOA who underwent MA-TKA and 26 patients who underwent CM-TKA from April 2023 to July 2023. Hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), American Knee Society Score (AKSS), Forgotten Joint Score-12 (FJS-12), visual analogue scale (VAS), and postoperative complications were recorded and compared between the two groups. RESULT Both groups successfully completed the surgeries. In terms of radiographic parameters, postoperative one month LDFA and HKA in the MA-TKA group were significantly lower than those in the CM-TKA group (P < 0.05). At the one month follow-up, 19 patients (86.4%) in the MA-TKA group had an HKA less than 3°, compared to 20 patients (76.9%) in the CM-TKA group. Clinically, VAS scores at 24 h, 48 h, and 72 h postoperatively were lower in the MA-TKA group both at rest and during activity. At one month and three months postoperatively, AKSS Function Scores and FJS-12 scores in the MA-TKA group were significantly higher than those in the CM-TKA group (P < 0.05). Regarding postoperative complications, no complications occurred in the MA-TKA group, while one patient in the CM-TKA group experienced postoperative knee stiffness, which resolved after physical therapy, with no statistically significant difference (P > 0.05). CONCLUSION Compared with conventional manual total knee arthroplasty, MAKO robot-assisted TKA demonstrates better short-term clinical efficacy, achieves better alignment planning, and maintains good safety.
Collapse
Affiliation(s)
- Nanshan Ma
- Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Pengfei Sun
- Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Pengfei Xin
- Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Sheng Zhong
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Jun Xie
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China
| | - Lianbo Xiao
- Department of Orthopedic Surgery, Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, People's Republic of China.
| |
Collapse
|
8
|
Zheng H, Chen M, Yang D, Shao H, Zhou Y. Robotic-assisted differential total knee arthroplasty with patient-specific implants: surgical techniques and preliminary results. ARTHROPLASTY 2024; 6:34. [PMID: 38853256 PMCID: PMC11163793 DOI: 10.1186/s42836-024-00255-1] [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: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE In total knee arthroplasty (TKA), achieving soft-tissue balance while retaining acceptable lower limb alignment is sometimes difficult and may lead to patient dissatisfaction. Theoretically, patient-specific implants can bring great benefits, while the lack of precise surgical tools may hinder the improvement of outcomes. The objective of this study was to illustrate surgical techniques and evaluate kinematics and early clinical outcomes of robotic-assisted TKA using patient-specific implants. METHODS Based on preoperative CT scan, femoral and tibial components were 3D printed. Medial and lateral tibial liners were separate with different thicknesses, posterior slopes and conformity. TiRobot Recon Robot was used for surgery, and was armed with smart tools that quantify gap, force and femoral-tibial track. We collected data on demographics, intraoperative gap balance and femoral-tibial motion. In the follow-up, we evaluated the range of motion, Visual Analogue Scale (VAS), forgotten joint score (FJS), Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) score. Radiological data were also harvested. RESULTS Fifteen patients (17 knees) were enrolled with a mean age of 64.6 ± 6.4 (53-76) years. In 5 knees, we used symmetric tibial liners, the rest were asymmetric. After surgery, the average alignment was 1.6 ± 2.0 (-3-5) degrees varus. The average follow-up lasted 6.7 ± 4.2 (1-14) months. The mean visual analogue scale was 0.8 ± 0.7 (0-2), FJS was 62.4 ± 25.3 (0-87), KOOS was 86.5 ± 9.4 (57-97). 11 patients were "very satisfied", 3 were "satisfied" with the result, and one patient was neutral due to restricted extension and unsatisfactory rehabilitation at five months' follow-up. CONCLUSIONS With patient-specific implants and robotics, TKA could be performed by a mathematical way, which was dubbed a "differential" TKA. Intraoperative kinematics was excellent in terms of gap-force balancing and femoral-tibial relative motion. Preliminary clinical outcomes were overall satisfactory.
Collapse
Affiliation(s)
- Hanlong Zheng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Mingxue Chen
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Grant AR, Zvi YS, Michalowski AK, Mattingly DA, Smith EL. The Relative Importance of Factors That Applicants Weigh When Ranking Adult Reconstruction Fellowships as Well as Their Perspectives on Robotic-Assisted Arthroplasty. J Arthroplasty 2024; 39:1609-1615.e2. [PMID: 38103804 DOI: 10.1016/j.arth.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Orthopedic Surgery Fellowship programs offer highly specialized training that varies based on the training environment and surgical experience. Additionally, for Adult Reconstruction programs, robotic-assisted surgery exposure has been a widely discussed topic. The purpose of this study was to determine the relative value of various factors to Adult Hip and Knee Fellowship applicants, and their perceptions of robotic-assisted arthroplasty. METHODS We surveyed 780 applicants who applied to our fellowship to matriculate in 2020 to 2024. We received 158 responses (20.3% response rate). We assessed factors concerning people and perceptions, logistics, salary and benefits, program reputation and curriculum, and surgical experience. Additionally, we surveyed fellows' attitudes toward using robotic surgery and its impact on patient outcomes. RESULTS The highest-rated factors were Level of Hands-On Operative Experience (4.83), Revision Hip Volume (4.72), Revision Knee Volume (4.71), Multiple Surgical Exposures to the Hip (4.59), and Clinical Case Variety (4.59). Respondents who were postfellowship matriculation placed significantly more value on Exposure to Multiple Attendings with Surgical Diversity (P = .01), and Anterior Hip Volume (P = .04), and less value on Geographic Location (P = .04) and Patient-Specific Instrumentation (P = .02) than prematriculates. Overall, 65% of applicants plan to or currently use robotics, 7.6% do not, and 27.2% said "Maybe". Those who plan to or currently use robotics most cited procedure fidelity, patient-preference, and marketability as reasons to use robotics. CONCLUSIONS Hands-on surgical experience and revision volume were the most important factors for fellowship applicants. Applicants placed lower importance on robotics exposure and their perspectives on robotics in their future practice were highly variable. Our results will inform fellowship programs and future applicants what previous applicants have valued in their training to help guide fellowship program structure, resource management, as well as recruitment.
Collapse
Affiliation(s)
- Andrew R Grant
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts; School of Medicine, New York Medical College, Valhalla, New York
| | - Yoav S Zvi
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Anna K Michalowski
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - David A Mattingly
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Eric L Smith
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Lundgren LS, Willems N, Marchand RC, Batailler C, Lustig S. Surgical factors play a critical role in predicting functional outcomes using machine learning in robotic-assisted total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38819941 DOI: 10.1002/ksa.12302] [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: 03/24/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE Predictive models help determine predictive factors necessary to improve functional outcomes after total knee arthroplasty (TKA). However, no study has assessed predictive models for functional outcomes after TKA based on the new concepts of personalised surgery and new technologies. This study aimed to develop and evaluate predictive modelling approaches to predict the achievement of minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) 1 year after TKA. METHODS Four hundred thirty robotic-assisted TKAs were analysed in this retrospective study. The mean age was 67.9 ± 7.9 years; the mean body mass index (BMI) was 32.0 ± 6.8 kg/m2. The following PROMs were collected preoperatively and 1-year postoperatively: knee injury and osteoarthritis outcome score for joint replacement, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) Function, WOMAC Pain. Demographic data, preoperative CT scan, implant size, implant position on the robotic system and characteristics of the joint replacement procedure were selected as predictive variables. Four machine learning algorithms were trained to predict the MCID status at 1-year post-TKA for each PROM survey. 'No MCID' was chosen as the target. Models were evaluated by class discrimination (F1-score) and area under the receiver operating characteristic curve (ROC-AUC). RESULTS The best-performing model was ridge logistic regression for WOMAC Function (area under the curve [AUC] = 0.80, F1 = 0.48, sensitivity = 0.79, specificity = 0.62). Variables most strongly contributing to not achieving MCID status were preoperative PROMs, high BMI and femoral resection depth (posterior and distal), supporting functional positioning principles. Conversely, variables contributing to a positive outcome (achieving MCID) were medial/lateral alignment of the tibial component, whether the procedure was an outpatient surgery and whether the patient received managed Medicare insurance. CONCLUSION The most predictive variables included preoperative PROMs, BMI and surgical planning. The surgical predictive variables were valgus femoral alignment and femoral rotation, reflecting the benefits of personalised surgery. Including surgical variables in predictive models for functional outcomes after TKA should guide clinical and surgical decision-making for every patient. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | | | - Robert C Marchand
- Orthopedic Surgery Department, South County Orthopaedics, Ortho Rhode Island, Wakefield, Rhode Island
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Univ Lyon, IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Univ Lyon, IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Villeurbanne, France
| |
Collapse
|
13
|
Cheng R, Kim B, Taylor WL, Westrich GH, Shen TS. Robotic-assisted total knee arthroplasty is associated with the use of thinner polyethylene liners compared to navigation-guided and manual techniques. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38738862 DOI: 10.1002/ksa.12228] [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: 03/03/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE The purpose of this study was to examine the effects of intraoperative technology use on the rate of using polyethylene liners 15 mm or greater during primary total knee arthroplasty (TKA). METHODS There were 103,295 implants from 16,386 primary unilateral TKAs performed on 14,253 patients at a single institution between 1 January 2018, and 30 June 2022, included in the current study. Robotic assistance and navigation guidance were used in 1274 (8%) and 8345 (51%) procedures, respectively. The remaining 6767 TKAs (41%) were performed manually. Polyethylene liners were manually identified and further subcategorised by implant thickness. Patients who underwent robotic-assisted TKA were younger (p < 0.001) and more likely to be male (p < 0.001) compared to patients who underwent navigation-guided or manual TKAs. RESULTS Average polyethylene liner thickness was similar between groups (10.5 ± 1.5 mm for robotic-assisted TKAs, 10.9 ± 1.8 mm for navigation-guided TKAs and 10.8 ± 1.8 mm for manual TKAs). The proportions of polyethylene liners 15 mm or greater used were 4.9%, 3.8% and 1.9% for navigation-guided, manual and robotic-assisted procedures, respectively (p < 0.001). Multivariate regression analyses demonstrated that navigation-guided (odds ratio [OR]: 2.6, 95% confidence Interval [CI]: [1.75-4.07], p < 0.001) and manual (OR: 2.0, 95% CI: [1.34-3.20], p = 0.001) procedures were associated with an increased use of polyethylene liners 15 mm or greater. CONCLUSION Robotic-assisted TKA was associated with a lower proportion of polyethylene liners 15 mm or greater used compared to navigation-guided and manual TKA. These findings suggest that robotic assistance can reduce human error via a more precise cutting system, limit over-resection of the tibia and flexion-extension gap mismatch and ultimately allow for more appropriately sized implants. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Ryan Cheng
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Billy Kim
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Walter L Taylor
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Geoffrey H Westrich
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
14
|
Zhou G, Wang X, Geng X, Li Z, Tian H. Comparison of Alignment Accuracy and Clinical Outcomes between a CT-Based, Saw Cutting Robotic System and a CT-Free, Jig-guided Robotic System for Total Knee Arthroplasty. Orthop Surg 2024; 16:1168-1174. [PMID: 38584130 PMCID: PMC11062876 DOI: 10.1111/os.14055] [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: 10/01/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE The different cutting mode of robot-assisted TKAs may influence the accuracy of alignment. The purpose of this study was to compare alignment accuracy and early clinical outcomes between a CT-based, saw cutting robotic system (MAKO) and a CT-free, jig-guided robotic system (ROSA) for total knee arthroplasty (TKA). METHODS A total of 20 MAKO TKAs and 20 ROSA TKAs from June 2021 to June 2022 were retrospectively analyzed. Differences in the postoperative hip-knee-ankle (HKA) angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior tibial slope (PTS) and 3° outlier frequency of the HKA, LDFA, MPTA and PTS were studied at 3 months and 1 year of follow-up. The operative time and total blood loss (TBL) were compared between these two groups. Clinical outcomes at 1 year after surgery, including range of motion (ROM), Western Ontario McMaster University Osteoarthritis Index (WOMAC) score, and Knee Society Score-2011 (KSS-2011), were also compared between these two groups. RESULTS The baseline characteristics of the two groups were comparable. There were no significant differences in the mean deviations of postoperative HKA, LDFA, MPTA or PTS between the two groups at 3 months or 1 year (all ps > 0.05). Moreover, there was no significant difference in the percentage of 3° outliers for HKA, LDFA, MPTA, or PTS between the two groups at 3-month or 1-year follow-up (all ps > 0.05). The mean operation time of MAKO was longer than that of ROSA (112.7 ± 12.8 min vs 94.8 ± 23.0 min, p = 0.001), but the mean TBL (1356.7 ± 648.5 mL vs 1384.5 ± 676.3 mL) and transfusion rate (15.0% vs 5.0%) were not significantly different between the two groups (all ps > 0.05). No significant differences were found in postoperative ROM, WOMAC score or KSS score at 1 year (all ps > 0.05). CONCLUSION The MAKO and ROSA had similar accuracy and precision in TKA alignment. The clinical outcomes at 1 year after surgery were also comparable.
Collapse
Affiliation(s)
- Ge Zhou
- Department of OrthopedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Xinguang Wang
- Department of OrthopedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Xiao Geng
- Department of OrthopedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Zijian Li
- Department of OrthopedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| | - Hua Tian
- Department of OrthopedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
| |
Collapse
|
15
|
Li S, Bao YG, Wu B. Letter to the editor regarding the article "artificial intelligence and computer-assisted navigation for shoulder surgery". J Orthop Surg (Hong Kong) 2024; 32:10225536241263656. [PMID: 38871346 DOI: 10.1177/10225536241263656] [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] [Indexed: 06/15/2024] Open
Affiliation(s)
- Shu Li
- Department of Clinical Medicine, Jining Medical University, Jining City, China
| | - Yong-Gang Bao
- Department of Clinical Medicine, Jining Medical University, Jining City, China
| | - Bin Wu
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, China
| |
Collapse
|
16
|
Ollivier B, Wakelin E, Plaskos C, Vandenneucker H, Luyckx T. Widening of tibial resection boundaries increases the rate of femoral component valgus and internal rotation in functionally aligned TKA. Knee Surg Sports Traumatol Arthrosc 2024; 32:953-962. [PMID: 38444096 DOI: 10.1002/ksa.12118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE The purpose of this study was to investigate the influence of increasing the tibial boundaries in functional alignment on femoral component orientation in total knee arthroplasty (TKA). METHODS A retrospective review of a database of robotic-assisted TKAs using a digital joint tensioning device was performed (BalanceBot®; Corin). A total of 692 TKAs with correctable deformity were included. Functional alignment with a tibia-first balancing technique was simulated by performing an anatomic tibial resection to recreate the native medial proximal tibial angle within certain boundaries (A, 87-90°; B, 86-90°; C, 84-92°), while accounting for wear. After balancing the knee, the resulting amount of femoral component outliers in the coronal and axial plane was calculated for each group and correlated to the coronal plane alignment of the knee (CPAK) classification. RESULTS The proportion of knees with high femoral component varus (>96°) or valgus (<87°) alignment increased from 24.5% (n = 170) in group A to 26.5% (n = 183) in group B and 34.2% (n = 237) in group C (p < 0.05). Similarly, more knees with high femoral component external rotation (>6°) or internal rotation (>3°) were identified in group C (33.4%, n = 231) than in group B (23.7%, n = 164) and A (18.4%, n = 127) (p < 0.05). There was a statistically significant (p < 0.01) overall increase in knees with both femoral component valgus <87° and internal rotation >3° from group A (4.0%, n = 28) to B (7.7%, n = 53) and C (15.8%, n = 109), with CPAK type I and II showing a 12.9- and 2.9-fold increase, respectively. CONCLUSION Extending the tibial boundaries when using functional alignment with a tibia-first balancing technique in TKA leads to a statistically significant higher percentage of knees with a valgus lateral distal femoral angle < 87° and >3° internal rotation of the femoral component, especially in CPAK type I and II. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Britt Ollivier
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Hilde Vandenneucker
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Thomas Luyckx
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| |
Collapse
|
17
|
Richardson MK, DiGiovanni RM, McCrae BK, Cooperman WS, Ludington J, Heckmann ND, Oakes DA. Robotic-Assisted Total Knee Arthroplasty in Obese Patients. Arthroplast Today 2024; 26:101320. [PMID: 38404408 PMCID: PMC10885316 DOI: 10.1016/j.artd.2024.101320] [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: 09/11/2023] [Revised: 11/14/2023] [Accepted: 01/21/2024] [Indexed: 02/27/2024] Open
Abstract
Background Robotic-assisted systems have gained popularity in total knee arthroplasty (TKA). The purpose of this study was to evaluate operative characteristics and radiographic outcomes of obese patients undergoing robotic-assisted TKA. Methods A retrospective review of consecutive cases performed by a single surgeon was performed from January 1, 2016, to January 31, 2022. Adult patients with body mass index ≥35 kg/m2 who underwent primary TKA using a computed tomography-assisted robotic system were compared to patients who underwent primary TKA using conventional instrumentation. Demographics, preoperative and postoperative radiographic measurements, and intraoperative outcomes were compared between cohorts. In total, 119 patients were identified, 60 in the robotic-assisted cohort and 59 in the conventional instrumentation cohort. Results Age, body mass index, and estimated blood loss were not significantly different between the cohorts. The robotic-assisted cohort experienced longer tourniquet times (93.3 vs 75.5 minutes, P < .001). Preoperative hip-knee-ankle angle (HKA) was similar between the robotic-assisted and conventional cohorts (8.4° ± 4.9° vs 9.3° ± 5.3°, P = .335). Postoperative HKA was 2.0° ± 1.4° in the robotic-assisted group and 3.1° ± 3.23° in the conventional group (P = .040). The proportion of patients with postoperative HKA > 3° of varus or valgus was 9 of 60 (15.0%) in the robotic-assisted cohort compared to 18 of 59 (30.5%) using conventional instrumentation (P = .043). Conclusions Obese patients treated with robotic-assisted TKA had postoperative alignment closer to neutral and fewer postoperative radiographic outliers than patients treated with conventional instrumentation. The results of this study support use of robotic-assisted technologies in TKA, particularly in obese patients.
Collapse
Affiliation(s)
- Mary K. Richardson
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | - Ryan M. DiGiovanni
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | - Brian K. McCrae
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wesley S. Cooperman
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | - John Ludington
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| | | | - Daniel A. Oakes
- Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
18
|
Cruz J, Gonçalves SB, Neves MC, Silva HP, Silva MT. Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:1613. [PMID: 38475148 DOI: 10.3390/s24051613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.
Collapse
Affiliation(s)
- João Cruz
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Sérgio B Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | | | - Hugo Plácido Silva
- IT-Instituto de Telecomunicações, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| | - Miguel Tavares Silva
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Hu Y, Li X, Chen X, Wang S, Cao L, Zhang H, Zhang Y, Wang Z, Yu B, Tong P, Zhou Q, Niu F, Yang W, Zhang W, Chen S, Yang Q, Shen T, Zhang P, Zhang Y, Miao J, Lin H, Wang J, Wang L, Ma X, Liu H, Stambler I, Bai L, Liu H, Jing Y, Liu G, Wang X, Wang D, Shi Z, Zhao RC, Su J. Expert consensus on Prospective Precision Diagnosis and Treatment Strategies for Osteoporotic Fractures. Aging Dis 2024:AD.2023.1223. [PMID: 38502589 DOI: 10.14336/ad.2023.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/23/2023] [Indexed: 03/21/2024] Open
Abstract
Osteoporotic fractures are the most severe complications of osteoporosis, characterized by poor bone quality, difficult realignment and fixation, slow fracture healing, and a high risk of recurrence. Clinically managing these fractures is relatively challenging, and in the context of rapid aging, they pose significant social hazards. The rapid advancement of disciplines such as biophysics and biochemistry brings new opportunities for future medical diagnosis and treatment. However, there has been limited attention to precision diagnosis and treatment strategies for osteoporotic fractures both domestically and internationally. In response to this, the Chinese Medical Association Orthopaedic Branch Youth Osteoporosis Group, Chinese Geriatrics Society Geriatric Orthopaedics Committee, Chinese Medical Doctor Association Orthopaedic Physicians Branch Youth Committee Osteoporosis Group, and Shanghai Association of Integrated Traditional Chinese and Western Medicine Osteoporosis Professional Committee have collaborated to develop this consensus. It aims to elucidate emerging technologies that may play a pivotal role in both diagnosis and treatment, advocating for clinicians to embrace interdisciplinary approaches and incorporate these new technologies into their practice. Ultimately, the goal is to improve the prognosis and quality of life for elderly patients with osteoporotic fractures.
Collapse
Affiliation(s)
- Yan Hu
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoqun Li
- First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xiao Chen
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Liehu Cao
- Luodian Hospital, Baoshan District, Shanghai, China
| | - Hao Zhang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yunfei Zhang
- Tangdu Hospital Air Force Medical University, Xi'an, China
| | - Zhiwei Wang
- Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Baoqing Yu
- Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Peijian Tong
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Qiang Zhou
- Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Niu
- First Bethune Hospital of Jilin University, Changchun, China
| | - Weiguo Yang
- HKU Li Ka Shing Faculty of Medicine, Hongkong, China
| | - Wencai Zhang
- First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shijie Chen
- Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Tao Shen
- Shengjing Hospital of Chinese Medical University, Shenyang, China
| | - Peng Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yong Zhang
- Tangdu Hospital Air Force Medical University, Xi'an, China
| | - Jun Miao
- Tianjin Hospital, Tianjin, China
| | | | - Jinwu Wang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Wang
- Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ma
- Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Hongjian Liu
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ilia Stambler
- Department of Science, Technology and Society, Bar Ilan University, Ramat Gan, Israel
- International Society on Aging and Disease, Bryan, TX, USA
| | - Long Bai
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Han Liu
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Yingying Jing
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Guohui Liu
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinglong Wang
- Department of Pharmacology & Toxicology, University of Arizona, Tucson, USA
| | - Dongliang Wang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongmin Shi
- Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Robert Chunhua Zhao
- International Society on Aging and Disease, Bryan, TX, USA
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jiacan Su
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| |
Collapse
|
21
|
Cornish BM, Diamond LE, Saxby DJ, Lloyd DG, Shi B, Lyon J, Abbruzzese K, Gallie P, Maharaj J. Sagittal plane knee kinematics can be measured during activities of daily living following total knee arthroplasty with two IMU. PLoS One 2024; 19:e0297899. [PMID: 38359050 PMCID: PMC10868843 DOI: 10.1371/journal.pone.0297899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Knee function is rarely measured objectively during functional tasks following total knee arthroplasty. Inertial measurement units (IMU) can measure knee kinematics and range of motion (ROM) during dynamic activities and offer an easy-to-use system for knee function assessment post total knee arthroplasty. However, IMU must be validated against gold standard three-dimensional optical motion capture systems (OMC) across a range of tasks if they are to see widespread uptake. We computed knee rotations and ROM from commercial IMU sensor measurements during walking, squatting, sit-to-stand, stair ascent, and stair descent in 21 patients one-year post total knee arthroplasty using two methods: direct computation using segment orientations (r_IMU), and an IMU-driven iCloud-based interactive lower limb model (m_IMU). This cross-sectional study compared computed knee angles and ROM to a gold-standard OMC and inverse kinematics method using Pearson's correlation coefficient (R) and root-mean-square-differences (RMSD). The r_IMU and m_IMU methods estimated sagittal plane knee angles with excellent correlation (>0.95) compared to OMC for walking, squatting, sit-to-stand, and stair-ascent, and very good correlation (>0.90) for stair descent. For squatting, sit-to-stand, and walking, the mean RMSD for r_IMU and m_IMU compared to OMC were <4 degrees, < 5 degrees, and <6 degrees, respectively but higher for stair ascent and descent (~12 degrees). Frontal and transverse plane knee kinematics estimated using r_IMU and m_IMU showed poor to moderate correlation compared to OMC. There were no differences in ROM measurements during squatting, sit-to-stand, and walking across the two methods. Thus, IMUs can measure sagittal plane knee angles and ROM with high accuracy for a variety of tasks and may be a useful in-clinic tool for objective assessment of knee function following total knee arthroplasty.
Collapse
Affiliation(s)
- Bradley M. Cornish
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Laura E. Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - David John Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - David G. Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Beichen Shi
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Jenna Lyon
- Stryker Corporation, Kalamazoo, Michigan, Unites States of America
| | - Kevin Abbruzzese
- Stryker Corporation, Kalamazoo, Michigan, Unites States of America
| | - Price Gallie
- Coast Orthopaedics and Sports Medicine, Gold Coast, Queensland, Australia
| | - Jayishni Maharaj
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
22
|
Cepolina F, Razzoli R. Review of robotic surgery platforms and end effectors. J Robot Surg 2024; 18:74. [PMID: 38349595 PMCID: PMC10864559 DOI: 10.1007/s11701-023-01781-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: 11/19/2023] [Accepted: 12/10/2023] [Indexed: 02/15/2024]
Abstract
In the last 50 years, the number of companies producing automated devices for surgical operations has grown extensively. The population started to be more confident about the technology capabilities. The first patents related to surgical robotics are expiring and this knowledge is becoming a common base for the development of future surgical robotics. The review describes some of the most popular companies manufacturing surgical robots. The list of the company does not pretend to be exhaustive but wishes to give an overview of the sector. Due to space constraints, only a limited selction of companies is reported. Most of the companies described are born in America or Europe. Advantages and limitations of each product firm are described. A special focus is given to the end effectors; their shape and dexterity are crucial for the positive outcome of the surgical operations. New robots are developed every year, and existing robots are allowed to perform a wider range of procedures. Robotic technologies improve the abilities of surgeons in the domains of urology, gynecology, neurology, spine surgery, orthopedic reconstruction (knee, shoulder), hair restoration, oral surgery, thoracic surgery, laparoscopic surgery, and endoscopy.
Collapse
Affiliation(s)
- Francesco Cepolina
- DIMEC-PMAR Lab, Instrumental Robot Design Research Group, Department of Machines Mechanics and Design, University of Genova, Via All'Opera Pia 15A, 16145, Genoa, Italy.
| | - Roberto Razzoli
- DIMEC-PMAR Lab, Instrumental Robot Design Research Group, Department of Machines Mechanics and Design, University of Genova, Via All'Opera Pia 15A, 16145, Genoa, Italy
| |
Collapse
|
23
|
Hasegawa M, Tone S, Naito Y, Sudo A. Comparison of accuracy and early outcomes in robotic total knee arthroplasty using NAVIO and ROSA. Sci Rep 2024; 14:3192. [PMID: 38326363 PMCID: PMC10850152 DOI: 10.1038/s41598-024-53789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/05/2024] [Indexed: 02/09/2024] Open
Abstract
This study aimed to compare the cutting and component placement accuracies and early outcomes after total knee arthroplasty (TKA) between an image-free handheld robotic system (NAVIO) and a radiography-based robotic system (ROSA). This retrospective study included 88 patients (88 knees) who underwent TKA using the NAVIO (40 patients) or ROSA (48 patients) robotic systems. The accuracies of the robotic systems were compared. Clinical scores were evaluated using the Knee Society Score 2011 (KSS 2011) and the forgotten joint score (FJS)-12 at 1 year postoperatively. The femoral sagittal cutting error was smaller in the NAVIO group than in the ROSA group. The other cutting errors were not statistically different in both groups. Implantation errors did not differ between the groups. Regarding the clinical outcomes of the KSS 2011 subscales, the symptoms score was higher in knees operated using ROSA than in those using NAVIO. The other KSS 2011 subscales and the FJS-12 showed no differences between the two groups. In conclusion, the femoral sagittal cutting error was smaller in the NAVIO group than in the ROSA group, and the KSS 2011 symptom score subsection at one year was higher in the knees operated using ROSA than in those using NAVIO.
Collapse
Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| |
Collapse
|
24
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
25
|
Salimy MS, Paschalidis A, Dunahoe JA, Bedair HS, Melnic CM. Patients Consistently Report Worse Outcomes Following Revision Total Knee Arthroplasty Compared to Primary Total Knee Arthroplasty. J Arthroplasty 2024; 39:459-465.e1. [PMID: 37572718 DOI: 10.1016/j.arth.2023.08.014] [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: 02/16/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Differences in patient-reported outcome measures (PROMs) between primary TKA (pTKA) and revision TKA (rTKA) have not been well-studied. Therefore, we compared pTKA and rTKA patients by the rates of achieving the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W). METHODS A total of 2,448 patients (2,239 pTKAs/209 rTKAs) were retrospectively studied. Patients who completed the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, or PROMIS Global-Physical questionnaires were identified by Current Procedural Terminology (CPT) codes. Patient-reported outcome measures and MCID-I/MCID-W rates were compared. Multivariate logistic regression models measured relationships between surgery type and postoperative outcomes. RESULTS Patients who underwent rTKA (all causes) had lower rates of improvement and higher rates of worsening compared to pTKA patients for KOOS-PS (MCID-I: 54 versus 68%, P < .001; MCID-W: 18 versus 8.6%, P < .001), PF10a (MCID-I: 44 versus 65%, P < .001; MCID-W: 22 versus 11%, P < .001), PROMIS Global-Mental (MCID-I: 34 versus 45%, P = .005), and PROMIS Global-Physical (MCID-I: 51 versus 60%, P = .014; MCID-W: 29 versus 14%, P < .001). Undergoing revision was predictive of worsening postoperatively for KOOS-PS, PF10a, and PROMIS Global-Physical compared to pTKA. Postoperative scores were significantly higher for all 4 PROMs following pTKA. CONCLUSION Patients reported significantly less improvement and higher rates of worsening following rTKA, particularly for PROMs that assessed physical function. Although pTKA patients did better overall, the improvement rates may be considered relatively low and should prompt discussions on improving outcomes following pTKA and rTKA. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aris Paschalidis
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacquelyn A Dunahoe
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| |
Collapse
|
26
|
Dretakis K, Igoumenou VG, Naoum S, Raptis K, Koutserimpas C. Robotic Arm-Assisted Total Knee Arthroplasty: Anatomical Alignment and Mid-Term Outcomes from the First Cohort Originating in Greece. J Long Term Eff Med Implants 2024; 34:55-63. [PMID: 38505894 DOI: 10.1615/jlongtermeffmedimplants.2023048690] [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: 03/21/2024]
Abstract
Robotic arm-assisted total knee arthroplasty (RATKA) represents a haptic assistive robotic arm used for bone preparation. The purpose of this study was to present implant survivorship, complications and evaluate patients' satisfaction, clinical and functional outcome of RATKA with a minimum of 1-year follow-up. The Oxford Knee Score was recorded preoperatively and at last follow-up. Patients' satisfaction rates, as well as complications and re-operations were studied. Anatomical alignment including varus, valgus deformities and flexion, extension, pre-and postoperatively were evaluated. A total of 156 patients with mean age = 71.9 years were included in the study. The mean follow-up was 35.7 months, while one revision was performed due to infection. Statistically significant improvement of the Oxford Knee Score, as well as of the knee alignment deformities were recorded, while 99.4% of patients reported to be "very satisfied" or "satisfied" with the procedure. RATKA seems to be a safe, as well as reproductible procedure at short-and mid-term follow-up, while the accurate implant positioning may lead to favorable long-term outcomes.
Collapse
Affiliation(s)
- Konstantinos Dretakis
- 2nd Department of Orthopaedics and Traumatology, Hygeia General Hospital of Athens, Athens, Greece
| | | | - Symeon Naoum
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Konstantinos Raptis
- 2nd Department of Orthopaedics and Traumatology, Hygeia General Hospital of Athens, Athens, Greece; Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Greece
| |
Collapse
|
27
|
Kayani B, Fontalis A, Haddad IC, Donovan C, Rajput V, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five-year follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:5453-5462. [PMID: 37804346 DOI: 10.1007/s00167-023-07578-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE This study reports the five-year functional outcomes from a prospective cohort study comparing robotic-arm assisted total knee arthroplasty (RO TKA) versus conventional manual total knee arthroplasty (CO TKA). METHODS This prospective single-surgeon study included 120 patients with symptomatic end-stage knee arthritis undergoing primary TKA. This included 60 consecutive patients undergoing CO TKA followed by 60 consecutive patients undergoing RO TKA using a semi-automated robotic device. Study patients were reviewed at one, two, and five years after surgery and the following outcomes recorded: The University of California at Los Angeles activity-level (UCLA), Knee Society Score (KSS), Oxford Knee Score (OKS) Forgotten Joint Score (FJS), and any complications. RESULTS There were no statistical differences between RO TKA and CO TKA in the median UCLA score (p = N.S), median KSS (p = N.S), and median OKS (p = N.S) at five-year follow-up. RO-TKA was associated with statistically significant improvements in the FJS at one (p = 0.001), two (p = 0.003), and five (p = 0.025) years of follow-up compared with CO TKA. There was no statistical difference in the incidence of knee stiffness requiring manipulation under anesthesia between the two treatment groups (p = N.S). CONCLUSION Patients in both treatment groups had excellent functional outcomes with comparable patient reported outcomes at five-year follow-up. RO TKA was associated with statistically significant improvements in the FJS compared with CO TKA, but these differences did not reach the minimal clinically important difference at any follow-up interval. There was no overall difference in complications between the two treatment groups at five-year follow-up. LEVEL OF EVIDENCE II (Prospective cohort study).
Collapse
Affiliation(s)
- Babar Kayani
- University College Hospital, 235 Euston Road, Bloomsbury, London, NW1 2BU, UK.
| | - Andreas Fontalis
- University College Hospital, 235 Euston Road, Bloomsbury, London, NW1 2BU, UK
| | | | - Christian Donovan
- University College Hospital, 235 Euston Road, Bloomsbury, London, NW1 2BU, UK
| | - Vishal Rajput
- University College Hospital, 235 Euston Road, Bloomsbury, London, NW1 2BU, UK
- Princess Grace Hospital, 42-52 Nottingham Place, Marylebone, London, W1U 5NY, UK
| | - Fares Sami Haddad
- University College Hospital, 235 Euston Road, Bloomsbury, London, NW1 2BU, UK
- Princess Grace Hospital, 42-52 Nottingham Place, Marylebone, London, W1U 5NY, UK
| |
Collapse
|
28
|
Marchand RC, Scholl L, Taylor KB, Erwin DJ, Bhowmik-Stoker M, Chen Z, Salem HS, Mont MA. Clinical Outcomes after Computed Tomography-Based Total Knee Arthroplasty: A Minimum 3-Year Analyses. J Knee Surg 2023; 36:1462-1466. [PMID: 36657463 DOI: 10.1055/s-0042-1759790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Computed tomography (CT) scan-based three-dimensional (3D) modeling operative technology has been shown to improve upon results of manual total knee arthroplasties (TKAs). Although there are many reports on superior precision of this CT-based technology, there has been continuing interest regarding extended clinical outcomes. The purpose of this study was to compare their clinical outcomes with manual TKAs at approximately 3-year follow-up. Specifically, we analyzed: (1) survivorship, (2) functional outcomes, (3) complications, and (4) radiographic outcomes (i.e., alignment, progressive radiolucencies). A total of 210 patients receiving CT-based TKAs performed by a single surgeon at a single center between July 1, 2016, and February 16, 2018, were compared with 210 manual TKAs completed by the same surgeon immediately preceding implementation of the CT-based technology. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) surveys were collected at ∼3 years postoperatively. Subgroup analyses of pain and physical function scores were performed. Follow-up radiographs were evaluated for alignment, loosening, and/or progressive radiolucencies. There was 100% survivorship at final follow-up. The postoperative mean pain scores for the CT-based cohort and manual cohort were 1 ± 2 (range, 0-14) and 2 ± 3 (range, 0-17), respectively (p < 0.05). The postoperative mean physical function scores for the CT-based cohort and manual cohort were 3 ± 4 (range, 0-18) and 5 ± 5 (range, 0-19), respectively (p < 0.05). The postoperative mean total WOMAC scores for the CT-based cohort and manual cohort were 5 ± 4 (range, 0-32) and 7 ± 8 (range, 0-35), respectively (p < 0.05). There were low numbers of postoperative complications at final follow-up in either cohort. None exhibited progressive radiolucencies by final follow-up. The 3-year postoperative clinical outcomes support excellent survivorship and radiographic outcomes, low complication rates, as well as improved pain, physical function, and total WOMAC scores for CT-based TKAs. Therefore, patients who undergo CT-based 3D modeling TKAs should expect to have superior long-term clinical outcomes.
Collapse
Affiliation(s)
- Robert C Marchand
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
- South County Health, South Kingston, Rhode Island
| | | | | | | | | | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, Maryland
| | - Hytham S Salem
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, Maryland
| |
Collapse
|
29
|
Omichi Y, Hamada D, Wada K, Tamaki Y, Shigekiyo S, Sairyo K. Robotic-assisted total knee arthroplasty improved component alignment in the coronal plane compared with navigation-assisted total knee arthroplasty: a comparative study. J Robot Surg 2023; 17:2831-2839. [PMID: 37755679 DOI: 10.1007/s11701-023-01708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
The purpose of this study was to directly compare implant placement accuracy and postoperative limb alignment between robotic-assisted total knee arthroplasty and navigation-assisted total knee arthroplasty. This retrospective case-control study included a consecutive series of 182 knees (robotic-assisted group, n = 103 knees; navigation-assisted group, n = 79). An image-free handheld robotic system (NAVIO) or an image-free navigation system (Precision N) was used. Component and limb alignment were evaluated on three-dimensional computed tomography scans and full-length standing anterior-posterior radiographs. We compared the errors between the final intraoperative plan and the postoperative coronal and sagittal alignment of the components and the hip-knee-ankle angle between the two groups. The orientation of the femoral and tibial components in the coronal plane were more accurate in the robotic-assisted group than in the navigation-assisted group (p < 0.05). There was no significant difference in the orientation of the femoral and tibial component in the sagittal plane between the two groups. There were fewer outliers in the tibial coronal plane in the robotic-assisted group (p < 0.05). There was also no significant difference in the frequency of outlying values for coronal or sagittal alignment of the femoral component or sagittal alignment of the tibial component or the hip-knee-ankle angle between the two groups. Robotic-assisted total knee arthroplasty using a handheld image-free system improved component alignment in the coronal plane compared with total knee arthroplasty using an image-free navigation system. Robotic surgery helps surgeons to achieve personalised alignment that may result in better clinical outcomes.
Collapse
Affiliation(s)
- Yasuyuki Omichi
- Department of Orthopedics, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Yasuaki Tamaki
- Department of Orthopedics, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Shota Shigekiyo
- Department of Orthopedics, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8503, Japan
| |
Collapse
|
30
|
Kafelov M, Batailler C, Shatrov J, Al-Jufaili J, Farhat J, Servien E, Lustig S. Functional positioning principles for image-based robotic-assisted TKA achieved a higher Forgotten Joint Score at 1 year compared to conventional TKA with restricted kinematic alignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:5591-5602. [PMID: 37851026 DOI: 10.1007/s00167-023-07609-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Few comparative studies assessed the current concept of individualised alignment for total knee arthroplasty (TKA) and their outcomes at mid-term. This study aimed to evaluate the functional outcomes at 1 year of primary TKA performed with a functional positioning technique based on an image-based robotic-assisted system, compared to conventional TKA performed with a restricted kinematic alignment technique. METHODS This retrospective comparative study included 100 primary TKAs performed with functional positioning principles using an image-based robotic-assisted system. A control group included 100 primary TKAs with the same posterior-stabilised implant as the robotic group but performed with manual instrumentation and restricted kinematic alignment technique. In the robotic group, the mean age was 69.2 years old ± 7.9; the mean body mass index was 29.7 kg/m2 ± 4.6. The demographic characteristics were similar between both groups. Kujala score, Forgotten Joint Score (FJS), Knee Society Score (KSS) knee and KSS function were collected 12 months postoperatively. Normally distributed continuous variables were compared using the Student t test. For non-normally distributed continuous variables, the Mann-Whitney test was used. RESULTS FJS was significantly higher in the robotic group (76.3 ± 13 vs. 68.6 ± 16.9 in the conventional group; p = 0.026). At a 1-year follow-up, there was no significant difference in the KSS knee and KSS function scores and the Kujala score between both groups. The mean KSS knee score was 90.8 ± 11.4 in the robotic group versus 89.4 ± 9.6 in the conventional group (p = 0.082). The mean KSS function score was 91.4 ± 12.3 versus 91.3 ± 12.6, respectively (p = 0.778). CONCLUSION Functional positioning principles using an image-based robotic-assisted system achieved a higher Forgotten Joint Score 1 year after TKA compared to restricted kinematic alignment. Personalised alignment and implant positioning are interesting paths to improve the functional outcomes after TKA. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Moussa Kafelov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
| | - Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Jihad Al-Jufaili
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Jawhara Farhat
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| |
Collapse
|
31
|
Hoeffel D, Goldstein L, Intwala D, Kaindl L, Dineen A, Patel L, Mayle R. Systematic review and meta-analysis of economic and healthcare resource utilization outcomes for robotic versus manual total knee arthroplasty. J Robot Surg 2023; 17:2899-2910. [PMID: 37819597 PMCID: PMC10678833 DOI: 10.1007/s11701-023-01703-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: 06/01/2023] [Accepted: 08/19/2023] [Indexed: 10/13/2023]
Abstract
The introduction of robotics in orthopedic surgery has led to improved precision and standardization in total knee arthroplasty (TKA). Clinical benefits of robotic versus manual TKA have been well established; however, evidence for economic and healthcare resource utilization outcomes (HRU) is lacking. The primary objective of this study was to compare economic and HRU outcomes for robotic and manual TKA. The secondary objective was to explore comparative robotic and manual TKA pain and opioid consumption outcomes. Multi-database literature searches were performed to identify studies comparing robotic and manual TKA from 2016 to 2022 and meta-analyses were conducted. This review included 50 studies with meta-analyses conducted on 35. Compared with manual TKA, robotic TKA was associated with a: 14% reduction in hospital length of stay (P = 0.022); 74% greater likelihood to be discharged to home (P < 0.001); and 17% lower likelihood to experience a 90-day readmission (P = 0.043). Robotic TKA was associated with longer mean operating times (incision to closure definition: 9.27 min longer, P = 0.030; general operating time definition: 18.05 min longer, P = 0.006). No differences were observed for total procedure cost and 90-day emergency room visits. Most studies reported similar outcomes for robotic and manual TKA regarding pain and opioid use. Coupled with the clinical benefits of robotic TKA, the economic impact of using robotics may contribute to hospitals' quality improvement and financial sustainability. Further research and more randomized controlled trials are needed to effectively quantify the benefits of robotic relative to manual TKA.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Robert Mayle
- California Pacific Orthopaedics, San Francisco, CA, USA
| |
Collapse
|
32
|
Ollivier B, Vandenneucker H, Vermue H, Luyckx T. A robotic-assisted simulation of kinematic alignment in TKA leads to excessive valgus and internal rotation in valgus knees. Knee Surg Sports Traumatol Arthrosc 2023; 31:4747-4754. [PMID: 37464100 DOI: 10.1007/s00167-023-07504-x] [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: 03/19/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Strategies to further improve patient satisfaction after total knee arthroplasty include the introduction of new alignment philosophies and more precise instruments such as navigation and robotics. The aim of this study was to investigate the effect of a combination of image-based robotic assistance and the use of modern alignment strategies on the resulting joint line obliquity as well as femoral component rotation and to compare this between varus, neutral and valgus knees. METHODS This retrospective study included 200 patients who received a robotic-assisted total knee arthroplasty (MAKO®, Stryker) using functional alignment between 2018 and 2020. The patients were divided into a varus (103 patients), neutral (57 patients) and valgus (40 patients) group. The intraoperatively recorded bone cuts and resulting joint line obliquity were identified and compared to values obtained with a robotic computer simulation of kinematic alignment. RESULTS The mean femoral coronal alignment of the varus, neutral and valgus group, respectively, equalled 0.5° (± 1.1°), 1.1° (± 0.8°) and 1.6° (± 0.7°) of valgus with functional alignment and 2.1° (± 2.1°), 4.1° (± 1.7°) and 6.2° (± 1.7°) of valgus with kinematic alignment. The mean femoral axial alignment of the valgus group resulted in 0.8° (± 2.0°) of internal rotation with functional alignment and 3.9° (± 2.8°) of internal rotation with kinematic alignment. Overall, 186 knees (93%) could be balanced while respecting certain safe zones by using functional alignment as opposed to 54 knees (27% and none in the valgus group) when applying kinematic alignment. Kinematic alignment led to a combination of femoral component valgus and internal rotation of more than 3° in 22 valgus knees (55%), 10 neutral knees (18%) and 3 varus knees (3%) compared to none in each group when applying functional alignment with safe zones. CONCLUSIONS Robotic-assisted kinematic alignment leads to a combination of excessive valgus and internal rotation of the femoral component in valgus and to a lesser extent also in neutral knees when compared with functional alignment. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Britt Ollivier
- Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Hilde Vandenneucker
- Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
- Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Louvain, Belgium
| | - Hannes Vermue
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Thomas Luyckx
- Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium
| |
Collapse
|
33
|
Yoon YK, Park KH, Shim DW, Han SH, Lee JW, Jung M. Robotic-assisted foot and ankle surgery: a review of the present status and the future. Biomed Eng Lett 2023; 13:571-577. [PMID: 37872981 PMCID: PMC10590355 DOI: 10.1007/s13534-023-00328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
The surgical application of robotics has increased significantly since its first application in 1985 for a brain biopsy acquisition. Robotic-assisted surgery has been one of the viable options in various surgical areas, and also in orthopaedic surgery. Robotic-assisted orthopaedic surgery has gained popularity as a mean of improving accuracy, reducing complications and achieving better patient satisfaction. Numerous clinical research studies have demonstrated advantages of robotic-assisted orthopaedic surgery, however, most of that researches were about the total knee arthroplasty, total hip arthroplasty and spine surgery. The application of robotic technology in foot and ankle surgery is in a very nascent stage. Furthermore, there has been little research on intraoperative use of robotics in foot and ankle surgery in literature. A review of previous preclinical studies in foot and ankle robotics and clinical research studies in various fields of robot-assisted orthopaedic surgery shows that its potential application and benefits over conventional techniques, such as total ankle arthroplasty, minimally invasive surgery for foot and ankle trauma or other corrective procedure, and intraoperative biomechanical testing. More studies on practical application of robotic technology to surgical procedure in the field of foot and ankle surgery are needed to confirm its clinical usefulness and cost effectiveness.
Collapse
Affiliation(s)
- Yeo Kwon Yoon
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Woo Shim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Jung
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
34
|
Dandois F, Taylan O, Müller JH, Scheys L. Sensitivity of Model-Based Predictions of Post-TKA Kinematic Behavior to Residual Errors in Ultrasound-Based Knee Collateral Ligament Strain Assessment. SENSORS (BASEL, SWITZERLAND) 2023; 23:8268. [PMID: 37837097 PMCID: PMC10574986 DOI: 10.3390/s23198268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023]
Abstract
Ultrasound-based ligament strain estimation shows promise in non-invasively assessing knee joint collateral ligament behavior and improving ligament balancing procedures. However, the impact of ultrasound-based strain estimation residual errors on in-silico arthroplasty predictions remains unexplored. We investigated the sensitivity of post-arthroplasty kinematic predictions to ultrasound-based strain estimation errors compared to clinical inaccuracies in implant positioning.Two cadaveric legs were submitted to active squatting, and specimen-specific rigid computer models were formulated. Mechanical properties of the ligament model were optimized to reproduce experimentally obtained tibiofemoral kinematics and loads with minimal error. Resulting remaining errors were comparable to the current state-of-the-art. Ultrasound-derived strain residual errors were then introduced by perturbing lateral collateral ligament (LCL) and medial collateral ligament (MCL) stiffness. Afterwards, the implant position was perturbed to match with the current clinical inaccuracies reported in the literature. Finally, the impact on simulated post-arthroplasty tibiofemoral kinematics was compared for both perturbation scenarios. Ultrasound-based errors minimally affected kinematic outcomes (mean differences < 0.73° in rotations, 0.1 mm in translations). Greatest differences occurred in external tibial rotations (-0.61° to 0.73° for MCL, -0.28° to 0.27° for LCL). Comparatively, changes in implant position had larger effects, with mean differences up to 1.95° in external tibial rotation and 0.7 mm in mediolateral translation. In conclusion, our study demonstrated that the ultrasound-based assessment of collateral ligament strains has the potential to enhance current computer-based pre-operative knee arthroplasty planning.
Collapse
Affiliation(s)
- Félix Dandois
- Institute for Orthopaedic Research and Training (IORT), Development and Regeneration Department, KU Leuven, 49 Herestraat, 3000 Leuven, Belgium (O.T.)
| | - Orçun Taylan
- Institute for Orthopaedic Research and Training (IORT), Development and Regeneration Department, KU Leuven, 49 Herestraat, 3000 Leuven, Belgium (O.T.)
| | | | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Development and Regeneration Department, KU Leuven, 49 Herestraat, 3000 Leuven, Belgium (O.T.)
- Department of Orthopaedics, University Hospitals Leuven, 49 Herestraat, 3000 Leuven, Belgium
| |
Collapse
|
35
|
Twomey-Kozak J, Hurley E, Levin J, Anakwenze O, Klifto C. Technological innovations in shoulder replacement: current concepts and the future of robotics in total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:2161-2171. [PMID: 37263482 DOI: 10.1016/j.jse.2023.04.022] [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: 02/22/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision and joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri- and preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty. METHODS A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on 2 primary factors: (1) the lack of eligible, peer-reviewed studies with high-quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by 2 independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics." RESULTS After exclusion criteria were applied, 4 studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, nonvalidated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with PSI. The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation, artificial intelligence, machine learning, and virtual, augmented, and mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy, more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies. CONCLUSION The evidence for the use of robotics in total hip arthroplasty and total knee arthroplasty demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. Although no such data currently exist for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present, and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.
Collapse
Affiliation(s)
- Jack Twomey-Kozak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Eoghan Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
36
|
Duan X, Zhao Y, Zhang J, Kong N, Cao R, Guan H, Li Y, Wang K, Yang P, Tian R. Prediction of early functional outcomes in patients after robotic-assisted total knee arthroplasty: a nomogram prediction model. Int J Surg 2023; 109:3107-3116. [PMID: 37352526 PMCID: PMC10583907 DOI: 10.1097/js9.0000000000000563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (RA-TKA) is becoming more and more popular as a treatment option for advanced knee diseases due to its potential to reduce operator-induced errors. However, the development of accurate prediction models for postoperative outcomes is challenging. This study aimed to develop a nomogram model to predict the likelihood of achieving a beneficial functional outcome. The beneficial outcome is defined as a postoperative improvement of the functional Knee Society Score (fKSS) of more than 10 points, 3 months after RA-TKA by early collection and analysis of possible predictors. METHODS This is a retrospective study on 171 patients who underwent unilateral RA-TKA at our hospital. The collected data included demographic information, preoperative imaging data, surgical data, and preoperative and postoperative scale scores. Participants were randomly divided into a training set ( N =120) and a test set ( N =51). Univariate and multivariate logistic regression analyses were employed to screen for relevant factors. Variance inflation factor was used to investigate for variable collinearity. The accuracy and stability of the models were evaluated using calibration curves with the Hosmer-Lemeshow goodness-of-fit test, consistency index and receiver operating characteristic curves. RESULTS Predictors of the nomogram included preoperative hip-knee-ankle angle deviation, preoperative 10-cm Visual Analogue Scale score, preoperative fKSS score and preoperative range of motion. Collinearity analysis with demonstrated no collinearity among the variables. The consistency index values for the training and test sets were 0.908 and 0.902, respectively. Finally, the area under the receiver operating characteristic curve was 0.908 (95% CI 0.846-0.971) in the training set and 0.902 (95% CI 0.806-0.998) in the test set. CONCLUSION A nomogram model was designed hereby aiming to predict the functional outcome 3 months after RA-TKA in patients. Rigorous validation showed that the model is robust and reliable. The identified key predictors include preoperative hip-knee-ankle angle deviation, preoperative visual analogue scale score, preoperative fKSS score, and preoperative range of motion. These findings have major implications for improving therapeutic interventions and informing clinical decision-making in patients undergoing RA-TKA.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
37
|
Rullán PJ, Grits D, Potluri A, Emara AK, Klika AK, Mont MA, Piuzzi NS. Identifying Trends and Quantifying Growth for Technological Innovation in Knee Arthroplasty: An Analysis of a Patent Database (1990 to 2020). J Knee Surg 2023; 36:1209-1217. [PMID: 36138534 DOI: 10.1055/s-0042-1756503] [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: 02/07/2023]
Abstract
Technological innovation is the key for surgical progress in knee arthroplasty and improvement in patient outcomes. Exploring patented technologies can help elucidate trends and growth for numerous innovative technologies. However, patent databases, which contain millions of patents, remain underused in arthroplasty research. Therefore, the present study aimed to: (1) quantify patent activity; (2) group patents related to similar technologies into well-defined clusters; and (3) compare growth between technologies in the field of knee arthroplasty over a 30-year period. An open-source international patent database was queried from January 1990 to January 2020 for all patents related to knee arthroplasty A search strategy identified 70,154 patents, of which 24,425 were unique and included analysis. Patents were grouped into 14 independent technology clusters using Cooperative Patent Classification (CPC) codes. Patent activity was normalized via a validated formula adjusting for exponential growth. Compound annual growth rates (CAGR) were calculated (5-year, 10-year, and 30-year CAGR) and compared for each cluster. Overall yearly patent activity increased by 2,023%, from 104 patents in 1990 to 2,208 patents in 2020. The largest technology clusters were "drugs" (n = 5,347; 23.8%), "components" (n = 4,343; 19.0%), "instruments" (n = 3,130; 13.7%), and "materials" (n = 2,378; 10.4%). The fastest growing technologies with their 5-year CAGR were: "user interfaces for surgical systems" (58.1%); "robotics" (28.6%); "modularity" (21.1%); "navigation" (15.7%); and "computer modeling" (12.5%). Since 1990, overall patent growth rate has been greatest for "computer modeling" (8.4%), "robotics" (8.0%), "navigation" (7.9%), and "patient-specific instrumentation" (6.4%). Most patents in knee arthroplasty for the last 30 years have focused on drugs, components, instruments, and materials. Recent exponential growth was mainly observed for user interfaces for surgical systems, robotics, modularity, navigation, and computer-assisted technologies. Innovation theory would suggest that these rapidly growing technologies are experiencing high innovation output, increased resource investments, growing adoption by providers, and significant clinical impact. Periodic monitoring of technological innovation via patent databases can be useful to establish trends and future directions in the field of knee arthroplasty.
Collapse
Affiliation(s)
- Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajay Potluri
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Mont
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
38
|
Sohail M, Kim JY, Park J, Kim HS, Lee J. Femoral coordinate system based on articular surfaces: Implications for computer-assisted knee arthroplasty. Comput Biol Med 2023; 163:107229. [PMID: 37413852 DOI: 10.1016/j.compbiomed.2023.107229] [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: 03/07/2023] [Revised: 05/28/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
Osteoarthritis knee can be restored by total knee arthroplasty (TKA). Imageless TKA requires several anatomical points to construct a reference coordinate system to measure bone resections and implant placement. Inaccuracies in the definition of the coordinate system lead to malalignment and failure of the implant. While the surgical transepicondylar axis (sTEA) is a reliable anatomical axis to define the lateromedial axis for the femoral coordinate system (FCS), the presence of the collateral ligaments and deterioration of the medial sulcus (MS) make the registration of sTEA a challenging task. In this work, sTEA is assigned using the articular surfaces of the femoral condyles, independent of the lateral epicondyle (LE) and MS. A single 3D arc is marked on each condyle, which is transformed into a 2D arc to get the best-fit curve according to the profile of condyles. The turning point of each best-fit curve, when transformed back to 3D, defines an axis parallel to sTEA. The condyles-based sTEA is measured experimentally on a 3D-printed bone using an Optitrack tracking setup. Using the proposed method, the angle between the aTEA, sTEA, and Whiteside's line was (3.77, 0.55, and 92.72)°, respectively. The proposed method provides the same level of accuracy and improves the anatomical points registration efficiency, as there is no need to register the LE or MS.
Collapse
Affiliation(s)
- Muhammad Sohail
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea
| | - Jun Young Kim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea
| | - Jaehyun Park
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea
| | - Heung Soo Kim
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea.
| | - Jaehun Lee
- Department of Mechanical, Robotics and Energy Engineering, Dongguk University-Seoul, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea.
| |
Collapse
|
39
|
Jin G, Fan Y, Jiang L, Chen Z, Wang C. MAKO robot-assisted total knee arthroplasty cannot reduce the aggravation of ankle varus incongruence after genu varus correction ≥ 10°: a radiographic assessment. BMC Musculoskelet Disord 2023; 24:492. [PMID: 37322501 DOI: 10.1186/s12891-023-06597-2] [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: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION The objective of this study was to investigate the ankle alignment alterations after the correction of knee varus deformity in MAKO robot-assisted total knee arthroplasty (MA-TKA). METHODS A retrospective analysis was conducted for 108 patients with TKA from February 2021 to February 2022. Patients were divided into two groups based on MAKO robot involvement during the procedure: the MA-TKA group (n = 36) and the conventional manual total knee arthroplasty (CM-TKA) group (n = 72). The patients were divided into four subgroups according to the degree of surgical correction of the knee varus deformity. Seven radiological measurements were evaluated pre and post-surgery: mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), tibial plafond inclination angle (TPIA), talar inclination angle (TIA), and tibiotalar tilt angle (TTTA). TTTA is a quantitative representation of the extent of ankle incongruence. RESULTS The number of mTFA, mLDFA, and MPTA outliers in the MA-TKA group was significantly lower compared to the CM-TKA group (P<0.05). Knee varus deformity was properly corrected and the mechanical axis was restored in all patients, regardless of the treatment group. Only for varus corrections ≥ 10° did TTTA change significantly (p < 0.01) and ankle varus incongruence aggravate post-operation. The ΔTTTA correlated negatively with ΔTFA (r=-0.310,P = 0.001) and correlated positively with ΔTPIA (r = 0.490,P = 0.000). When the varus correction was ≥ 7.55°, the probability of ankle varus incongruence exacerbation increased 4.86-fold. CONCLUSION Compared with CM-TKA, MA-TKA osteotomy showed more precision but was unable to reduce post-operation ankle varus incongruence. When the varus correction ≥ 10°, ankle varus incongruence aggravated, while when the varus correction ≥ 7.55°, the probability of ankle varus incongruence increased 4.86-fold. This may occasion the pathogenesis of ankle pain following TKA.
Collapse
Affiliation(s)
- Gang Jin
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 318000, Zhejiang, P.R. China
| | - Yongyong Fan
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 318000, Zhejiang, P.R. China
| | - Lingjun Jiang
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 318000, Zhejiang, P.R. China
| | - Zhongyi Chen
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 318000, Zhejiang, P.R. China
| | - Chenglong Wang
- Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 318000, Zhejiang, P.R. China.
| |
Collapse
|
40
|
Jung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in asian patients: a prospective study. BMC Musculoskelet Disord 2023; 24:332. [PMID: 37106353 PMCID: PMC10134614 DOI: 10.1186/s12891-023-06422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (r-TKA) can reportedly achieve more accurate implant positioning than conventional total knee arthroplasty (c-TKA), although its learning curve is controversial. Moreover, few studies have investigated r-TKA in Asians, who have different anatomical characteristics. This study aimed to determine the learning curve for r-TKA and compare implant positions between r-TKA and c-TKA according to the learning curve in Asian patients. METHODS This prospective study included 50 consecutive c-TKAs (group C), followed by 50 consecutive r-TKAs conducted using the MAKO robotic system (Stryker, USA). Cumulative summation analyses were performed to assess the learning curve for operative time in r-TKA. Accordingly, the r-TKA cases were divided into the initial (group I) and proficiency cases (group P). The femoral and tibial component positions in the coronal, sagittal, and axial planes and lower limb alignment were compared among the three groups. RESULTS r-TKA was associated with a learning curve for operative time in 18 cases. The operative time was significantly shorter in groups C and P than that in group I, with no significant difference between groups C and P. Groups I and P demonstrated fewer outliers with respect to lower limb alignment, femoral component coronal position, axial position, and tibial component sagittal position than those in group C, with no significant difference between groups I and P. CONCLUSION The operative time did not differ significantly between r-TKA and c-TKA after the learning curve. Surgeons could expect more accurate and reproducible lower limb alignment and implant positioning with r-TKA in Asian patients, irrespective of the learning curve.
Collapse
Affiliation(s)
- Ho Jung Jung
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Min Wook Kang
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Hwa Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| |
Collapse
|
41
|
Sequeira SB, Duvall GT, Boucher H. A biomechanical comparison between robotic and conventional total knee arthroplasty (TKA) in resection accuracy: a meta-analysis on cadaveric specimens. J Exp Orthop 2023; 10:34. [PMID: 36995538 PMCID: PMC10063757 DOI: 10.1186/s40634-023-00587-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/10/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE Robotic total knee arthroplasty (TKA) has seen a rapid increase in utilization with recent literature suggesting that implant accuracy and resection are better optimized than in conventional TKA. The purpose of this study was to evaluate the biomechanical properties of robotic-assisted versus conventional TKA in minimizing biplanar femoral and tibial resection error in cadaveric specimens. METHODS A systematic review and meta-analysis was performed by searching through PubMed, Cochrane library, and Embase to identify studies that analyzed the biomechanical properties of robotic assisted and conventional TKA, according to standard PRISMA guidelines. Evaluated outcomes included femoral coronal resection error (deg), femoral sagittal resection error (deg), tibial coronal resection error (deg), and tibial sagittal resection error (deg). RESULTS Seven studies met inclusion criteria, including a total of 140 cadaveric specimens (robotic: 70, conventional: 70), for resection accuracy between robotic and conventional TKA. Pooled analysis from seven studies revealed a significant difference in femoral coronal and sagittal resection error in favor of robotic systems compared to conventional systems (p < 0.001 & p < 0.001, respectively). The pooled analysis from seven studies revealed a significant difference in tibial sagittal resection error in favor of robotic systems compared to conventional systems following TKA (p = 0.012). Posthoc power analysis revealed a power of 87.2%. CONCLUSION The use of robotic TKA is associated with lower femoral coronal, lower femoral sagittal and tibial sagittal resection error compared to conventional TKA. It should be noted that these findings are purely biomechanical - surgeons should interpret these findings along with clinical differences between conventional and robotic systems to determine which system is best for each patient.
Collapse
Affiliation(s)
- Sean B Sequeira
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert, Street, Suite 400, Baltimore, MD, 21218, USA.
| | - Grant T Duvall
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert, Street, Suite 400, Baltimore, MD, 21218, USA
| | - Henry Boucher
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 North Calvert, Street, Suite 400, Baltimore, MD, 21218, USA
| |
Collapse
|
42
|
Fabrizio M, Edoardo B, Niccolò G, Roberto C, Bernardo I. How reproducible are clinical measurements in robotic knee surgery? J Exp Orthop 2023; 10:32. [PMID: 36961581 PMCID: PMC10039133 DOI: 10.1186/s40634-023-00582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/30/2023] [Indexed: 03/25/2023] Open
Abstract
PURPOSE Robotic-assisted surgery has been recently introduced to improve biomechanical restoration, and thus better clinical and functional outcomes, after knee joint arthroplasty operations. Robotic-assisted uni-compartmental knee arthroplasty (UKA) aims indeed to improve surgical bone resection and alignment accuracy, optimized component positioning and knee balancing, relying on a series of calibration measurements performed during the surgery. These advantages focus therefore on improving the reproducibility of UKA surgeries, reducing (if not eliminating) eventual differences among high- and low-volume surgeons. The purpose of this study is to investigate and quantify the reproducibility of in-vivo measurements performed with a robotic system: the intra- and inter-observer variability of a series of measurements was therefore analyzed and compared among differently experienced operators. METHODS Five patients were analyzed and underwent robotic-assisted UKA using a semi-active robotic system. Three different observers with different experience levels were involved to independently perform the measurements of two parameters of the preoperative knee (Hip-Knee-Ankle angle [HKAa], Internal-External Rotation) at different degrees of knee flexion. Inter-observer and intra-observer comparisons were performed. RESULTS The average variability in the measurements obtained from the intra-observer and inter-observer comparisons were always < 0.68° for HKAa and < 2.59° for internal-external rotation, and the ICCs showed excellent agreement (> 0.75) for most cases and good agreement (> 0.60) in the remaining ones. CONCLUSION This study demonstrated high reproducibility of the measurements obtainable in clinical environment with the robotic system. The inter-observer results furthermore showed that the level of confidence with the robotic system is not significantly influencing the measurement.
Collapse
Affiliation(s)
- Matassi Fabrizio
- Orthopedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Bori Edoardo
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Giabbani Niccolò
- Orthopedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Civinini Roberto
- Orthopedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Innocenti Bernardo
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
| |
Collapse
|
43
|
Alshatwi R, Alfadhel S, Alrasheed M, Alhakbani A, AlShaya O. Comparison of Postoperative Pain and Function in Robotic Total Knee Arthroplasty and Conventional Total Knee Arthroplasty Amongst Patients at King Fahad Medical City in Riyadh, Saudi Arabia. Cureus 2023; 15:e36285. [PMID: 37073178 PMCID: PMC10105976 DOI: 10.7759/cureus.36285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is the definitive surgical treatment for end-stage osteoarthritis and has been proven to relieve pain and improve function. With the rise in demand and the number of TKA procedures every year, more studies have been conducted on robotic TKA. Objective The objective of this study is to compare the postoperative pain between robotic and conventional TKA and the postoperative functional level between robotic and conventional TKA. Method This is a quantitative, observational, prospective study conducted from February 2022 to August 2022 amongst patients in the orthopaedic department of King Fahad Medical City, Riyadh, Saudi Arabia, who have undergone primary TKA for end-stage osteoarthritis using robotic TKA and conventional TKA. After applying the exclusion and inclusion criteria, a total of 26 patients (12 robotic and 14 conventional) were included in the study. The patients were assessed at three time points: two weeks, six weeks, and three months post-op. They were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the visual analogue scores (VAS) used to assess pain. Result A total of 26 patients were included in this research. The patients were divided into two groups: 12 robotic TKA patients and 14 conventional TKA patients. In this study, while comparing patients who underwent robotic TKA with those who underwent conventional TKA, no statistical significance was found regarding pain and function at all stages postoperatively. Conclusion There was no short-term difference between robotic and conventional TKA regarding pain and function. There is a need for further extensive research on robotic TKA in terms of cost-effectiveness, complications, implant survivorship, and long-term outcomes.
Collapse
|
44
|
Functional alignment with robotic‑arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:1072-1080. [PMID: 36378291 DOI: 10.1007/s00167-022-07227-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion-extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA). METHODS A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups. RESULTS Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P < 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively). CONCLUSIONS Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments. LEVEL OF EVIDENCE III.
Collapse
|
45
|
Batailler C, Anderson MB, Flecher X, Ollivier M, Parratte S. Is sequential bilateral robotic total knee arthroplasty a safe procedure? A matched comparative pilot study. Arch Orthop Trauma Surg 2023; 143:1599-1609. [PMID: 35536354 DOI: 10.1007/s00402-022-04455-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/15/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION To our knowledge, no papers have reported the results of robotic-assisted surgery for sequential bilateral Total Knee Arthroplasty (TKA). Indeed, sequential bilateral TKA present several benefits, as one single anesthesia, surgical episode, hospitalization, and rehabilitation. The purpose of our study was to evaluate peri-operative outcomes and compare the complication rates, clinical outcomes, and implant positioning of sequential bilateral TKA performed with a robotic-assisted system versus a conventional technique. MATERIALS AND METHODS All patients who underwent a sequential bilateral robotic-assisted primary TKA (raTKA) in our institution between November 2019 and February 2021 were included. Twenty patients met the inclusion criteria and were matched with 20 sequential bilateral TKA performed with a conventional technique. The two groups were comparable for the demographic data and the preoperative parameters, including preoperative anticoagulation and ASA score. The minimum follow-up was 6 months. RESULTS The operative time was significantly longer in the robotic group (< 0.0001), with a mean additional time of 29 min. There was no significant difference between both groups for postoperative blood loss, rate of blood transfusion, or postoperative pain. The average length of stay was 5 days. There was one early complication in the robotic group due to the tibial trackers. The functional outcomes were similar between both groups, except for the functional KSS score, which was better at 6 months in the robotic group (p < 0.0001). The restoration of the knee alignment and the distal femoral anatomy were significantly better in the robotic group than in the conventional group. CONCLUSIONS Despite a longer operative time, the peri-operative parameters of sequential bilateral TKA were similar between robotic and conventional techniques. Further, sequential bilateral raTKA was at least as safe as a conventional technique, without additional risk of medical complications.
Collapse
Affiliation(s)
- Cécile Batailler
- Department of Orthopaedic Surgery, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
| | | | - Xavier Flecher
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, Marseille, France
| | - Sébastien Parratte
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, Marseille, France.,Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| |
Collapse
|
46
|
Daffara V, Zambianchi F, Bazzan G, Matveitchouk N, Berni A, Piacentini L, Cuoghi Costantini R, Catani F. No difference in clinical outcomes between functionally aligned cruciate-retaining and posterior-stabilized robotic-assisted total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:711-717. [PMID: 36648533 DOI: 10.1007/s00264-023-05693-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/11/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare the clinical outcomes of subjects undergoing primary robotic-assisted total knee arthroplasty (RA-TKA), following functional alignment (FA) principles, with cruciate-retaining (CR) or posterior-stabilized (PS) bearing designs, at a minimum of 24 months of follow-up. METHODS This observational, retrospective study included 167 consecutive patients undergoing RA-TKA with cemented PS and cementless CR implants performed with a CT-base robotic-arm assisted system (Mako, Stryker), following FA principles, between 2017 and 2020. Patients were followed up with a clinical and radiographic assessment and were administered the Forgotten Joint Score-12 (FJS-12), Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), and the 5-level Likert scale (5-LLS). RESULTS Three TKA revisions were performed (2 PS, 1 CR); therefore, a total of 164 knees with a mean age of 71.7 years (SD 8.9) were considered (80 cemented PS; 84 cementless CR). No statistically significant differences were recorded between study groups relative to FJS-12, KOOS-JR, and 5-LLS at a minimum of two year follow-up (FJS-12 89.3 ± 9.2 vs 87.5 ± 12.8, p-value 0.46; KOOS-JR 88.8 ± 10.0 vs 86.7 ± 14.0, p-value 0.31; 5-LLS 4.5 ± 0.7 vs 4.5 ± 0.8, p-value 0.34). CONCLUSION No significant outcome differences were reported between patients undergoing PS and CR RA-TKA at a minimum of two year follow-up. RA-TKA achieves excellent clinical results and high satisfaction scores, regardless of the implant design used.
Collapse
Affiliation(s)
- Valerio Daffara
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio-Emilia, Modena, Italy.
| | - Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Gabriele Bazzan
- 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
| | - Alessandro Berni
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Laura Piacentini
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Riccardo Cuoghi Costantini
- Department of Maternal, Child and Adult Medical and Surgical Sciences, 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
| |
Collapse
|
47
|
Scaturro D, Vitagliani F, Caracappa D, Tomasello S, Chiaramonte R, Vecchio M, Camarda L, Mauro GL. Rehabilitation approach in robot assisted total knee arthroplasty: an observational study. BMC Musculoskelet Disord 2023; 24:140. [PMID: 36814210 PMCID: PMC9945668 DOI: 10.1186/s12891-023-06230-2] [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: 12/05/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate the impact of total knee arthroplasty (TKA) with the aid of Navio Robot, comparing it with standard prosthetic surgery on the functional outcomes of patients after an intensive rehabilitation program. METHOD A case-control observational study was conducted on patients undergoing TKA for severe KOA. All patients underwent the same intensive hospital rehabilitation program of 14 daily sessions lasting 3 h. The following rating scales were administered: Numeric Rating Scale (NRS), Knee Society Score (KSS) and 12-Item Short Form Survey scale. Patient assessments were performed 1 week post-surgery (T0), 1 month post-surgery (T2), and 3 months post-surgery (T3). The primary outcomes were active knee extension and flexion and pain severity. The secondary outcomes were functional capacity and quality of life. RESULTS Using repeated measures ANOVA, we observed at T1 a statistically different difference for the treatment group compared to the control group about KSS (p < 0.05), pain (p < 0.05), and knee flexion (p < 0.05). No statistically significant difference between the two groups was observed for knee extension (p = 0.09) and the SF-12 scale (p = 0.52). At T2 instead, we observed a statistically significant difference for the treatment group compared to the control group as regards KSS (p < 0.05) and knee flexion (p < 0.05), while no statistically significant difference was observed for pain (p = 0.83), knee extension (p = 0.60), and the SF-12 scale (0.44). CONCLUSIONS Our study has demonstrated that robot-NAVIO assisted knee prosthesis surgery, associated with a specific intensive rehabilitation treatment, in the short and medium term, determines good pain control, better flexion recovery and a improvement of functional capacity.
Collapse
Affiliation(s)
- Dalila Scaturro
- Department of Surgery, Oncology and Stomatology, University of Palermo, 90127, Palermo, Italy.
| | - Fabio Vitagliani
- grid.8158.40000 0004 1757 1969University of Catania, Via Santa Sofia 87, 95100 Catania, Italy
| | - Dario Caracappa
- grid.8158.40000 0004 1757 1969University of Catania, Via Santa Sofia 87, 95100 Catania, Italy
| | - Sofia Tomasello
- grid.10776.370000 0004 1762 5517University of Palermo, 90127 Palermo, Italy
| | - Rita Chiaramonte
- grid.8158.40000 0004 1757 1969Department of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, 95124, Italy, University of Catania, Catania, Italy
| | - Michele Vecchio
- grid.412844.f0000 0004 1766 6239Rehabilitation Unit, AOU Policlinico Vittorio Emanuele, Via Santa Sofia 78, 95100 Catania, Italy ,grid.8158.40000 0004 1757 1969Department of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, 95124, Italy, University of Catania, Catania, Italy
| | - Lawrence Camarda
- grid.10776.370000 0004 1762 5517Department of Surgery, Oncology and Stomatology, University of Palermo, 90127 Palermo, Italy
| | - Giulia Letizia Mauro
- grid.10776.370000 0004 1762 5517Department of Surgery, Oncology and Stomatology, University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
48
|
Is the femoral intramedullary alignment already actual in total knee arthroplasty? J Exp Orthop 2023; 10:16. [PMID: 36786874 PMCID: PMC9929006 DOI: 10.1186/s40634-022-00563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient-specific instrumentation (PSI) and robotic and computer-assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion.
Collapse
|
49
|
Murphy GT, Shatrov J, Duong J, Fritsch BA. How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms. INTERNATIONAL ORTHOPAEDICS 2023; 47:1221-1232. [PMID: 36740610 PMCID: PMC10079723 DOI: 10.1007/s00264-022-05681-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/16/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to compare the effect of an image-based (MAKO) system using a gap-balancing technique with an imageless (OMNIbot) robotic tool utilising a femur-first measured resection technique. METHODS A retrospective cohort study was performed on patients undergoing primary TKA with a functional alignment philosophy performed by a single surgeon using either the MAKO or OMNIbot robotic systems. In all cases, the surgeon's goal was to create a balanced knee and correct sagittal deformity (eliminate any fixed flexion deformity). Intra-operative data and patient-reported outcomes (PROMS) were compared. RESULTS A total of 207 MAKO TKA and 298 OMNIbot TKAs were analysed. MAKO TKA patients were younger (67 vs 69, p=0.002) than OMNIbot patients. There were no other demographic or pre-operative alignment differences. Regarding implant positioning, in MAKO TKAs the femoral component was more externally rotated in relation to the posterior condylar axis (2.3° vs 0.1°, p<0.001), had less valgus femoral cuts (1.6° vs 2.7° valgus, p<0.001) and more varus tibial cuts (2.4° vs 1.9° varus, p<0.001), and had more bone resected compared to OMNIbot TKAs. OMNIbot cases were more likely to require tibial re-cuts than MAKO (15% vs 2%, p<0.001). There were no differences in femur recut rates, soft tissue releases, or rate of achieving target coronal and sagittal leg alignment between robotic systems. A subgroup analysis of 100 MAKO and 100 OMNIbot propensity-matched TKAs with 12-month follow-up showed no significant difference in OKS (42 vs 43, p=0.7) or OKS PASS scores (83% vs 91%, p=0.1). MAKO TKAs reported significantly better symptoms according to their KOOS symptoms score than patients that had OMNIbot TKAs (87 vs 82, p=0.02) with a higher proportion of KOOS PASS rates, at a slightly longer follow-up time (20 months vs 14 months, p<0.001). There were no other differences in PROMS. CONCLUSION A gap-balanced technique with an image-based robotic system (MAKO) results in different implant positioning and bone resection and reduces tibial recuts compared to a femur-first measured resection technique with an imageless robotic system (OMNIbot). Both systems achieve equal coronal and sagittal deformity correction and good patient outcomes at short-term follow-ups irrespective of these differences.
Collapse
Affiliation(s)
- Geoffrey T Murphy
- Sydney Orthopaedic Research Institute, Level 2, 500 Pacific Highway, St Leonards, St. Leonards, Sydney, 2065, Australia. .,University of New South Wales, Sydney, Australia.
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute, Level 2, 500 Pacific Highway, St Leonards, St. Leonards, Sydney, 2065, Australia.,Sydney University, Sydney, Australia
| | - Julian Duong
- Sydney Orthopaedic Research Institute, Level 2, 500 Pacific Highway, St Leonards, St. Leonards, Sydney, 2065, Australia
| | - Brett A Fritsch
- Sydney Orthopaedic Research Institute, Level 2, 500 Pacific Highway, St Leonards, St. Leonards, Sydney, 2065, Australia
| |
Collapse
|
50
|
Moving beyond radiographic alignment: applying the Wald Principles in the adoption of robotic total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:365-373. [PMID: 35532787 PMCID: PMC9877041 DOI: 10.1007/s00264-022-05411-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 01/29/2023]
Abstract
The use of robotics in total knee arthroplasty (TKA) is growing at an exponential rate. Despite the improved accuracy and reproducibility of robotic-assisted TKA, consistent clinical benefits have yet to be determined, with most studies showing comparable functional outcomes and survivorship between robotic and conventional techniques. Given the success and durability of conventional TKA, measurable improvements in these outcomes with robotic assistance may be difficult to prove. Efforts to optimize component alignment within two degrees of neutral may be an attainable but misguided goal. Applying the "Wald Principles" of rationalization, it is possible that robotic technology may still prove beneficial, even when equivalent clinical outcomes as conventional methods, if we look beyond the obvious surrogate measures of success. Robotic systems may help to reduce inventory, streamline surgical trays, enhance workflows and surgical efficiency, optimize soft tissue balancing, improve surgeon ergonomics, and integrate artificial intelligence and machine learning algorithms into a broader digital ecosystem. This article explores these less obvious alternative benefits of robotic surgery in the field of TKA.
Collapse
|