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Yi J, Gao Z, Huang Y, Liu Y, Zhang Y, Chai W. Evaluating the accuracy of a new robotically assisted system in cadaveric total knee arthroplasty procedures. J Orthop Surg Res 2024; 19:354. [PMID: 38879524 PMCID: PMC11179344 DOI: 10.1186/s13018-024-04788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/07/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (TKA) has been shown to facilitate high-precision bone resection, which is an important goal in TKA. The aim of this cadaveric study was to analyze the accuracy of the target angle and bone resection thickness of a recently introduced robotic TKA system. METHODS This study used 4 frozen cadaveric specimens (8 knees), 2 different implant designs, navigation, and a robotic system. The 4 surgeons who participated in this study were trained and familiar with the basic principles and operating procedures of this system. The angle of the bone cuts performed using the robotic system was compared with the target angles from the intraoperative plan. For each bone cut, the resection thickness was recorded and compared with the planned resection thickness. RESULTS The mean angular difference for all specimens was less than 1°, and the standard deviation was less than 2°. The mean difference between the planned and measured angles was close to 0 and not significantly different from 0 except for the difference in the frontal tibial component angle, which was 0.88°. The mean difference in the hip-knee-ankle axis angle was - 0.21°± 1.06°. The mean bone resection difference for all specimens was less than 1 mm, and the standard deviation was less than 0.5 mm. CONCLUSIONS The results of the cadaveric experimental study showed that the new TKA system can realize highly accurate bone cuts and achieve planned angles and resection thicknesses. Despite the limitations of small sample sizes and large differences between cadaveric and clinical patients, the accuracy of cadaveric experiments provides strong support for subsequent clinical trials.
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Affiliation(s)
- Jiafeng Yi
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
| | - Zhisen Gao
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
| | - Yijian Huang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co. Ltd, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics and Sports Rehabilitation, Beijing, China.
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Nedopil AJ, Howell SM, Hull ML, Hirschmann MT. A TKA can be kinematically aligned without restrictions: Current evidence. Knee Surg Sports Traumatol Arthrosc 2024; 32:1354-1358. [PMID: 38501289 DOI: 10.1002/ksa.12132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California at Davis, Davis, California, USA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California at Davis, Davis, California, USA
- Department of Mechanical Engineering, University of California at Davis, Davis, California, USA
- Department of Orthopaedic Surgery, University of California at Davis, Davis, California, USA
| | - Michael T Hirschmann
- Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, Basel, Switzerland
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Zambianchi F, Matveitchouk N, Pavesi M, Clemenza S, Cuoghi Costantini R, Marcovigi A, Seracchioli S, Catani F. Small deviations between planned and performed bone cuts using a CT-based robotic-arm-assisted total knee arthroplasty system. Knee Surg Sports Traumatol Arthrosc 2024; 32:1539-1547. [PMID: 38572678 DOI: 10.1002/ksa.12171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Computed tomography (CT)-based robotic system for total knee arthroplasty (TKA) has shown improved accuracy compared to conventional. This study was designed to (1) confirm the accuracy of the robotic system in achieving the plan and (2) establish the alignment and positioning deviation between final components and planning, by measuring the discrepancy between final implant alignment and the corresponding planned cut. METHODS Ninety-six cementless robotic-arm assisted (RA) TKAs were assessed. Bone resections were performed using the haptically controlled robotic arm. Alignment in the coronal and sagittal plane and resection depth of the distal femoral and proximal tibial cuts were recorded with a navigation planar probe. After final components were impacted, the probe was positioned on each implant surface to determine its alignment and positioning. RESULTS The mean tibial resections and implanted tibial component's positioning were 0.4 mm (standard deviation, SD: 0.6) and 0.9 mm (SD: 0.8), respectively, higher than planned (p < 0.01). The tibial sagittal cut had 19/96 cases (19.8%) of ±1° outliers from plan. In 40/96 cases (41.7%), the tibial component was more prominent than planned of more than 1 mm. The mean femoral resections and impacted femoral component's positioning was 0.1 mm (SD: 0.8) and 0.2 mm (SD: 0.7), respectively, higher than planned. In 23/96 cases (24.0%), the femoral sagittal cut and femoral component coronal alignment deviated more than ±1° from plan. CONCLUSIONS The computed tomography-based robotic-assisted TKA system showed good accuracy regarding bone preparation and component's positioning relative to the planning. Cementless tibial component impaction resulted in the most deviation from plan, with a large proportion of cases resulting in being more prominent than planned. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Nikita Matveitchouk
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | | | - Sebastiano Clemenza
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Riccardo Cuoghi Costantini
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Stefano Seracchioli
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Zaidi F, Goplen CM, Fitz-Gerald C, Bolam SM, Hanlon M, Munro JT, Monk AP. High in-vivo accuracy of a novel robotic-arm-assisted system for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769790 DOI: 10.1002/ksa.12272] [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: 02/15/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Robotic-assisted total knee arthroplasty (TKA) has been shown to improve the accuracy and precision of bony resections and implant position. However, the in vivo accuracy of the full surgical workflow has not been widely reported. The primary objective of this study is to determine the accuracy and precision of a robotic-arm-assisted system throughout the intraoperative workflow. METHODS This was a retrospective cohort study of adult patients who underwent primary TKA with various workflows and alignment targets by three arthroplasty-trained surgeons with previous experience using the ROSA® Knee System (Zimmer Biomet) over a 3-month follow-up period. Accuracy and precision were determined by measuring the difference between various workflow time points, including the final preoperative plan (PP), robot-validated (RV) resection angle and postoperative radiographs (PR). The absolute mean difference between the measurements determined accuracy, and the standard deviation represented precision. The lateral distal femoral angle, medial proximal tibial angle, femoral flexion angle and tibial slope were measured on postoperative coronal long-leg radiographs and true short-leg lateral radiographs. RESULTS A total of 77 patients were included in the final analyses. The accuracy for the coronal femoral angle was 1.62 ± 1.11°, 0.75 ± 0.79° and 1.96 ± 1.29° for the differences between PP and PR, PP and RV and RV and PR. The tibial coronal accuracy was 1.44 ± 1.03°, 0.81 ± 0.67° and 1.57 ± 1.14° for PP/PR, PP/RV and RV/PR, respectively. Femoral flexion accuracy was 1.39 ± 1.05°, 0.83 ± 0.59° and 1.81 ± 1.21° for PP/PR, PP/RV and RV/PR, respectively. Tibial slope accuracy was 0.99 ± 0.72°, 1.19 ± 0.87° and 1.63 ± 1.11°, respectively. The proportion of patients within 3° was 93.2%, 95.3%, 97.3% and 94.6% for the distal femur, proximal tibia, femoral flexion and tibial slope angles when the final intraoperative plan was compared to PRs. No patients had a postoperative complication at the final follow-up. CONCLUSIONS The ROSA Knee System has acceptable accuracy and precision of coronal and sagittal plane resections with few outliers at various steps throughout the platform's entire workflow in vivo. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Faseeh Zaidi
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Craig M Goplen
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Connor Fitz-Gerald
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Scott M Bolam
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Michael Hanlon
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacob T Munro
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Andrew P Monk
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
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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.
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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
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Valpiana P, Salvi AG, Ghirardelli S, Bernardi M, Petralia G, Aloisi G, Schaller C, Indelli PF. Asymmetric gap balancing improves knee kinematic following primary total knee arthroplasty. ARTHROPLASTY 2024; 6:29. [PMID: 38659002 PMCID: PMC11044442 DOI: 10.1186/s42836-024-00243-5] [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: 11/28/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The purpose of this study was to demonstrate closer-to-normal knee kinematics following primary total knee arthroplasty (TKA) performed establishing asymmetric gap balancing intraoperatively. MATERIAL AND METHOD Two age-, sex-, BMI-matched groups of patients underwent medially stabilized TKA because of isolated knee disease. Group A (12 patients) underwent "unrestricted" kinematic alignment (uKA) according to Howell while group B (15 patients) received robot-assisted "simplified" KA (sKA) with an alignment goal (Hip-Knee-Ankle axis-HKA) ± 5° respect to the mechanical axis. Intraoperatively, in group B, the flexion gap at 90° was first set at an average of 1.5 mm (0-5 mm; SD 4.4 mm) tighter in the medial compartment with respect to the lateral; in the same way, the extension gap was then set at an average of 2.0 mm (0-4.5 mm; SD 3.1 mm) tighter in the medial compartment with respect to the lateral. All patients, including a non-arthritic cohort (group C: 5 controls) underwent gait analysis using an instrumented treadmill (WalkerView-WV) equipped with an instrumented belt armed with a 3D video camera. The WV software evaluated multiple spatiotemporal and kinematic parameters, including: (1) contact time (s); (2) knee ROM during gait cycle; (3) step length percentage with respect to total gait (%) and pure step length (cm). Statistical analyses included t-Test and ANOVA and were conducted by using SPSS. RESULTS At the final FU, significant differences were noted during gait between the two TKA groups (uKA-sKA) and the controls. Both TKA groups showed superior mean contact time on the surgical knee (uKA 1 s; sKA 0.97 s) as compared to the controls (0.72 s) (P = 0.002) while no differences were found between them (P = 0.11). TKA groups showed a lower, maximum ROM in the surgical knee (mean uKA 36º; mean sKA 49º) relative to the controls (mean 57º) (P < 0.05) but a statistical difference was found between them (P = 0.003). Both TKA groups showed a higher step length percentage with respect to the total gait and a shorter step length on the surgical side (uKA: mean 8.28% and mean step length 35.5 cm; sKA: mean 8.38% and mean step length 34.6 cm) in comparison to the controls (mean 3.38%; mean step length 71.4 cm) (P < 0.05) while no statistical differences were found between them. CONCLUSION To our knowledge, this was the first study to exhibit the kinematic advantages of a slightly asymmetric gap balancing during KA TKA. Combining a medially-stabilized implant design and a surgical technique aiming to obtain a tighter medial compartment represents a promising approach to improve outcomes after TKA.
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Affiliation(s)
- Pieralberto Valpiana
- Südtiroler Sanitätsbetrieb, 39042, Brixen, Italy
- Institute for Biomedicine, EURAC Institute, 39100, Bozen, Italy
- Personalized Arthroplasty Society (PAS), One Glenlake Parkway NE, Suite 1200, Atlanta, GA, 30328, USA
- Institute of Biomechanics, Paracelsus Medical University (PMU), 5020, Salzburg, Australia
| | | | - Stefano Ghirardelli
- Südtiroler Sanitätsbetrieb, 39042, Brixen, Italy
- Institute of Biomechanics, Paracelsus Medical University (PMU), 5020, Salzburg, Australia
| | | | - Giuseppe Petralia
- Department of Clinical Medicine, Public Health, Life and Nature, University of L'Aquila, P.Le S. Tommasi 1, 67100, L'Aquila, Italy
| | - Giuseppe Aloisi
- Department of Clinical Medicine, Public Health, Life and Nature, University of L'Aquila, P.Le S. Tommasi 1, 67100, L'Aquila, Italy
| | | | - Pier Francesco Indelli
- Südtiroler Sanitätsbetrieb, 39042, Brixen, Italy.
- Institute for Biomedicine, EURAC Institute, 39100, Bozen, Italy.
- Personalized Arthroplasty Society (PAS), One Glenlake Parkway NE, Suite 1200, Atlanta, GA, 30328, USA.
- Institute of Biomechanics, Paracelsus Medical University (PMU), 5020, Salzburg, Australia.
- The Breyer Center for Overseas Studies, Stanford University in Florence, 50125, Florence, Italy.
- "Paolo Aglietti" Gait Lab, CESAT, Azienda Sanitaria Toscana Centro, 50054, Fucecchio, Italy.
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Mayne AI, Rajgor H, Munasinghe C, Agrawal Y, Pagkalos J, Davis ET, Sharma AD. The ROSA robotic-arm system reliably restores joint line height, patella height and posterior condylar offset in total knee arthroplasty. Knee 2024; 48:1-7. [PMID: 38461736 DOI: 10.1016/j.knee.2024.02.007] [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: 05/06/2023] [Revised: 12/26/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION There is growing interest in the use of robotic TKA to improve accuracy of component positioning in Total Knee Arthroplasty (TKA). The aim of this study was to investigate the accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Patella Height and Posterior Condylar Offset (PCO). METHODS This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. Both the image-based and imageless workflow were used and two prosthesis types were implanted. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Patella Height and Posterior Condylar Offset. RESULTS 100 consecutive patients undergoing TKA using the ROSA system were included; mean age 70 years (range 49-95 years). Mean change in joint line height was 0.2 mm, patella height (Insall-Salvati ratio) 0.01 and posterior condylar offset 0.02 mm; there was no statistically significant difference between the pre and post-operative values. No difference was demonstrated between image-based or imageless workflows, or between implant design (Persona versus Vanguard) regarding joint line height, patella height and PCO. CONCLUSION This study validates the use of the ROSA® knee system in accurately restoring Joint Line Height, Patella Height and Posterior Condylar Offset in TKA surgery. No significant differences were found between imageless and image-based groups, or between implant designs (Persona versus Vanguard).
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Affiliation(s)
- Alistair Iw Mayne
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK.
| | - Harshadkumar Rajgor
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Chathura Munasinghe
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Yuvraj Agrawal
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Joseph Pagkalos
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Edward T Davis
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Akash D Sharma
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
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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.
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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
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Castellarin G, Bori E, Barbieux E, Grandjean VP, Jost G, Innocenti B. Is Total Knee Arthroplasty Surgical Performance Enhanced Using Augmented Reality? A Single-Center Study on 76 Consecutive Patients. J Arthroplasty 2024; 39:332-335. [PMID: 37572726 DOI: 10.1016/j.arth.2023.08.013] [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: 03/01/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Augmented reality (AR) is a powerful multipurpose tool. With a dedicated visor, AR allows the visualization of a series of information and/or images superimposed on the user's field of vision. For this reason, it was recently introduced as a surgical assistant tool. This single-center study aimed to evaluate the intraoperative outcomes of total knee arthroplasties performed with AR assistance in terms of time required and the difference between preplanned and achieved implant positioning (in terms of tibial cut varus and slope angles). METHODS A total of 76 consecutive patients was selected. Preplanning was performed according to the AR protocol, and the target varus and slope angles were defined to instruct the device, which subsequently guided the tibial cuts intraoperatively. Surgeries were performed starting from the tibial cut, and the time required to perform the calibration, registration, and fixation of the resection block was recorded. The varus and slope angles achieved were recorded to compare with the preplanned ones to determine the means and SDs of the differences. RESULTS The mean usage time of the AR tool was 5 ± 1 minutes. Results showed a mean difference of 0.59 ± 0.55° for varus angles and 0.70 ± 0.75° for the slope. For varus angles, the differences were <1° for 96% of the cases. Concerning the slope, 89% of the cases were <1°. CONCLUSION The results showed excellent accuracy of the surgical cuts and a limited increase in surgery duration. Therefore, these outcomes highlighted the potential of this new technology as a valid option for surgical assistance.
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Affiliation(s)
| | - Edoardo Bori
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Elodie Barbieux
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Grace Jost
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
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Gamal A, Moschovas MC, Jaber AR, Saikali S, Perera R, Headley C, Patel E, Rogers T, Roche MW, Leveillee RJ, Albala D, Patel V. Clinical applications of robotic surgery platforms: a comprehensive review. J Robot Surg 2024; 18:29. [PMID: 38231279 DOI: 10.1007/s11701-023-01815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
Robotic surgery has expanded globally across various medical specialties since its inception more than 20 years ago. Accompanying this expansion were significant technological improvements, providing tremendous benefits to patients and allowing the surgeon to perform with more precision and accuracy. This review lists some of the different types of platforms available for use in various clinical applications. We performed a literature review of PubMed and Web of Science databases in May 2023, searching for all available articles describing surgical robotic platforms from January 2000 (the year of the first approved surgical robot, da Vinci® System, by Intuitive Surgical) until May 1st, 2023. All retrieved robotic platforms were then divided according to their clinical application into four distinct groups: soft tissue robotic platforms, orthopedic robotic platforms, neurosurgery and spine platforms, and endoluminal robotic platforms. Robotic surgical technology has undergone a rapid expansion over the last few years. Currently, multiple robotic platforms with specialty-specific applications are entering the market. Many of the fields of surgery are now embracing robotic surgical technology. We review some of the most important systems in clinical practice at this time.
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Affiliation(s)
- Ahmed Gamal
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA.
| | - Marcio Covas Moschovas
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
- University of Central Florida (UCF), Orlando, FL, USA
| | - Abdel Rahman Jaber
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Shady Saikali
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Roshane Perera
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Chris Headley
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Ela Patel
- Stanford University, Palo Alto, CA, USA
| | - Travis Rogers
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
| | - Martin W Roche
- Department of Arthroplasty, Hospital for Special Surgery Florida, West Palm Beach, FL, USA
| | | | - David Albala
- Associated Medical Professionals, Urology, Syracuse, NY, USA
| | - Vipul Patel
- Adventhealth Global Robotics Institute, 380 Celebration Place, Orlando, FL, 34747, USA
- University of Central Florida (UCF), Orlando, FL, USA
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11
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Rossi SMP, Panzera RM, Sangaletti R, Andriollo L, Giudice L, Lecci F, Benazzo F. Problems and Opportunities of a Smartphone-Based Care Management Platform: Application of the Wald Principles to a Survey-Based Analysis of Patients' Perception in a Pilot Center. Healthcare (Basel) 2024; 12:153. [PMID: 38255043 PMCID: PMC10815320 DOI: 10.3390/healthcare12020153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Mobile health (mHealth) solutions can become a means of improving functional recovery and reducing the peri-operative burden and costs associated with arthroplasty procedures. The aim of this study is to explore the objectives, functionalities, and outcomes of a platform designed to provide personalized surgical experiences to qualified patients, along with the associated problems and opportunities. (2) Methods: A survey-based analysis was conducted on patients who were prescribed the use of a specific care management platform and underwent primary robotic total knee arthroplasty (rTKA) between January 2021 and February 2023. (3) Results: Patients registered on the platform who have undergone primary robotic TKA (rTKA) were considered. The mean age of registered patients is 68.6 years. The male (M)/female (F) ratio is 45.1%/54.9%. The patients interviewed were at an average distance of 485 days from the intervention, with a standard deviation of 187.5. The survey highlighted appreciation for the app and its features, but also limitations in its use and in its perception by the patients. All these data were evaluated according to the Wald principles and strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimized surgical experiences. (4) Conclusions: This patient care platform may have the potential to impact surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalized care. There is a need to emphasize the importance of integrating the recruiting process, improving adherence strategies, and creating a comprehensive patient journey within the platform.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
| | - Rocco Maria Panzera
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
| | - Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Laura Giudice
- Divisione Government, Health and Not for Profit, CERGAS, SDA Bocconi School of Management (Milano), 20136 Milano, Italy; (L.G.); (F.L.)
| | - Francesca Lecci
- Divisione Government, Health and Not for Profit, CERGAS, SDA Bocconi School of Management (Milano), 20136 Milano, Italy; (L.G.); (F.L.)
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, 25124 Brescia, Italy; (R.M.P.); (L.A.)
- Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Divisione Government, Health and Not for Profit, CERGAS, SDA Bocconi School of Management (Milano), 20136 Milano, Italy; (L.G.); (F.L.)
- IUSS Istituto Universitario di Studi Superiori, 27100 Pavia, Italy
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12
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Mancino F, Rossi SMP, Sangaletti R, Caredda M, Terragnoli F, Benazzo F. Increased accuracy in component positioning using an image-less robotic arm system in primary total knee arthroplasty: a retrospective study. Arch Orthop Trauma Surg 2024; 144:393-404. [PMID: 37755480 DOI: 10.1007/s00402-023-05062-y] [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: 10/22/2022] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (RTKA) and navigated total knee arthroplasty (NTKA) have shown improved knee alignment and reduced radiographic outliers. Recent studies have proven that conventional mechanical alignment may not be the optimal goal for every patient. The aim of this study was to compare the accuracy of the planned implant positioning of a novel image-less robotic technique with an established navigated technique (NTKA). METHOD The study is a retrospective analysis of prospectively collected data that compared the implant positioning and lower-limb alignment of 86 image-less RTKA with 86 image-less NTKA. Radiographic analysis was performed to evaluate the lower-limb overall alignment, femoral and tibial components positioning in the coronal and sagittal planes. Outliers were evaluated with a cutoff of ± 3°. RESULTS No difference was noted between the two groups for radiographic outliers within ± 3° from neutral (p = 0.098). The mean hip-knee-ankle angle deviation from target was 1.3° in the RTKA group compared to 1.9° in the NTKA (p < 0.001). Femoral sagittal deviation (femoral component flexion) was smaller in the RTKA group (0.9° vs 1.9°; p < 0.001). Similarly, tibial coronal deviation (0.8° vs 1.5°; p < 0.001) and tibial sagittal deviation (tibial slope) were smaller in the RTKA group compared to the NTKA group (0.9° vs 1.7°; p < 0.001). CONCLUSIONS The RTKA group reported a substantial and significant reduced error from the planned target angles for both tibial and femoral components. No difference in terms of radiographic outliers was noted between navigation and robotic assistance.
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Affiliation(s)
- Fabio Mancino
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, WA, Australia
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- Università degli Studi di Pavia, Pavia, Italy
| | - Matteo Caredda
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavio Terragnoli
- U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- IUSS Istituto Universitario Di Studi Superiori, Pavia, Italy
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Zhang H, Bai X, Wang H, Zhu Z, Li X. Learning curve analysis of robotic-assisted total knee arthroplasty with a Chinese surgical system. J Orthop Surg Res 2023; 18:900. [PMID: 38012732 PMCID: PMC10680304 DOI: 10.1186/s13018-023-04382-4] [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: 09/03/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE The aim of this study was to analyze the learning curve of total operative time, bone cutting accuracy, and limb alignment in total knee arthroplasty (TKA) using a Chinese image-based knee surgery robot known as HURWA. Additionally, a comparison was conducted with conventional TKA to ascertain the benefits of robotic-assisted TKA. METHODS In this retrospective study, we analyzed a series of patients (n = 90) who underwent robotic-assisted total knee arthroplasty using the HURWA robot between December 2021 and October 2022. The procedures were performed by one of three orthopedic surgeons with varying levels of experience. As a control group, we selected the last 30 conventional TKA cases performed by each of these three surgeons. To determine the learning curve, we recorded the operative time, bone cutting error, and pre- and post-surgery radiographs. RESULTS The study found no significant differences in total operative time, bone cutting accuracy, or limb alignment among the three surgeons. Of the three surgeons, surgeon 1, who had the most experience in joint arthroplasty, reached the learning curve in case 8, with the shortest bone cutting time and robot time. Surgeon 2 reached the learning curve in case 16, while surgeon 3 reached the learning curve in case 9. There was no observable learning curve effect for bone cutting accuracy and limb alignment. However, the percentage of cases where limb alignment differed from preoperative planning by 3° or less was higher in robotic-assisted TKA (77.97%) than in conventional TKA (47.19%). CONCLUSION The study determined that the learning curve for robotic-assisted TKA using the HURWA knee surgery robot ranged from 8 to 20 cases. No observable learning curve effect was detected for bone cutting accuracy or limb alignment. Experienced surgeons using the HURWA robot for bone cutting took less time and reached the learning curve earlier. The HURWA robot achieved better limb alignment without depending on the experience of conventional TKA.
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Affiliation(s)
- Haoran Zhang
- Department of Sports Medicine and Joint Surgery, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, 33 Wenyi Road, Shenyang, 110000, China
| | - Xizhuang Bai
- Department of Sports Medicine and Joint Surgery, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, 33 Wenyi Road, Shenyang, 110000, China
| | - Huisheng Wang
- Department of Sports Medicine and Joint Surgery, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, 33 Wenyi Road, Shenyang, 110000, China
| | - Zhiyong Zhu
- Department of Sports Medicine and Joint Surgery, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, 33 Wenyi Road, Shenyang, 110000, China
| | - Xi Li
- Department of Sports Medicine and Joint Surgery, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, 33 Wenyi Road, Shenyang, 110000, China.
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Demirtas Y, Emet A, Ayik G, Cakmak G, Aksahin E, Celebi L. A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience. Medicine (Baltimore) 2023; 102:e35710. [PMID: 37861507 PMCID: PMC10589563 DOI: 10.1097/md.0000000000035710] [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: 06/29/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is a successful procedure in the treatment of knee osteoarthritis. Searches in surgical technique have focused surgeons in particular on implant alignment. For this purpose, the use of robot-assisted total knee arthroplasty has become increasingly common in the last 10 years. METHODS A total of 46 patients (66 knees) who were operated for knee osteoarthritis with Robotic Surgical Assistant (ROSA, Zimmer-Biomet, Warshaw, Indiana, USA) between 2021 and 2023 were included in the study. Preoperative planning and intraoperative incision time, total surgical time, range of motion and follow-up time recorded. Oxford knee scores and knee society scores (KSS) of the patients were compared before and after surgery. At the last follow-up Forgotten Joint Score and the sagittal and coronal plane alignments were evaluated. RESULTS Preoperative mean Oxford score of the right knee of the patients was 18.5 ± 3.2, post-surgery mean Oxford score progressed to 43.5 ± 2.2. While the preoperative left knee Oxford score of the patients was 16.9 ± 2.3, the mean left knee Oxford score improved to 43.4 ± 2.2 postoperatively. The mean KSS score of the patients' right knee preoperatively was 49.7 ± 3.5, and progressed to 89.2 ± 4.7 postoperatively. While the preoperative mean left knee KSS score of the patients was 46.5 ± 4.3, the mean KSS score improved to 89.8 ± 3.2 postoperatively. The mean Forgotten Joint Score of the left knee at the last follow-up of the patients was 77.4 ± 3.8, while the mean Forgotten Joint Score of the right knee was 75.4 ± 5.9. CONCLUSION The results of ROSA-supported knee arthroplasty found to be functionally successful.
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Affiliation(s)
- Yunus Demirtas
- Yuksek İhtisas University Medical School Orthopedics and Traumatology Department, Ankara, Turkey
| | - Abdulsamet Emet
- Department of Orthopedics and Traumatology, Etlik City Hospital, Ankara, Turkey
| | | | - Gokhan Cakmak
- Yuksek İhtisas University Medical School Orthopedics and Traumatology Department, Ankara, Turkey
| | - Ertugrul Aksahin
- Yuksek İhtisas University Medical School Orthopedics and Traumatology Department, Ankara, Turkey
| | - Levent Celebi
- Yuksek İhtisas University Medical School Orthopedics and Traumatology Department, Ankara, Turkey
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15
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Prakash R, Agrawal Y. Robotic technology in total knee arthroplasty. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 37364881 DOI: 10.12968/hmed.2022.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Key factors for successful total knee arthroplasty include accurate implant positioning with precise tibial and femoral resection, combined with appropriate soft tissue balancing to achieve the desired alignment. Robotic-assisted total knee arthroplasty allows surgeons to execute pre-planned strategies with precision, with growing evidence suggesting that robotic-assisted-total knee arthroplasty reduces radiological outliers. This has yet to be proven to translate into long-term improvements in patient-reported outcomes and implant survivorship. Robotic-assisted-total knee arthroplasty systems can be divided into fully autonomous and semi-autonomous systems. While fully autonomous systems showed initial promise, semi-autonomous systems are gaining popularity with encouraging early outcomes suggesting improved radiological and clinical outcomes, although concerns remain regarding a significant learning curve, installation costs, radiation exposure and cost associated with preoperative imaging. The future of total knee arthroplasty seems certain to involve robotic technology, although to what degree and in what capacity will depend on further high-quality studies assessing long-term outcomes, complications, survivorship and cost-benefit analyses.
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Affiliation(s)
- Rohan Prakash
- Department of Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Yuvraj Agrawal
- Department of Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
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16
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Individualized alignment and ligament balancing technique with the ROSA® robotic system for total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:755-762. [PMID: 36596998 DOI: 10.1007/s00264-022-05671-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Higher patient's expectations and dissatisfaction following total knee arthroplasty are well-documented phenomena. Despite the implications of different patients' related factors both modifiable and nonmodifiable, in the last decade a lot of emphasis has been focused on surgical technique, implant alignment and stability both as a cause and a potential solution of several problems. METHODS Different alignment and balancing techniques have been recently described and the introduction of new technologies such as computer and robotic-assisted surgery have been the basis for their optimization. In this paper, the surgical technique of the ROSA Knee System will be described focusing on the potential alignment options and the ligament balancing technique. The current literature available about the system will also be analyzed. RESULTS The ROSA® robotic system have been recently introduced in the market and presents specific and peculiar features to optimize ligament balancing and an individualized alignment of the implant in a three dimensional prospective. DISCUSSION The system is showing a favourable gap balancing technique and the possibility to create an individualized alignment. Preliminary results have now been shown in the literature both on the accuracy of the system and on clinical outcomes. CONCLUSIONS Preliminary results are promising both in terms of accuracy of the system and of clinical outcomes.
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17
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Image-Free Robotic-Assisted Total Knee Arthroplasty Results in Quicker Recovery but Equivalent One-Year Outcomes Compared to Conventional Total Knee Arthroplasty. J Arthroplasty 2023; 38:S232-S237. [PMID: 36801477 DOI: 10.1016/j.arth.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Few studies have addressed whether robotic-assisted total knee arthroplasty (RA-TKA) significantly impacts functional outcomes. This study was conducted to determine whether image-free RA-TKA improves function compared to conventional total knee arthroplasty (C-TKA), performed without the utilization of robotics or navigation, using the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) as measures of meaningful clinical improvement. METHODS A multicenter propensity score-matched retrospective study was conducted of RA-TKA using an image-free robotic system and C-TKA cases at an average follow-up of 14 months (range, 12 months to 20 months). Consecutive patients who underwent primary unilateral TKA and had a preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) were included. The primary outcomes were the MCID and PASS for KOOS-JR. 254 RA-TKA and 762 C-TKA patients were included, with no significant differences in sex, age, body mass index, or comorbidities. RESULTS Preoperative KOOS-JR scores were similar in the RA-TKA and C-TKA cohorts. Significantly greater improvement in KOOS-JR scores were achieved at 4 to 6 weeks postoperatively with RA-TKA compared to C-TKA. While the mean 1-year postoperative KOOS-JR was significantly higher in the RA-TKA cohort, no significant differences were found in the Delta KOOS-JR scores between the cohorts, when comparing preoperative and 1-year postoperative. No significant differences existed in the rates of MCID or PASS being achieved. CONCLUSION Image-free RA-TKA reduces pain and improves early functional recovery compared to C-TKA at 4 to 6 weeks, but functional outcomes at 1 year are equivalent based on the MCID and PASS for KOOS-JR.
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18
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An orthopaedic intelligence application successfully integrates data from a smartphone-based care management platform and a robotic knee system using a commercial database. INTERNATIONAL ORTHOPAEDICS 2023; 47:485-494. [PMID: 36508053 DOI: 10.1007/s00264-022-05651-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the feasibility of using a smartphone-based care management platform (sbCMP) and robotic-assisted total knee arthroplasty (raTKA) to collect data throughout the episode-of-care and assess if intra-operative measures of soft tissue laxity in raTKA were associated with post-operative outcomes. METHODS A secondary data analysis of 131 patients in a commercial database who underwent raTKA was performed. Pre-operative through six week post-operative step counts and KOOS JR scores were collected and cross-referenced with intra-operative laxity measures. A Kruskal-Wallis test or a Wilcoxon sign-rank was used to assess outcomes. RESULTS There were higher step counts at six weeks post-operatively in knees with increased laxity in both the lateral compartment in extension and medial compartment in flexion (p < 0.05). Knees balanced in flexion within < 0.5 mm had higher KOOS JR scores at six weeks post-operative (p = 0.034) compared to knees balanced within 0.5-1.5 mm. CONCLUSION A smartphone-based care management platform can be integrated with raTKA to passively collect data throughout the episode-of-care. Associations between intra-operative decisions regarding laxity and post-operative outcomes were identified. However, more robust analysis is needed to evaluate these associations and ensure clinical relevance to guide machine learning algorithms.
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19
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Zimmermann F, Franke J, Vetter SY, Grützner PA. [Computer-assisted procedures in orthopedics and trauma surgery-Where do we stand?]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:292-298. [PMID: 36600030 DOI: 10.1007/s00104-022-01789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/06/2023]
Abstract
Computer-assisted procedures are becoming increasingly more relevant in orthopedics and trauma surgery. The data situation on these systems has improved in recent years but still has a low level of evidence. In particular, data on short-term or medium-term results on the use of these procedures are currently available. These could show that improved precision and reproducibility of the surgical procedures can be achieved by the use of computer-assisted procedures. Nevertheless, there is still no recommendation in the current guidelines for routine use.
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Affiliation(s)
- Felix Zimmermann
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland.
| | - Jochen Franke
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Sven Y Vetter
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
| | - Paul A Grützner
- BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland
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20
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Tuecking LR, Ettinger M, Windhagen H, Savov P. [Market overview: Robotic-assisted arthroplasty : Current robotic systems, learning curve and cost analysis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:727-738. [PMID: 35945459 DOI: 10.1007/s00132-022-04286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Robotic-assisted arthroplasty has been rapidly entering clinical routine in recent years. The leading endoprosthesis manufacturers have all meanwhile placed robotic systems on the market, which, however, differ significantly from one another technically. Current systems are currently classified according to the degree of autonomy (active vs. semi-active vs. passive) and the data/image source (image-based: CT vs. X‑ray, imageless). Some systems already offer the possibility of robotic-assisted or navigated implantation of hip endoprostheses. In the following review article, the currently leading robotic systems will be presented and compared with regard to their characteristics. Furthermore, the analysis of the learning curves for the different systems, currently available cost analysis models and an outlook on future developments and challenges will be given.
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Affiliation(s)
- Lars-René Tuecking
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland.
| | - Max Ettinger
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| | - Henning Windhagen
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| | - Peter Savov
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
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21
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Mancino F, Rossi SMP, Sangaletti R, Lucenti L, Terragnoli F, Benazzo F. A new robotically assisted technique can improve outcomes of total knee arthroplasty comparing to an imageless navigation system. Arch Orthop Trauma Surg 2022; 143:2701-2711. [PMID: 35913518 DOI: 10.1007/s00402-022-04560-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/18/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Robotic assisted total knee arthroplasty (RTKA) has shown improved knee alignment and reduced radiographic outliers. However, there remains debate on functional outcomes and patient-reported outcomes (PROMs). This study compares the 1-year clinical outcomes of a new imageless robotically assisted technique (ROSA Knee System, Zimmer Biomet, Warsaw, IN) with an imageless navigated procedure (NTKA, iAssist Knee, Zimmer, Warsaw, IN). METHODS The study is a retrospective analysis of prospectively collected data that compared the functional outcomes and PROMs of 50 imageless RTKA with 47 imageless NTKA at 1-year follow-up. Baseline characteristics, intraoperative and postoperative information were collected including complications, revisions, Knee Society Score (KSS), Knee injury and Osteoarthritis Outcome Score (KOOS) score, and Forgotten Joint Score (FJS-12). Radiographic analysis of preoperative and postoperative images evaluating hip-knee-ankle (HKA) angle was performed. RESULTS There was no difference regarding baseline characteristics between the groups. Mean operative time was significantly longer in the RTKA group (122 min vs. 97 min; p < 0.0001). Significant differences were reported for the "Pain" (85 [RTKA] vs 79.1 [NTKA]; p = 0.0283) subsection of the KOOS score. In addition, RTKA was associated with higher maximum range of motion (119.4° vs. 107.1°; p < 0.0001) and better mean improvement of the arc of motion by 11.67° (23.02° vs. 11.36°; p < 0.0001). No significant differences were noted for other subsections of KOOS, KSS, FJS-12, complications, or limb alignment at 1-year follow-up. CONCLUSIONS Imageless RTKA was associated with longer surgical time, better pain perception and improved ROM at 12-month follow-up compared with NTKA. No significant differences were reported on other PROMs, complication rates and radiographic outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Fabio Mancino
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,Unità di Ortopedia e Traumatologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Ludovico Lucenti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Flavio Terragnoli
- U.O.C. Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
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22
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Kenanidis E, Paparoidamis G, Milonakis N, Potoupnis M, Tsiridis E. Comparative outcomes between a new robotically assisted and a manual technique for total knee arthroplasty in patients with osteoarthritis: a prospective matched comparative cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1231-1236. [PMID: 35552535 DOI: 10.1007/s00590-022-03274-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Studies comparing clinical outcomes between manual (mTKA) and robotic-assisted TKA (raTKA) are limited. This prospective comparative cohort study aimed to compare early postoperative outcomes, satisfaction, and patient-reported outcome measures (PROMS) between patients undergoing mTKA and ROSA raTKA (Zimmer Biomet, Warsaw, IN) performed by one surgeon. METHODS Thirty ROSA raTKAs and 30 mTKAs performed by one surgeon during 2020-2021 were prospectively evaluated. Groups were matched for age, sex, and body mass index. All procedures were primary unilateral TKAs using the same posterior-stabilized prosthesis (Nexgen Legacy, Zimmer Biomet, Warsaw, IN). Length of hospital stay (LOS) and blood transfusion rate were recorded. Complications, visual analogue scale score (VAS), and Oxford Knee Score (OKS) were assessed preoperatively and for six postoperative months. The Forgotten Joint Score (FJS) and patient satisfaction were evaluated 6 months postoperatively. RESULTS No complications and similar blood transfusion rate were recorded between groups (p = 0.228). The LOS was non-significantly shorter in raTKA than in the mTKA group (p = 0.120). Mean preoperative and third-month OKS and VAS scores were comparable between groups. However, the mean 6-month OKS (p = 0.006) and VAS score (p = 0.025) were significantly better for the raTKA group. The 6-month FJS was significantly greater for raTKA than the mTKA group (p < 0.001). One patient was unhappy in raTKA, and three in the mTKA group (p = 0.301). Significantly more raTKA patients answered that they would undergo surgery again (p = 0.038). CONCLUSION raTKA was associated with the same complication risk, less pain level, better patient satisfaction, and PROMs on 6-month follow-up than the mTKA group.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece. .,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece. .,Department of Robotic Orthopaedic Surgery, Interbalkan European Medical Center, 54636, Thessaloniki, Greece.
| | - George Paparoidamis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Nikolaos Milonakis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece.,Department of Robotic Orthopaedic Surgery, Interbalkan European Medical Center, 54636, Thessaloniki, Greece
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