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Hepinstall MS, Di Gangi C, Oakley C, Sybert M, Meere PA, Meftah M. Variability in Alignment and Bone Resections in Robotically Balanced Total Knee Arthroplasties. Bioengineering (Basel) 2024; 11:845. [PMID: 39199803 PMCID: PMC11351558 DOI: 10.3390/bioengineering11080845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024] Open
Abstract
Image-based robotic-assisted total knee arthroplasty (RA-TKA) allows three-dimensional surgical planning informed by osseous anatomy, with intraoperative adjustment based on a dynamic assessment of ligament laxity and gap balance. The aim of this study was to identify ranges of implant alignment and bone resections with RA-TKA. We retrospectively reviewed 484 primary RA-TKA cases, stratified by preoperative coronal alignment. Demographics and intraoperative data were collected and compared using Chi-square and ANOVA tests. Planned limb, femoral, and tibial alignment became increasingly varus in a progressive order from valgus to neutral to the highest in varus knees (p < 0.001). Planned external transverse rotation relative to the TEA was lowest in the valgus cohort; relative to the PCA, whereas the varus cohort was highest (p < 0.001, both). Planned resections of the lateral distal femur and of the medial posterior femur were greater in the varus group compared to neutral and valgus (p < 0.001). There were significant differences between cohorts in planned tibia resections, laterally and medially. Varus knees demonstrated higher variability, while valgus and neutral had more metrics with low variability. This study demonstrated trends in intraoperative planned alignment and resection metrics across various preoperative coronal knee alignments. These findings contribute to the understanding of RA-TKA and may inform surgical decision-making.
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Tsushima T, Sasaki E, Sakamoto Y, Kimura Y, Tsuda E, Ishibashi Y. Joint line convergence angle is the most associated alignment factor with the severity of medial knee osteoarthritis. J Exp Orthop 2024; 11:e70007. [PMID: 39176253 PMCID: PMC11339597 DOI: 10.1002/jeo2.70007] [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: 05/18/2024] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 08/24/2024] Open
Abstract
Purpose The purpose of this study was to evaluate the relationship between the joint line convergence angle (JLCA) and the severity of medial knee osteoarthritis (OA). We hypothesise that JLCA is the most associated factor with the severity of medial knee OA. Methods This retrospective study included a total of 202 knees that underwent either high tibial osteotomy or medial meniscus repair/partial resection. Kellgren-Lawrence grade and hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and JLCA were assessed from preoperative radiographs. Medial meniscus extrusion (MME) was measured using preoperative magnetic resonance imaging. The International Cartilage Research Society (ICRS) grade on the medial femoral condyle and medial tibial plateau were also assessed. The relationships between JLCA and Kellgren-Lawrence grades and MME and ICRS grades were analysed using Spearman's correlation test and regression analysis. Results The JLCA was correlated with the Kellgren-Lawrence grade (R = 0.765, p < 0.001), MME (R = 0.638, p < 0.001), ICRS grade on the MFC (R = 0.586, p < 0.001) and the MTP (R = 0.586, p < 0.001). Regression analysis showed that age (p = 0.002) and JLCA (p < 0.001) were associated with Kellgren-Lawrence grade. Furthermore, JLCA was related to ICRS grade on the MFC (p < 0.001) and MTP (p < 0.001). Conclusion The JLCA, reflecting radiological severity, meniscus status, and cartilage lesion, was the most associated alignment parameter in the severity of medial knee OA. The JLCA may be beneficial for quantitative assessment of medial knee OA. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Takahiro Tsushima
- Department of Orthopaedic SurgeryHirosaki University, Graduate School of MedicineHirosakiJapan
| | - Eiji Sasaki
- Department of Orthopaedic SurgeryHirosaki University, Graduate School of MedicineHirosakiJapan
| | - Yukiko Sakamoto
- Department of Orthopaedic SurgeryHirosaki University, Graduate School of MedicineHirosakiJapan
| | - Yuka Kimura
- Department of Orthopaedic SurgeryHirosaki University, Graduate School of MedicineHirosakiJapan
| | - Eiichi Tsuda
- Department of Rehabilitation MedicineHirosaki University, Graduate School of MedicineHirosakiJapan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic SurgeryHirosaki University, Graduate School of MedicineHirosakiJapan
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Jeffrey M, Marchand P, Kouyoumdjian P, Coulomb R. Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment. SICOT J 2024; 10:2. [PMID: 38240728 PMCID: PMC10798231 DOI: 10.1051/sicotj/2024002] [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: 09/28/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Ligament balancing is essential to the functional outcome of total knee arthroplasty (TKA). The optimal method of alignment remains a controversial issue. The primary objective was to compare the clinical outcomes of TKA between functional and adjusted mechanical alignment techniques. The secondary objectives were to compare bone resection, robotic alignment, and radiological assessment. MATERIALS AND METHODS This was a retrospective case-control series comparing TKA performed with functional alignment (FA) and adjusted mechanical alignment (aMA). Sixty-four FA subjects were matched with 64 aMA controls. These two groups were matched for age, gender, body mass index (BMI), surgeon, and type of frontal deformity. Both surgical procedures were performed using the MAKO® haptic robotic system. Functional scores (Forgotten Joint Score (FJS), Knee Society Score (KSS), and Oxford Knee Score (OKS)) were measured at the final postoperative follow-up. A radiographic evaluation was performed at the same time. RESULTS Mean FJS were respectively 63.4 ± 25.1 [0-100] and 51.2 ± 31.8 [0-100] in FA versus aMA group (p = 0.034). Mean OKS were respectively 40.8 ± 6.3 [21-48] and 34.9 ± 11.8 [3-48] in FA versus aMA group (p = 0.027). Mean KSS were respectively 184.9 ± 17.0 [126-200] and 175.6 ± 23.1 [102-200] in FA versus aMA group (p = 0.02). The main residual symptom was "none" for 73.0% versus 57.8%, "instability" for 6.4% versus 21.9%, "Pain" for 19.1% versus 12.5%, and "effusion" for 1.6% and 7.8% respectively for FA and aMA group (p = 0.016). There were 4 complications in the FA group versus 5 in the aMA group (p > 0.999). Mean postoperative hip-knee-ankle (HKA) robotic assessment were respectively 177.3° ± 2.0 [172-180] and 178.2° ± 2.0 [173-180] for FA and aMA group (p = 0.018). The median difference between HKA robotic and HKA radiological was -3.0° (IQR = 3.0; p < 0.001). CONCLUSION With greater residual deformity and without release, functional alignment showed a statistically significantly better short-term clinical outcome than adjusted mechanical alignment. This difference may not be clinically significant.
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Affiliation(s)
- Michaud Jeffrey
- Orthopedic and Traumatology Surgery Department, CHU Nîmes, University Montpellier 1, Nîmes Place du Professeur Robert Debré 30029 Nîmes France
| | - Philippe Marchand
- Orthopedic and Traumatology Surgery Department, CHU Nîmes, University Montpellier 1, Nîmes Place du Professeur Robert Debré 30029 Nîmes France
| | - Pascal Kouyoumdjian
- Orthopedic and Traumatology Surgery Department, CHU Nîmes, University Montpellier 1, Nîmes Place du Professeur Robert Debré 30029 Nîmes France
- Laboratory LMGC, CNRS UMR 5508, University of Montpellier II 860 Rue de St – Priest 34090 Montpellier France
| | - Remy Coulomb
- Orthopedic and Traumatology Surgery Department, CHU Nîmes, University Montpellier 1, Nîmes Place du Professeur Robert Debré 30029 Nîmes France
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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).
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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
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Shen TS, Uppstrom TJ, Walker PJ, Yu JS, Cheng R, Mayman DJ, Jerabek SA, Ast MP. High degree of alignment precision associated with total knee arthroplasty performed using a surgical robot or handheld navigation. Knee Surg Sports Traumatol Arthrosc 2023; 31:4735-4740. [PMID: 37382709 DOI: 10.1007/s00167-023-07495-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE The purpose of this study was to compare the precision of bony resections during total knee arthroplasty (TKA) performed using different computer-assisted technologies. METHODS Patients who underwent a primary TKA using an imageless accelerometer-based handheld navigation system (KneeAlign2®, OrthAlign Inc.) or computed tomography-based large-console surgical robot (Mako®, Stryker Corp.) from 2017 to 2020 were retrospectively reviewed. Templated alignment targets and demographic data were collected. Coronal plane alignment of the femoral and tibial components and tibial slope were measured on postoperative radiographs. Patients with excessive flexion or rotation preventing accurate measurement were excluded. RESULTS A total of 240 patients who underwent TKA using either a handheld (n = 120) or robotic (n = 120) system were included. There were no statistically significant differences in age, sex, and BMI between groups. A small but statistically significant difference in the precision of the distal femoral resection was observed between the handheld and robotic cohorts (1.5° vs. 1.1° difference between templated and measured alignments, p = 0.024), though this is likely clinically insignificant. There were no significant differences in the precision of the tibial resection between the handheld and robotic groups (coronal plane 0.9° vs. 1.0°, n.s.; sagittal plane 1.2° vs. 1.1°, n.s.). There were no significant differences in the rate of overall precision between cohorts (n.s.). CONCLUSIONS A high degree of component alignment precision was observed for both imageless handheld navigation and CT-based robotic cohorts. Surgeons considering options for computer-assisted TKA should take other important factors, including surgical principles, templating software, ligament balancing, intraoperative adjustability, equipment logistics, and cost, into account. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tony S Shen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Tyler J Uppstrom
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Paul J Walker
- Department of Orthopaedic Surgery, UCLA, Los Angeles, CA, USA
| | - Jonathan S Yu
- Department of Orthopaedic Surgery, UCLA, Los Angeles, CA, USA
| | - Ryan Cheng
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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