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Pipino G, Giai Via A, Ratano M, Spoliti M, Lanzetti RM, Oliva F. Robotic Total Knee Arthroplasty: An Update. J Pers Med 2024; 14:589. [PMID: 38929810 PMCID: PMC11204817 DOI: 10.3390/jpm14060589] [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: 03/04/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Total knee arthroplasty (TKA) is a gold standard surgical procedure to improve pain and restore function in patients affected by moderate-to-severe severe gonarthrosis refractory to conservative treatments. Indeed, millions of these procedures are conducted yearly worldwide, with their number expected to increase in an ageing and more demanding population. Despite the progress that has been made in optimizing surgical techniques, prosthetic designs, and durability, up to 20% of patients are dissatisfied by the procedure or still report knee pain. From this perspective, the introduction of robotic TKA (R-TKA) in the late 1990s represented a valuable instrument in performing more accurate bone cuts and improving clinical outcomes. On the other hand, prolonged operative time, increased complications, and high costs of the devices slow down the diffusion of R-TKA. The advent of newer technological devices, including those using navigation systems, has made robotic surgery in the operatory room more common since the last decade. At present, many different robots are available, representing promising solutions to avoid persistent knee pain after TKA. We hereby describe their functionality, analyze potential benefits, and hint at future perspectives in this promising field.
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Affiliation(s)
- Gennaro Pipino
- Department of Orthopedic Surgery and Traumatology Villa Erbosa Hospital, Gruppo San Donato, 40129 Bologna, Italy;
- San Raffaele University, 20132 Milan, Italy
| | - Alessio Giai Via
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (M.S.); (R.M.L.)
| | - Marco Ratano
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Spoliti
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (M.S.); (R.M.L.)
| | - Riccardo Maria Lanzetti
- Department of Orthopedic Surgery and Traumatology, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (M.S.); (R.M.L.)
| | - Francesco Oliva
- Full Professor Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy;
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Rezaei A, Moon J, Lichtig A, Mera B, Drake B, Choubey AS, Kim S, Tueni N, Piponov H, Koh J, Karam J, Amirouche F. Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty. Front Surg 2024; 11:1331902. [PMID: 38645507 PMCID: PMC11026714 DOI: 10.3389/fsurg.2024.1331902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release. Methods Cadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed. Results A total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm-7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm-26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm-4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm-25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988). Discussion Our results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.
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Affiliation(s)
- Arash Rezaei
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - John Moon
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Asher Lichtig
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Barbara Mera
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Brett Drake
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Apurva S. Choubey
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Sunjung Kim
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Nicole Tueni
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Hristo Piponov
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Jason Koh
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL, United States
| | - Joseph Karam
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
| | - Farid Amirouche
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, United States
- Department of Orthopaedic Surgery, Northshore University Health System, Skokie, IL, United States
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Ping HY, An HM, Cao Z, Nan SK, Li HF, Chai W. Efficacy of the newly designed "SkyWalker" robot compared to the MAKO robotic system in primary total knee arthroplasty: a one-year follow-up study. INTERNATIONAL ORTHOPAEDICS 2024; 48:761-772. [PMID: 37962579 DOI: 10.1007/s00264-023-06023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Robot-assisted surgical systems for performing total knee arthroplasty (TKA) have gained significant attention. This study was designed to compare the surgical outcomes in primary TKA surgery between the recently developed "SkyWalker" robot system and the more commonly used MAKO robot. METHODS A total of 75 patients undergoing primary TKA surgery by the same surgical team were included in this study, with 30 patients in the "SkyWalker" group and 45 patients in the "MAKO" group. We documented the osteotomy plan for both robotic systems. The lower limb alignment angles were evaluated by postoperative radiographic assessment. The operation time, estimated blood loss, postoperative hospital stays, and changes in laboratory indexes were collected during hospitalization. In addition, a comparative evaluation of knee functional assessments and complications was conducted during six month and one year follow-ups. RESULTS There were no significant differences between the two groups in terms of the accuracy of restoring lower limb alignment, estimated blood loss, or operation time. The knee function assessments at six months and one year postoperatively were similar in both groups. Except for day three after surgery, the level of interleukin-6 (IL-6) and the change in IL-6 (∆IL-6) from preoperative baseline were higher in the "SkyWalker" group than in the MAKO group (median: 20.53 vs. 14.17, P=0.050 and median: 17.30 vs. 10.09, P=0.042, respectively). Additionally, one patient from the MAKO group underwent revision surgery at nine months postoperatively due to ongoing periprosthetic discomfort. CONCLUSIONS The newly developed "SkyWalker" robot showed comparable efficacy to the MAKO robot in terms of lower limb alignment accuracy and postoperative six month and one year follow-up of clinically assessed resumption of knee function.
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Affiliation(s)
- Hang-Yu Ping
- School of Medicine, Nankai University, Tianjin, 300071, China
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Hao-Ming An
- School of Medicine, Nankai University, Tianjin, 300071, China
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Zheng Cao
- School of Medicine, Nankai University, Tianjin, 300071, China
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Shao-Kui Nan
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China
| | - Hai-Feng Li
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100048, China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, China.
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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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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: 1] [Impact Index Per Article: 1.0] [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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Rossi SMP, Sangaletti R, Andriollo L, Matascioli L, Benazzo F. The use of a modern robotic system for the treatment of severe knee deformities. Technol Health Care 2024:THC231261. [PMID: 38251078 DOI: 10.3233/thc-231261] [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: 01/23/2024]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (TKA) have shown promising results in recent years with improved clinical outcomes using standard primary implants. OBJECTIVE The purpose of this study was to assess the experience of a single center in correcting severe coronal deformities with the use of a robotic-assisted TKA system and an increased constrained implant. METHODS Between July 2020 and December 2022, 30 knees in 28 patients with a major deformity and an associated ligament laxity requiring an increased constrained implant treated using an imageless robotic-assisted TKA were prospectively enrolled. Patients included in the study showed a minimum 15 degrees varus or 10 degrees valgus deviation. RESULTS 20 cases were varus knees and 10 cases were valgus knees. Postoperative neutral alignment was defined as 0∘± 2.5∘. A CCK implant was used in 20 cases while a Constrained Posterior Stabilized implant was used in 10 cases. A neutral alignment was achieved in all patients. At a minimum 6 months follow up (f-u 6-30 months) clinical outcomes including ROM, KSS, HSS, OKS and WOMAC showed significant improvement and no major complications were registered. CONCLUSIONS The robotic system showed the achievement of a mechanical alignment with reliable radiographic outcomes and clinical results in the treatment of major deformities of the lower limb with the use of higher constrained implants at short term follow up. Further follow up and studies are necessary to confirm and verify these promising outcomes.
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Affiliation(s)
- Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Andriollo
- UOC Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy
| | - Luca Matascioli
- UOC Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, UOC Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy
- Istituto Universitario di Studi Superiori (IUSS), Pavia, Italy
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Desai KB, Mulpur P, Jayakumar T, Suhas Masilamani A, Ranjan A, Gurava Reddy A. Adoption of robotics in arthroplasty- a survey of perceptions, utilization and challenges with technology amongst Indian surgeons. J Orthop 2023; 46:51-57. [PMID: 37942218 PMCID: PMC10630109 DOI: 10.1016/j.jor.2023.10.019] [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: 08/04/2023] [Revised: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Total joint replacement surgeries are standard procedures for managing end-stage hip or knee arthritis. Despite advances in technology, some patients experience dissatisfaction after total knee arthroplasty (TKA). Robotic technology has evolved significantly and has shown promise in improving component positioning, alignment, and surgical outcomes. However, the widespread adoption of robotics in arthroplasty faces challenges such as high costs, a steep learning curve, and limited evidence on long-term outcomes. Methods This cross-sectional observational study used a structured self-administered online survey to assess the perceptions of Indian arthroplasty surgeons regarding robotic technology. The survey included questions about the surgeon's background, experience, perceptions of robotic joint replacement, and limiting factors for robotic usage. A total of 417 responses were collected from practising arthroplasty surgeons. Results Most participants(78.1 %) expressed a willingness to adopt robotics in their arthroplasty practice if the cost of installation was reduced. Robotic users were more convinced about the benefits of robotics, including improved alignment, reduced pain, faster rehabilitation, and better outcomes. High-volume robotic surgeons demonstrated a greater belief in the broader potential of robotics beyond implant positioning and alignment. The major barriers to adoption were the high cost of installation and limited insurance coverage for robotic-assisted procedures. Lack of formal robotic training opportunities, resistance from corporate management, patient acceptance issues, and limited published literature supporting robotic advantages were also cited as limiting factors. Conclusion Robotic technology is increasingly being adopted in India for TKA. The main obstacle to widespread adoption is the high cost of installation. As technology costs decrease, we can expect a rise in the number of installations across the country. Advocacy from national orthopaedic organizations may be needed to address insurance reimbursement challenges. Overall, this study provides valuable insights into the perceptions and challenges associated with the adoption of robotic technology in arthroplasty in India.
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Affiliation(s)
- Keyur B. Desai
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Praharsha Mulpur
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Tarun Jayakumar
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - Abhishek Ranjan
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - A.V. Gurava Reddy
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
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