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Zaidi F, Goplen CM, Bolam SM, Monk AP. Accuracy and Outcomes of a Novel Cut-Block Positioning Robotic-Arm Assisted System for Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Arthroplast Today 2024; 29:101451. [PMID: 39188576 PMCID: PMC11345934 DOI: 10.1016/j.artd.2024.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/09/2024] [Accepted: 06/03/2024] [Indexed: 08/28/2024] Open
Abstract
Background The primary objective of this study was to determine the accuracy and precision of component positioning of the ROSA Robotic System for total knee arthroplasty (TKA). Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analysis systematic review was conducted using 4 electronic databases (MEDLINE, EMBASE, Pubmed, and Cochrane Library) to identify all clinical and radiological studies reporting information about the use and results of the ROSA system. The criteria for inclusion were published research articles evaluating the accuracy of component positioning, learning curve, component alignment, complications, and functional outcomes in adults who underwent robotic-assisted TKA. The National Institutes of Health Quality Assessment Tool was used to evaluate the quality of all the included studies. Results A total of 26 studies were assessed for eligibility, and 17 met the inclusion criteria. Nine studies reported on the accuracy and precision of component positioning. The ROSA platform for TKA had a cutting error of less than 0.6° for all coronal and sagittal parameters. Pooled analysis demonstrated accuracy within 0.61-1.87° and precision within 0.97-1.34° when the final intraoperative plan was compared to postoperative radiographs with fewer outliers. Four studies reported improved functional scores with ROSA-assisted TKA than conventional TKA within 1 year of surgery. There was no difference in overall complication rates when compared to conventional TKA. Conclusions The ROSA system is both highly accurate and precise, with fewer outliers when analyzed at various time points, including postoperative standing radiographs. Future studies with robust methodology and longer follow-up are required to demonstrate whether these findings have any clinical benefits in the long term.
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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 Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Scott M. Bolam
- Department of Surgery, University of Auckland, 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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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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Adkar N, Patil M, Vaidya S, Kumbar R, Kerhalkar R, Mote G, Thareja S, Sadalagi P, Bajwa S. Correlation Between Planned and Executed Bone Cuts Using Robotics in Total Knee Arthroplasty: A Prospective Study of 500 Patients. Indian J Orthop 2024; 58:1103-1108. [PMID: 39087031 PMCID: PMC11286900 DOI: 10.1007/s43465-024-01196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 08/02/2024]
Abstract
Objective This study evaluated the precision of robotic-arm-assisted total knee arthroplasty (RATKA) in performing bone resection, predicting component size, managing soft tissue tension, and determining postoperative range of motion (ROM). Methods A total of 500 participants were enrolled in this prospective cohort research. The procedures were conducted at a single facility, with a uniform method and implant design. The Cuvis system, a fully automated robot, was utilized for the study. The precise removal of bone at both the tibial and femur sites, the positioning of the implant, and the release of soft tissue were documented and then compared to the preoperative plan. Results The distal (medial and lateral) femoral cuts had a mean absolute deviation from the plan of 0.23 mm, while the posterior (medial and lateral) femoral cuts had a mean absolute difference of 1 mm and 1.4 mm, respectively. The absolute discrepancies in the medial and lateral tibial cuts are 0.93 mm and - 0.06 mm, respectively. Out of 1000 bone resections, 980 (98%) were within < 1 mm from the preoperative plan. The predictions for the sizes of the tibial and femoral components had accuracies of 100% and 98.9%, respectively. Conclusion These findings collectively underscore the effectiveness of the fully automated Cuvis robotic system in achieving consistent and accurate results in bone resections and implant sizing, highlighting its potential as a valuable tool in orthopedic surgery.
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Affiliation(s)
- Neeraj Adkar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Mangesh Patil
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Swapnil Vaidya
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Rajendra Kumbar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Ravi Kerhalkar
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Girish Mote
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Satwik Thareja
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Prajwal Sadalagi
- Department of Orthopedics, SaiShree Hospital, Sr. No. 157, CTS No. 1104/3, Plot No 26, DP Road, Aundh, Pune, Maharashtra 411007 India
| | - Supreet Bajwa
- Department of Orthopedics and Joint Replacement, Wockhardt Hospital, Mumbai Central, Maharashtra India
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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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Moreau A, Rony L, Robelet A, Laubacher H, Lebelle-Dehaut AV. In vitro comparative study of deformation of 3D-printed models using different polylactic acids treated by steam sterilization. Orthop Traumatol Surg Res 2024:103849. [PMID: 38428488 DOI: 10.1016/j.otsr.2024.103849] [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: 05/24/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION 3D printing, which is becoming ever more widespread in orthopedic surgery, requires specific materials. Polylactic acid (PLA) is the most widely used in general-purpose 3D printing, but its thermosensitivity can be incompatible with sterilization. Even so, it is easy to use, inexpensive, non-toxic and biodegradable. Controversy surrounds its use. 3D printing of directly sterilizable PLA parts according to surgeons' needs would be highly advantageous, but doubts remain. We therefore performed an in vitro study to determine which PLAs resist steam sterilization regarding deformation. HYPOTHESIS The study hypothesis was that, depending on make and shape, 3D-printed PLA parts can retain their properties after steam sterilization. MATERIAL AND METHODS We selected 4 makes of PLA and used each to print 4 simple cubes and 4 complex shapes corresponding to cuboid bones. They were subjected to steam sterilization under normal French hospital conditions. The size of the cubes was measured before and after sterilization, using a digital caliper. RESULTS Cuboid parts in HT-PLA and PLA-WANAO showed mean deformation of -0.02mm and -0.4mm, respectively after sterilization, the differences being non-significant (p=0.679 and p=0.241, respectively). Cuboid parts in PLA-SUNLU and PLA-G3D showed significant mean deformation: respectively, -1.37mm (p=0.026) and -35.03mm (p>0.001). Cubes in all types of PLA showed significant mean deformation: HT-PLA, -0.61mm (p=0.004); PLA-SUNLU, -2.70mm (p=0.002); PLA-G3D, -28.64mm (p>0.001); and PLA-WANAO, -1.33mm (p=0.010). DISCUSSION The study confirmed recent findings that steam sterilization is feasible with certain PLA-printed parts, with deformations less than 1mm, and that choice of PLA is crucial for success. Computer-designed objects (here, cubes) did not resist sterilization without significant deformation. Analysis of resistance to various stresses was not performed, and therefore it cannot be claimed that the process could be used other than for printing anatomic parts. Use of 3D printing in French hospitals is probably a real source of innovation and improvement in care quality; however, a legal framework needs establishing for the use of 3D-printed parts, to ensure patient safety and promote research in this field. LEVEL OF EVIDENCE III; prospective in vitro study.
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Affiliation(s)
- Antoine Moreau
- Service de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - Louis Rony
- Service de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Antoine Robelet
- Service de stérilisation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Hélène Laubacher
- Service de stérilisation, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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Migliorini F, Maffulli N, Schäfer L, Simeone F, Bell A, Hofmann UK. Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) in patients who have undergone total knee arthroplasty: a systematic review. Knee Surg Relat Res 2024; 36:3. [PMID: 38212863 PMCID: PMC10782530 DOI: 10.1186/s43019-024-00210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The present systematic review investigated the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) of several frequent and established PROMs used to assess patients who have undergone TKA. This study was conducted according to the 2020 PRISMA statement. METHODS In September 2023, PubMed, Web of Science, and Embase were accessed with no time constraint All clinical studies investigating tools to assess the clinical relevance of PROMs used to evaluate patients having received TKA were accessed. Only studies which evaluated the MCID, PASS, or SCB were eligible. The PROMs of interest were the Forgotten Joint Score-12 (FJS-12), the Oxford Knee Score (OKS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and its related subscales activity of daily living (ADL), pain, quality of life (QoL), sports and recreational activities, and symptoms, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the Knee Society Score (KSS) and related function score, and the Short Form-12 (SF-12) and Short Form-36 (SF-36). RESULTS Data from 29,737 patients were collected. The overall risk of bias was low to moderate. The great variability of thresholds for MCID, SCB and PASS between questionnaires but also between investigated aspects was noted, whereby MCIDs for the SF-36 appear lower than for knee-specific questionnaires. CONCLUSION Despite its critical role from a patient's perspective, the dimension of SCB is still neglected in the literature. Moreover, thresholds for the different concepts need to be condition-specific. We encourage authors to specifically report such data in future studies and to adhere to previously reported definitions to allow future comparison. Level of evidence Level IV, systematic review and meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University la Sapienza, 00185, Rome, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke On Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Francesco Simeone
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
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Migliorini F, Feierabend M, Hofmann UK. Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques. J Healthc Leadersh 2023; 15:327-338. [PMID: 38020721 PMCID: PMC10676205 DOI: 10.2147/jhl.s383916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Osteoarthritis of the knee is common. Early sports trauma or cartilage defects are risk factors for osteoarthritis. If conservative treatment fails, partial or total joint replacement is often performed. A joint replacement aims to restore physiological biomechanics and the quality of life of affected patients. Total knee arthroplasty is one of the most performed surgeries in musculoskeletal medicine. Several developments have taken place over the last decades that have truly altered the way we look at knee arthroplasty today. Some of the fascinating aspects will be presented and discussed in the present narrative review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100 Bolzano, Italy
| | - Martina Feierabend
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Aachen, 52074, Germany
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Chandrashekar P, Babu KA, Nagaraja HS, Hiral SG, Karthikeyan S, Bajwa S. Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India. Indian J Orthop 2023; 57:1800-1808. [PMID: 37881287 PMCID: PMC10593704 DOI: 10.1007/s43465-023-00970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/01/2023] [Indexed: 10/27/2023]
Abstract
Background Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. Methods The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. Results There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. Conclusion The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.
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Affiliation(s)
- P. Chandrashekar
- Institute of Orthopaedics, Sakra World Hospital, Devarabeesanahalli, Bangalore, India
| | - K. Adarsh Babu
- Institute of Orthopaedics, Sakra World Hospital, Devarabeesanahalli, Bangalore, India
| | - H. S. Nagaraja
- Institute of Orthopaedics, Sakra World Hospital, Devarabeesanahalli, Bangalore, India
| | - S. Gangu Hiral
- Institute of Orthopaedics, Sakra World Hospital, Devarabeesanahalli, Bangalore, India
| | - S. Karthikeyan
- Institute of Orthopaedics, Sakra World Hospital, Devarabeesanahalli, Bangalore, India
| | - Supreet Bajwa
- Hip and Knee Specialist, Wockhardt Hospital, 1877, Dr Anandrao Nair Marg, Near Agripada, Mumbai Central, Mumbai, Maharashtra India
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Fernandes LR, Arce C, Martinho G, Campos JP, Meneghini RM. Accuracy, Reliability, and Repeatability of a Novel Artificial Intelligence Algorithm Converting Two-Dimensional Radiographs to Three-Dimensional Bone Models for Total Knee Arthroplasty. J Arthroplasty 2023; 38:2032-2036. [PMID: 36503105 DOI: 10.1016/j.arth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With the emergence of advanced technology, such as robotics, three-dimensional (3D) imaging is necessary to execute preoperative surgical plans accurately. However, 3D imaging adds cost and potential risk to patients. This study determined the measurement accuracy, reliability, and repeatability of a novel artificial intelligence (AI) algorithm which converts two-dimensional (2D) radiographs to 3D bone models. METHODS An AI algorithm was developed to convert 2D radiographs to 3D bone model reconstructions. The accuracy of the AI algorithm was evaluated by comparing mean absolute error in measurements performed on 3D bone reconstructions, 3D computed tomography (CT) scans, and manual measurements on five cadaveric knees. Reliability and repeatability of the AI algorithm were evaluated by assessing the inter-observer and intra-observer agreement between measurements performed on 3D bone reconstructions, respectively. RESULTS Accuracy of the AI algorithm was considered excellent with mean absolute errors <2mm in 9 of 12 anatomical parameters compared with measurements performed on CTs and manual calipers. All inter-observer and intra-observer correlation coefficients were greater than 0.90 representing a high level of measurement reliability and repeatability by independent observers and the same observers. CONCLUSION This particular AI algorithm demonstrated a high degree of accuracy, reliability, and repeatability for converting 2D radiographs to 3D bone reconstructions similar to a CT-scan. Study results suggest this AI algorithm has the potential for use in preoperative surgical planning due to its efficiencies related to cost and time and reduced radiation exposure without the use of 3D imaging.
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Affiliation(s)
| | - Carlos Arce
- Department of Orthopaedic Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Gonçalo Martinho
- Department of Orthopaedic Surgery, Hospital CUF Santarém, Santarém, Portugal
| | - João Pedro Campos
- Department of Orthopaedic Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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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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Yang P, He R, Lei K, Liu L, Yang L, Guo L. Clinical evaluation of the first semi-active total knee arthroplasty assisting robot made in China: a retrospective propensity score-matched cohort study. Int J Surg 2023; 109:1552-1560. [PMID: 37131329 PMCID: PMC10389537 DOI: 10.1097/js9.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The precision of overall alignment and knee morphotype after robot-assisted total knee arthroplasty has been fully confirmed. This study aims to conduct a clinical evaluation of the first China-made semi-active total knee arthroplasty assisting robot. METHODS After a 1 : 2 propensity score matching, that is, a matched cohort study, patients were matched to the robot group (52 cases) and the conventional group (104 cases). The robot group received osteotomy according to preoperative planning, while the conventional group adopted preoperative planning based on the full-length radiograph and received conventional osteotomy. Perioperative clinical indicators, such as operation time, tourniquet time, hospitalization days, intraoperative bleeding, and hemoglobin level of the two groups were recorded; radiological indicators of postoperative prosthesis position, including hip-knee-ankle angle, frontal femoral component angle, frontal tibial component angle, lateral femoral component angle, and lateral tibial component angle were also recorded; deviations and outliers of the radiological indicators were calculated. RESULTS Compared with the conventional group, the operation time and tourniquet time of the robot group were longer, and the postoperative hemoglobin level decreased less, the differences were statistically significant; the lateral tibial component angle of the conventional group was 80.9°±3.6°, which was smaller than 86.7 °±2.3° of the robot group, the difference was statistically significant ( P <0.001); except for lateral femoral component angle, the absolute deviations of the radiological indicators in the robot group were significantly smaller than that in the conventional group ( P ≤0.001); the outliers of the radiological indicators in the robot group were significantly smaller than that in the conventional group with a statistical difference ( P <0.05). CONCLUSION Compared with the conventional group, the operation time of the robot group was relatively longer, but the perioperation blood loss was less. The robot group could better control the posterior inclination of the tibial prosthesis, and the absolute deviations and outliers of the prosthesis position were relatively smaller. There was no difference in short-term clinical score between the two groups.
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Affiliation(s)
| | | | | | | | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Is the femoral intramedullary alignment already actual in total knee arthroplasty? J Exp Orthop 2023; 10:16. [PMID: 36786874 PMCID: PMC9929006 DOI: 10.1186/s40634-022-00563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
Clinical outcomes and overall alignment after total knee arthroplasty (TKA) depend on femoral component positioning in the sagittal and the coronal plane, making choice of the distal femoral cutting guide crucial. Currently, there is no consensus on the potential advantage of an extramedullary (EM) guide compared to an intramedullary (IM) guide in TKA. The IM guide is the most widely used system for making the distal femoral cut although evidence for its superiority over the EM guide is lacking. However, inaccuracies arising with the IM guide include location of the rod entry point in the coronal plane, femoral canal diameter, femoral bowing, and structural features of the rod. Furthermore, the invasive procedure is associated with increased risk of postoperative blood loss, thromboembolic complications, and intraoperative fractures. While the EM guide has no such difficulties, its accuracy depends on the instruments used. Studies have reported results not inferior to the IM guide and a lower number of postoperative complications. Patient-specific instrumentation (PSI) and robotic and computer-assisted TKA have achieved excellent clinical and radiographic results and can overcome the problems inherent to the IM and the EM guide. Authors performed a systematic review of the literature and proposed a narrative review to summarize the characteristics of the IM and the EM guide and compare the advantages and disadvantages of each, as well as their limitations in comparison with new technologies. Authors also expressed their expert opinion.
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Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties. Orthop Traumatol Surg Res 2023; 109:103477. [PMID: 36375721 DOI: 10.1016/j.otsr.2022.103477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite the optimization of implant positioning, the clinical benefit of the use of robotic assistance during THA remains uncertain. In this case-control study (robotic versus manual technique) we made a retrospective short-term comparison of: (1) the functional results, (2) the complications, (3) and the influence of radiological symmetrization of the hips on the functional result. HYPOTHESIS The use of a robotic arm improved the functional results of a THA. MATERIALS AND METHOD A retrospective case-control study was performed, including patients with unilateral hip osteoarthritis who underwent a robotic arm-assisted THA (THA-R). The controls (THA-C) were matched according to age, sex, body mass index and surgical approach. The Harris (HHS), Oxford (OHS) and Forgotten Joint (FJS) scores were collected preoperatively and 1 year postoperatively. At each review, complications were categorized into minor events, revision surgery with and without implant change. Radiographic analysis was performed on weight-bearing images of the pelvis 3 months postoperatively. The objective of the surgery was symmetrization of the THA in the contralateral healthy hip. For each measured parameter of the hip joint center of rotation (COR), global offset (GO) and articular leg length discrepancy (aLLD), the difference between the two sides corresponding to the delta symmetrization was compared. RESULTS Ninety-eight patients were included in the THA-R group and matched to 98 controls in the THA-C group. At 1 year postoperatively, the FJS and OHS scores were statistically higher in the THA-R group, respectively 82.1±22.3 [8.3; 100] and 40.8±8.8 [6; 48] vs. 71.2±27.8 [0; 100] and 38.1±9.7 [12; 48] in the THA-C group (p=0.004 and p=0.043). There was no difference in HHS (THA-R: 85.9±15.8 [31; 100] vs. THA-C: 85.8±13.3 [49-100] (p=0.962)). The implant revision rate at 1 year was significantly higher in the THA-C group (0% vs. 5.1% (p=0.025)). There was no difference in the reoperation without component exchange despite 3 dislocations (3.1%) in the THA-R group (5 (5.1%) vs. 9 (9.2%) (p=0.273)). The rate of abarticular pathologies (ilio-psoas irritation and greater trochanteric bursitis) was higher in the THA-C group (10 (10.8%) vs. 2 (2%) (p=0.016). Robotic acetabular assistance allowed a significantly better restitution of the horizontal position (THA-R: 1mm±4.8 [-11.7; 12.6] vs. THA-C: 4.1mm±7 [-29.6; 28] (p=0.0005)) and vertical COR (THA-R: 0.5mm±3.1 [-6; 8.3] vs. THA-C: 2mm±4.1 [-6; 14.6] (p=0.0068)). Navigated assistance of the femur did not significantly optimize the restitution of the Global Offset (THA-R: +2mm±6.4 [-16.4; 27.6] vs. THA-C: +0.5mm±7 .7 [-34; 30.2] (p=0.145)), or lower limb length (THA-R: +1.1mm±5 [-8.2; 13.5] vs. THA-C: +0.3mm±6 [-14.1; 22.5] (p=0.344). The FJS was statistically correlated with the restoration of the symmetry of the COR and the aLLD. A post-hoc power analysis confirmed sufficient potency (1-β=0.85). CONCLUSION Robotic acetabular assistance combined with femoral navigation improves clinical outcomes of THAs with fewer short-term complications. The precision of the positioning of the implants, optimized by the computer-assisted surgery system, is correlated with the missed joint score. LEVEL OF EVIDENCE III, retrospective case-control study.
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Lustig S, Servien E, Batailler C. How to optimize patellar tracking in knee arthroplasty? Orthop Traumatol Surg Res 2023; 109:103458. [PMID: 36302447 DOI: 10.1016/j.otsr.2022.103458] [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: 11/21/2021] [Accepted: 04/04/2022] [Indexed: 12/24/2022]
Abstract
Good patellar tracking is needed for functionally successful total knee arthroplasty (TKA), and depends on several factors. The aim of the present Instructional Lecture is to identify the main factors and how to control them so as to optimize patellar tracking: more or less "patella-friendly" prosthetic trochlea design, requiring precise assessment and choice of model; patellar component design; type of tibial implant; surgical approach and management of peripatellar structures, and any lateral release; distal and posterior femoral bone cuts, determining femorotibial alignment, femoral component rotation and patellar height; tibial implant rotation with respect to the anterior tibial tubercle; patellar cut characteristics in resurfacing. In case of instability or patellar maltracking despite correct implant positioning, there are 2 main surgical techniques: medial patellofemoral ligament reconstruction, and anterior tibial tubercle medialization. To obtain optimal patellar tracking, correction of other factors should be associated: trochlear component design, distal and posterior femoral bone cuts, tibial implant positioning, patellar component shape and positioning, etc.
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Affiliation(s)
- Sébastien Lustig
- Service de chirurgie orthopédique et médecine du sport, centre d'Excellence FIFA, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Elvire Servien
- Service de chirurgie orthopédique et médecine du sport, centre d'Excellence FIFA, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cécile Batailler
- Service de chirurgie orthopédique et médecine du sport, centre d'Excellence FIFA, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Ogawa H, Sengoku M, Shimokawa T, Nakamura Y, Ohnishi K, Matsumoto K, Akiyama H. Extra-articular factors of the femur and tibia affecting knee balance in mechanically aligned total knee arthroplasty. Orthop Traumatol Surg Res 2022; 108:103297. [PMID: 35508294 DOI: 10.1016/j.otsr.2022.103297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Although the joint gap distance and compartment loading of the knee are different parameters for obtaining balanced knees in patients with total knee arthroplasty (TKA), the extent to which a balanced knee is achieved in patients with mechanically aligned TKA (MA-TKA) is unclear. This study aimed to investigate the anatomical factors that affect the ligament balancing in MA-TKA according to a gap balancing technique by measured resection technique. METHODS The relationship between compartment loading, gap distance, and lower limb alignment was analysed in forty-three patients who underwent navigation-assisted MA-TKA with the minimum soft-tissue release. Radiographic parameters included hip-knee-ankle (HKA) angle, femorotibial angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, posterior tibial slope, varus and valgus joint line convergence angle, femoral valgus angle, femoral shaft curve, and tibial shaft curve (TSC). RESULTS The postoperative HKA angle was 0.4±1.5°, with one coronal alignment outlier (2.3%). The gap distance showed four unbalanced knees for extension (9.3%) and flexion (9.3%), whereas the compartment loading identified 17 unbalanced knees (39.5%) at extension, 8 (18.6%) at 45° flexion, 7 (16.2%) at 90° flexion, and 10 (23.2%) at full flexion in MA-TKA. Mediolateral differentials of compartment loading correlated with femoral valgus angle (0°, 45°, and 90° flexion), mLDFA (45° and 90° flexion), and TSC (45° and 90° flexion). Femoral valgus angle and TSC were risk factors of the mediolateral differentials of compartment loading. CONCLUSION Extra-articular factors of femoral valgus angle, mLDFA, and TSC were associated with the mediolateral imbalance of compartmental loading, suggesting there is a limit to obtaining balanced knees in MA-TKA due to these unadjustable extra-articular factors. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan; Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan.
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Yutaka Nakamura
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
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Winnock de Grave P, Kellens J, Luyckx T, Tampere T, Lacaze F, Claeys K. Inverse Kinematic Alignment for Total Knee Arthroplasty. Orthop Traumatol Surg Res 2022; 108:103305. [PMID: 35513224 DOI: 10.1016/j.otsr.2022.103305] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Patient specific alignment might improve clinical outcomes in total knee arthroplasty (TKA). Different alignment concepts are described, each providing specific features with theoretical benefits or possible disadvantages. Inverse kinematic alignment (iKA) is a new patient specific alignment concept with excellent reported clinical outcome and patient satisfaction at short-term follow-up. iKA is a tibia-first, gap balancing technique restoring the native tibial joint line obliquity (JLO). In each patient, within boundaries, equal medial and lateral tibial resections are performed, compensating for cartilage and bone loss. We describe the surgical technique of iKA using a robotic assisted system (Mako, Stryker, Kalamazoo, USA). A case series of 100 consecutive iKA cases is assessed and the bony resections and resection angles are reported. Both in the coronal plane and axial plane, iKA might offer advantages over existing alignment strategies, possibly providing optimal clinical outcome and durable long-term survival, regardless of the alignment is varus, neutral or valgus.
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Affiliation(s)
- Philip Winnock de Grave
- AZ Delta Roeselare, Department Orthopaedic Surgery, Roeselare, Belgium; KU Leuven, Department Rehabilitation Sciences, Brugge, Belgium.
| | - Jonas Kellens
- UZ Leuven, Department Orthopaedic Surgery, Leuven, Belgium
| | - Thomas Luyckx
- AZ Delta Roeselare, Department Orthopaedic Surgery, Roeselare, Belgium; UZ Leuven, Department Orthopaedic Surgery, Leuven, Belgium
| | - Thomas Tampere
- AZ Delta Roeselare, Department Orthopaedic Surgery, Roeselare, Belgium; UZ Gent, Department Orthopaedic Surgery, Gent, Belgium
| | - Franck Lacaze
- Orthosud, Clinic Saint Jean de France, Saint Jean de Vedas, France
| | - Kurt Claeys
- KU Leuven, Department Rehabilitation Sciences, Brugge, Belgium
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Lei K, Liu L, Yang P, Xiong R, Yang L, He R, Guo L. Robotics versus personalized 3D preoperative planning in total knee arthroplasty: a propensity score-matched analysis. J Orthop Surg Res 2022; 17:227. [PMID: 35410239 PMCID: PMC8996413 DOI: 10.1186/s13018-022-03115-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Lower limb alignment is crucial in total knee arthroplasty (TKA). Previous studies have shown that robotics and personalized three-dimensional (3D) preoperative planning could improve postoperative alignment accuracy compared with conventional TKA, but comparison between the above two techniques has never been reported. The authors hypothesized that robotics may be superior to personalized 3D preoperative planning in terms of postoperative alignment in primary TKA, with similar patient-reported outcome measures (PROMs) but higher cost and longer operative time.
Methods
A consecutive series of patients who received TKA in our center from September 2020 to January 2021 were enrolled retrospectively. After 1:2 matching, 52 and 104 patients were included and divided into study group for robotics and control group for personalized 3D preoperative planning, respectively. Multiple postoperative alignment angles were measured, and clinical features such as operation and tourniquet time, length of hospital stay and hemoglobin (Hb) were recorded. Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate clinical results.
Results
Compared with control group, robotics group had significantly lower frontal femoral component angle (FFC) and frontal tibial component angle (FTC) absolute deviation (P < 0.05). It also had less outliers in hip–knee–ankle angle (HKA), FTC, lateral femoral component angle (LFC) and lateral tibial component angle (LTC) (P < 0.05). Hb loss of robotics group was significantly lower than control group (P < 0.001), while the operation and tourniquet time were longer (P < 0.001). There was no significant difference in KSS and WOMAC scores between two groups.
Conclusion
Compared with control group, patients in robotics group had significantly less malalignment, malposition, Hb loss, but similar PROMs. The operations in robotics group spent longer operation time and cost more compared with control group.
Trial registration: The Chinese Clinical Trial Registry, ChiCTR2000036235. Registered 22 August 2020, http://www.chictr.org.cn/showproj.aspx?proj=59300.
Level of evidence
III.
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Versatility and accuracy of a novel image-free robotic-assisted system for total knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2077-2086. [PMID: 34255174 DOI: 10.1007/s00402-021-04049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Technological advances alongside increased demand for knee replacement surgery have led to the development of a novel image-free bed rail-mounted robotic-assisted system for total knee arthroplasty (TKA). The device is capable of real-time tracking to accommodate for leg motion during bone resection allowing for precise control and positioning of the bone saw in the planned resection plane. The purpose of this study is to discuss the versatility and accuracy of this novel image-free robotic-assisted technology in TKA. METHODS AND MATERIALS The novel robotic-assisted system underwent a stepwise assessment to verify its versatility and accuracy. First, functional accuracy was bench tested to evaluate predetermined surgical plans independent of user variability and anatomic variability compared to conventional instrumentation. This was followed by assessments utilizing cadaveric specimens for resection accuracy, implant positioning, and soft tissue involvement. RESULTS Test bench accuracy revealed overall pooled linear positional accuracy of 0.326 ± 0.249 mm and pooled angular positional accuracy of 0.365 ± 0.611°. Resection errors for both robotic and conventional cohorts ranged between 0.6° and 1.9°. Concerning coronal alignment, 33/40 robotic specimen were within ± 1° and 38/40 within ± 3° of the femoral varus-valgus target, compared with 17/40 and 37/40 with conventional instrumentation, respectively. Twenty-four of the 40 robotic specimens were within ± 1° and 40/40 within ± 3° of the tibial varus-valgus target compared with 15/40 and 32/40 with conventional instrumentation, respectively. Soft tissue structures were uncompromised in all robotic-assisted cases. Conventional instruments revealed two cases of partial cleavage of the posterior cruciate ligament and two instances of a compromised posterior medial capsule. There were no significant differences between the two techniques concerning the samples that were uncompromised and fully functional (40/40 vs. 38/40, p = 0.49). CONCLUSION The novel image-free robotic-assisted surgical system demonstrates excellent benchtop accuracy to aid bony resection in cadaveric specimens. It offers notable improvement in coronal implant alignment compared to conventional instrumentation.
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Robotic-assisted knee arthroplasty: an evolution in progress. A concise review of the available systems and the data supporting them. Arch Orthop Trauma Surg 2021; 141:2099-2117. [PMID: 34491411 DOI: 10.1007/s00402-021-04134-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A review of the data supporting robotic systems currently available is presented focussing on precision and reproducibility, radiological outcomes, clinical outcomes, and survivorship. MATERIALS AND METHODS Scientific literature published on robotic systems for knee arthroplasty was reviewed using the reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were any study involving robotic-assisted UKA or TKA that reported precision of implant positioning or functional outcomes or range of motion or survivorship, including cadaveric or dry bone studies with a minimum of 6-month follow-up. RESULTS Thirty-nine studies were identified for robotic-assisted unicompartmental knee arthroplasty, and 24 studies for robotic-assisted total knee arthroplasty. Those that reported on radiological outcomes or cadaver studies consistently demonstrated improved precision with the use of robotic systems irrespective of the system. PROMS and survival data demonstrated equivalent short-term results. However, many studies reported outcomes inconsistently and few had long-term clinical follow-up or survivorship data. CONCLUSIONS This review adds to the body of evidence supporting improved precision and reproducibility with robotic assistance in knee arthroplasty. Despite intensive funding of research into robotic knee systems, there remains considerable heterogeneity in exposure and outcome analysis and few quality long-term studies demonstrating translation to better clinical outcomes and implant survivorship.
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