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Mancino F, Fontalis A, Kayani B, Magan A, Plastow R, Haddad FS. The current role of CT in total knee arthroplasty. Bone Joint J 2024; 106-B:892-897. [PMID: 39216858 DOI: 10.1302/0301-620x.106b9.bjj-2023-1303.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Advanced 3D imaging and CT-based navigation have emerged as valuable tools to use in total knee arthroplasty (TKA), for both preoperative planning and the intraoperative execution of different philosophies of alignment. Preoperative planning using CT-based 3D imaging enables more accurate prediction of the size of components, enhancing surgical workflow and optimizing the precision of the positioning of components. Surgeons can assess alignment, osteophytes, and arthritic changes better. These scans provide improved insights into the patellofemoral joint and facilitate tibial sizing and the evaluation of implant-bone contact area in cementless TKA. Preoperative CT imaging is also required for the development of patient-specific instrumentation cutting guides, aiming to reduce intraoperative blood loss and improve the surgical technique in complex cases. Intraoperative CT-based navigation and haptic guidance facilitates precise execution of the preoperative plan, aiming for optimal positioning of the components and accurate alignment, as determined by the surgeon's philosophy. It also helps reduce iatrogenic injury to the periarticular soft-tissue structures with subsequent reduction in the local and systemic inflammatory response, enhancing early outcomes. Despite the increased costs and radiation exposure associated with CT-based navigation, these many benefits have facilitated the adoption of imaged based robotic surgery into routine practice. Further research on ultra-low-dose CT scans and exploration of the possible translation of the use of 3D imaging into improved clinical outcomes are required to justify its broader implementation.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Cochrane NH, Kim BI, Stauffer TP, Hallows RK, Urish KL, Carvajal Alba JA, Seyler TM. Revision Total Knee Arthroplasty With an Imageless, Second-Generation Robotic System. J Arthroplasty 2024; 39:S280-S284. [PMID: 38355066 DOI: 10.1016/j.arth.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty is increasingly used in revision total knee arthroplasty (rTKA), with imageless systems recently receiving Food and Drug Administration (FDA) approval. However, there remains a paucity of literature on the use of robotic assistance in revision total knee arthroplasty (TKA). This paper describes the imageless surgical technique for robotic revision TKA using a second-generation robotic system and details both intraoperative and 90-day outcomes. METHODS This was a retrospective review of 115 robotic revision TKAs from March 2021 to May 2023 at 3 tertiary academic centers. Patient demographics, perioperative surgical data, and 90-day outcomes were collected. Pain and Patient-Reported Outcomes Measurement Information System scores preoperatively and postoperatively were recorded. All-cause reoperations at the final follow-up were detailed. The mean patient age was 65 years (range, 43 to 88), and 58% were women. The mean follow-up time was 13 months (range, 3 to 51). RESULTS The most common indications for rTKA were instability (n = 37, 32%) and aseptic loosening (n = 42, 37%). There were 83 rTKAs to a posterior-stabilized liner, 22 to a varus-valgus constrained liner, and 5 to a hinged construct. The median polyethylene size was 11 (interquartile range, 10 to 13), and 93% of patients had their joint line restored within 5 millimeters of the native contralateral knee. Within the 90-day postoperative window, there were 8 emergency department visits and 2 readmissions. At the final follow-up, there were 5 reoperations and 2 manipulations under anesthesia. There were 4 patients who required irrigation and debridement after superficial wound dehiscence, and one had an arthrotomy disruption after a fall. CONCLUSIONS This review demonstrates favorable intraoperative and 90-day outcomes and suggests that imageless robotic surgery is a promising modality in rTKA. Further studies comparing the longitudinal outcomes after robotic and conventional rTKA are warranted.
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Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Taylor P Stauffer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rhett K Hallows
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaime A Carvajal Alba
- Department of Orthopaedic Surgery, University of Miami Health System, Miami, Florida
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Mancino F, Fontalis A, Grandhi TSP, Magan A, Plastow R, Kayani B, Haddad FS. Robotic arm-assisted conversion of unicompartmental knee arthroplasty to total knee arthroplasty. Bone Joint J 2024; 106-B:680-687. [PMID: 38945538 DOI: 10.1302/0301-620x.106b7.bjj-2023-0943.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Aims Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up. Methods This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36). Results There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439). Conclusion Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Tarani S P Grandhi
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Gamie Z, Paparoidamis G, Milonakis N, Kenanidis E, Tsiridis E. The ROSA knee robotic system demonstrates superior precision in restoring joint line height and posterior condylar offset compared to conventional manual TKA: a retrospective case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2449-2455. [PMID: 38634885 PMCID: PMC11291514 DOI: 10.1007/s00590-024-03942-6] [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: 03/16/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Variations in total knee arthroplasty (TKA) joint line height may lead to complications such as pain and altered joint mechanics, while posterior condylar offset (PCO) can influence knee stability. METHODS Single-centre, single-surgeon retrospective analysis from December 2019 to May 2023 investigated primary unilateral TKA (Nexgen Legacy, Zimmer Biomet) in patients with knee osteoarthritis, using ROSA robotic system (raTKA) or conventional manual technique (mTKA). Joint line height and PCO were measured and compared in 182 raTKA and 144 mTKA patients. RESULTS The groups were matched in age (p = 0.847) and sex distribution (p = 0.2). Excellent interobserver agreement (ICC ≥ 0.9). RaTKA mean joint line height difference was - 0.0001 mm (± 3.48, 95% CI - 0.509, 0.509) (p = 0.523), - 0.951 mm for mTKA (± 4.33, 95% CI - 1.664, - 0.237) (p = 0.009). RaTKA mean PCO difference was 0.52 mm (± 2.45, 95% CI 0.160, 0.880) (p = 0.005), 1.15 mm for mTKA (± 4.01, 95% CI - 1.496, 1.818) (p < 0.001). Mean difference in joint line height of 0.95 mm between groups was significant (p = 0.027), and for PCO, it was 0.63 mm, demonstrating tendency towards significance (p = 0.08). Mean absolute value in joint line height difference between groups was not significant (p = 0.235) but highly significant for PCO (p < 0.001). CONCLUSION The ROSA knee robotic system can more accurately restore joint line height and PCO compared to conventional manual TKA. The improved degree of precision raTKA offers may be a vehicle for better Patient-Reported Outcome Measures, but further correlational studies are required.
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Affiliation(s)
- Zakareya Gamie
- Tsiridis Orthopaedic Institute, ICAROS Clinic, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Paparoidamis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikos Milonakis
- Tsiridis Orthopaedic Institute, ICAROS Clinic, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Tsiridis Orthopaedic Institute, ICAROS Clinic, Thessaloniki, Greece.
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Eleftherios Tsiridis
- Tsiridis Orthopaedic Institute, ICAROS Clinic, Thessaloniki, Greece
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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Rinehart DB, Stambough JB, Mears SC, Barnes CL, Stronach B. Robotic Total Knee Arthroplasty Surgeon Marketing: Do Claims Align With the Literature? Arthroplast Today 2024; 27:101357. [PMID: 38524152 PMCID: PMC10958061 DOI: 10.1016/j.artd.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Background Robotic total knee arthroplasty (R-TKA) utilization and marketing continue to rise. We examined the marketing on surgeon websites regarding R-TKA benefits and sought to determine if the claims were supported by existing literature. Methods A Google search identified 10 physician websites from each of the 5 largest U.S. markets by population with the term "robotic total knee arthroplasty city, state." Claims on websites about R-TKA were categorized. Literature from 2012-2022 was reviewed for data "for" or "against" each claim. Level of evidence for each publication was collected. Results Fifty websites were captured that included 59 surgeons. A specific R-TKA platform was mentioned on 68% of websites. Website claims about robotics were placed into 8 major categories. Literature review supported the claims of more precise/accurate, reduced injury to tissue, and less pain with more literature "for" than "against" the claims. Conclusions Claims made on physician websites regarding the benefits of R-TKA are variable and not definitively supported by existing literature. Most available data can be categorized into levels of evidence III, IV, and V. There is a paucity of level I evidence to support the various marketing statements. Physicians should be cognizant of both the claims made on their websites and the literature that could be used to support or refute those specific claims.
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Affiliation(s)
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Cozzarelli NF, DeSimone CA, D'Amore T, Sherman MB, Lonner JH. Joint line position change in primary total knee arthroplasty: a radiographic analysis comparing conventional and robotic techniques. INTERNATIONAL ORTHOPAEDICS 2024; 48:1023-1030. [PMID: 37946052 PMCID: PMC10933191 DOI: 10.1007/s00264-023-06031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Joint line (JL) position change in total knee arthroplasty (TKA) may alter knee biomechanics and impact function. The purpose of this study was to compare the change in JL position between robotic-assisted TKA (RA-TKA) and conventional TKA (C-TKA). METHODS A retrospective, radiographic analysis was conducted of patients who underwent RA-TKA and C-TKA to compare JL position change. JL position was measured in consecutive RA-TKAs and C-TKAs performed by four fellowship-trained arthroplasty surgeons. Statistical analysis was done utilizing t-tests and Mann Whitney U tests, with statistical significance being defined as a p value < 0.05. RESULTS Six hundred total RA-TKAs and 400 total C-TKAs were included in the analysis. There were no significant differences in patient baseline characteristics such as body mass index, range of motion, and tibiofemoral coronal alignment. RA-TKAs were associated with an average of 0.04 (2.2) mm JL position change, and C-TKAs were associated with an average 0.5 (3.2) mm JL position change (p = 0.030). There were inter-surgeon differences when comparing the change in JL position for RA-TKAs and C-TKAs between the four participating surgeons. CONCLUSION RA-TKA leads to better preservation of the JL position than C-TKA, and this seems to be dependent on the arthroplasty surgeon's preferences and techniques during TKA. Whether this statistically significant difference is clinically relevant needs to be further investigated.
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Affiliation(s)
- Nicholas F Cozzarelli
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA.
| | - Cristian A DeSimone
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
| | - Taylor D'Amore
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
| | - Matthew B Sherman
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
| | - Jess H Lonner
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, 125 South 9th Street Suite 1000, Philadelphia, PA, 19107, USA
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Tuecking LR, Savov P, Zander M, Jeremic D, Windhagen H, Ettinger M. Comparable accuracy of femoral joint line reconstruction in different kinematic and functional alignment techniques. Knee Surg Sports Traumatol Arthrosc 2023; 31:3871-3879. [PMID: 36917247 DOI: 10.1007/s00167-023-07360-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE A key part of kinematic alignment (KA) and functional alignment (FA) is to restore the natural femoral joint line, in particular the medial joint line. KA is known to reproduce the femoral joint line accurately; however, direct comparisons with other surgical techniques such as FA are currently lacking. The purpose of this study was to evaluate differences of alignment parameters in KA and FA techniques with a special focus given to the femoral joint line. METHODS We performed a retrospective radiological analysis of pre- and postoperative long leg radiographs of 221 consecutive patients with varus or neutral leg alignment, who underwent primary total knee arthroplasty (TKA) procedures from 2018 to 2020. Patients were assigned to one of four groups: (1) FA: image-based robotic-assisted TKA, (2) FA: imageless robotic-assisted TKA, (3): restricted KA: 3D cutting block-assisted (patient-specific instruments, PSI) TKA, (4): unrestricted KA: calipered technique. Patients' radiographs were (re)-analyzed for overall limb alignment, medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), as well as medial and lateral femoral joint line alteration. Statistical significance was determined using unpaired t testing (FA vs. KA group) and one-way ANOVA (subgroup analyses). RESULTS Comparisons of KA vs. FA, as well as individual subgroups of KA and FA did not show any differences in the accuracy of medial joint line reconstruction (< 2 mm, p = 0.384, p = 0.744, respectively) and LDFA alteration (< 2°, p = 0.997, 0.921, respectively). Correction of MPTA (3.4° vs. 2.2°) and lateral femoral joint line (2.1 mm vs. 1.5 mm) was higher for FA and FA subgroups compared to KA and KA subgroups (both p < 0.001). CONCLUSION Kinematic and functional alignments showed a comparable accuracy in reconstruction of the medial femoral joint line and femoral joint line orientation. Increased correction of MPTA and lateral femoral joint line was recorded with FA techniques. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lars-Rene Tuecking
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany.
| | - Peter Savov
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
- Department of Orthopaedic and Trauma Surgery, Pius Hospital, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Mats Zander
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Dragan Jeremic
- Department of Orthopaedic Surgery, St.Vincenz Hospital Brakel, Danziger Str. 17, 33034, Brakel, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
| | - Max Ettinger
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna Von Borries Str. 1-6, 30625, Hannover, Germany
- Department of Orthopaedic and Trauma Surgery, Pius Hospital, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Danoff JR, Heimroth J, Willinger M, Trout S, Sodhi N. Surgical Technique: Robotic-Assisted 1.5-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infection. Arthroplast Today 2023; 21:101126. [PMID: 37234598 PMCID: PMC10205596 DOI: 10.1016/j.artd.2023.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023] Open
Abstract
A 1.5-stage exchange total knee arthroplasty for periprosthetic joint infection has been described; however, achieving a balanced and well-aligned construct can sometimes be difficult given the bony defects often encountered in these cases. The use of robotic navigation technologies allows for accurate and precise implant placement. This technique report details the utilization of robotic navigation in a 1.5-stage exchange total knee arthroplasty for periprosthetic joint infection and describes the outcome of 6 patients. This technique guide highlights how robotic technology can account for many commonly encountered bone voids, joint line identification, and component orientation, while achieving a balanced and well-aligned knee.
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Affiliation(s)
- Jonathan R. Danoff
- Corresponding author: Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, 611 Northern Blvd, Suite 200 Great Neck, NY 11021, USA. Tel.: +1 516 325 7013.
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Ngim HLJ, Van Bavel D, De Steiger R, Tang AWW. Robotic-assisted revision total knee arthroplasty: a novel surgical technique. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:5. [PMID: 36691107 PMCID: PMC9872350 DOI: 10.1186/s42836-022-00160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Revision total knee arthroplasty is a challenging procedure. The robotic-assisted system has been shown to enhance the accuracy of preoperative planning and improve reproducibility in primary arthroplasty surgeries. The aim of this paper was to describe the surgical technique for robotic-assisted revision total knee arthroplasty and the potential benefits of this technique. METHOD This single-centre retrospective study included a total of 19 patients recruited from April 1, 2021 to April 30, 2022. Inclusion criteria were patients who had Mako™ robotic-assisted revision total knee arthroplasty done within the study period with a more than 6 months follow-up. Statistical analysis was done using Microsoft Excel 16.0. RESULTS All 19 patients were followed up for 6 to 18 months. All patients in this study had uneventful recoveries without needing any re-revision surgery when reviewed to date. CONCLUSION With the development of dedicated revision total knee software, robot-assisted revision TKA can be a promising technique that may improve surgical outcomes by increasing the accuracy of implant placement, and soft tissue protection and achieving a better well-balanced knee.
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Affiliation(s)
- Hui-Ling Joanne Ngim
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| | - Dirk Van Bavel
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| | - Richard De Steiger
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
| | - Andrew W. W. Tang
- grid.414539.e0000 0001 0459 5396Epworth Healthcare, Melbourne, 3121 Victoria Australia
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Stauffer TP, Kim BI, Grant C, Adams SB, Anastasio AT. Robotic Technology in Foot and Ankle Surgery: A Comprehensive Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:686. [PMID: 36679483 PMCID: PMC9864483 DOI: 10.3390/s23020686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Recent developments in robotic technologies in the field of orthopaedic surgery have largely been focused on higher volume arthroplasty procedures, with a paucity of attention paid to robotic potential for foot and ankle surgery. The aim of this paper is to summarize past and present developments foot and ankle robotics and describe outcomes associated with these interventions, with specific emphasis on the following topics: translational and preclinical utilization of robotics, deep learning and artificial intelligence modeling in foot and ankle, current applications for robotics in foot and ankle surgery, and therapeutic and orthotic-related utilizations of robotics related to the foot and ankle. Herein, we describe numerous recent robotic advancements across foot and ankle surgery, geared towards optimizing intra-operative performance, improving detection of foot and ankle pathology, understanding ankle kinematics, and rehabilitating post-surgically. Future research should work to incorporate robotics specifically into surgical procedures as other specialties within orthopaedics have done, and to further individualize machinery to patients, with the ultimate goal to improve perioperative and post-operative outcomes.
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Affiliation(s)
| | - Billy I. Kim
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Caitlin Grant
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Samuel B. Adams
- Departmen of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
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11
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Jenny JY, Baldairon F. The coronal alignment technique impacts deviation from native knee anatomy after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 31:1427-1432. [PMID: 36125511 DOI: 10.1007/s00167-022-07157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to analyze and quantify the changes in native coronal alignment of a population of TKA patients according to different alignment goals. METHODS Five hundred and twenty TKAs were analyzed. The following angles were measured using an image-free navigation system prior to prosthetic implantation: medial femorotibial mechanical angle without stress and with maximum manual stress to reduce the deformity, medial distal femoral mechanical angle, medial proximal tibial mechanical angle. The native angles were derived from the osteoarthritic knee angles using a validated correction technique, and the overall, femoral and tibial coronal phenotypes were defined. Five different coronal alignment techniques were simulated: mechanical (MA), restricted mechanical (RMA), anatomical (AA), kinematic (KA) and restricted kinematic (RKA). The overall, femoral and tibial coronal phenotypes were compared before and after TKA. The primary endpoint was the binary criterion of whether or not TKA restored the natural overall phenotype. Secondary endpoints were the binary criteria of whether or not the natural femoral and tibial phenotypes were restored by TKA. The rates of restored and non restored phenotypes were compared with a Chi-square test at a 0.05 level of significance, with post hoc tests between all pairs of techniques at a 0.01 level of significance. RESULTS The overall phenotype was restored significantly differently by the five alignment techniques: 15% for MA, 23% for RMA, 2% for AA, 100% for KA and 79% for RKA (p < 0.001). There was a significant difference between each of the technique pairs (p < 0.01 to p < 0.001), except for the mechanical alignment-restricted mechanical alignment pair. The femoral phenotype was restored significantly differently by the five alignment techniques: 37% for MA, 58% for RMA, 19% for AA, 100% for KA and 85% for RKA (p < 0.001). The tibial phenotype was restored significantly differently by the five alignment techniques: 36% for MA, 36% for RMA, 17% for AA, 100% for KA and 88% for RKA (p < 0.001). There was a significant difference between each pair of techniques for both femoral and tibial phenotypes (p < 0.01 to p < 0.001). CONCLUSION Except for the kinematic alignment technique, the various alignment techniques induce significant changes in the pre-arthritic anatomy of the TKA patient. The surgeon must be aware of these modifications. The clinical relevance of this alteration still needs to be defined. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jean-Yves Jenny
- Locomax Unit, University Hospital, 1 avenue Molière, 67200, Strasbourg, France.
| | - Florent Baldairon
- Locomax Unit, University Hospital, 1 avenue Molière, 67200, Strasbourg, France
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