Image-Free Robotic-Assisted Total Knee Arthroplasty Improves Implant Alignment Accuracy: A Cadaveric Study

Abstract Introduction Robotic-assisted surgery techniques are increasing in total knee arthroplasty (TKA). One crucial point is the prolonged time of surgery. The primary objective of this study was to determine the learning curve necessary to minimize the time of surgery. The secondary objective was to evaluate the accuracy of the implant alignment when using an imageless robotic system for TKA. Materials and methods In a case–control study, the first 70 consecutive robotic-assisted TKA procedures performed by a single senior surgeon were analyzed with regard to surgery time and implant alignment by comparing the intraoperative plan with the postoperative alignment. The evaluation of the learning curve with respect to surgery time was conducted using cumulative summation (CUSUM) analysis. The joint line height was measured with a new technique. Surgery time and joint line reconstruction were compared to 70 consecutive conventional TKA procedures. Results The learning curve for robotic TKA was completed after 11 cases. The learning curve did not influence the accuracy of joint line obliquity, joint line height, or limb alignment. The intraoperative plan designed for the robotic system was precisely implemented. The mean skin-to-skin time in the robotic group after the learning curve was completed did not differ from that in the manual group. A significant positive correlation was observed between the preoperative hip–knee–ankle angle and the postoperative distalization of the joint line in the robotic-assisted TKA group. Conclusion After completing the initial learning curve of 11 cases, the surgery time required to perform imageless robotic handpiece-assisted TKA was similar to that for the conventional technique. However, no learning curve was observed for the implant positioning when using the imageless robotic system. The implementation of the intraoperative plan was accurate up to < 2°. The precision of the system allows the implementation of different joint balancing approaches between valgus and varus morphotypes.

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After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Arthroplasty ◽

10.1186/s42836-021-00100-9 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Siddharth M. Shah

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Computer Navigation ◽

Soft Tissue Release ◽

Computer Assisted ◽

Robotic Assisted ◽

Total Knee ◽

Implant Alignment ◽

Navigated Tka

Abstract Background Limb and implant alignment along with soft tissue balance plays a vital role in the outcomes after total knee arthroplasty (TKA). Computer navigation for TKA was first introduced in 1997 with the aim of implanting the prosthetic components with accuracy and precision. This review discusses the technique, current status, and scientific evidence pertaining to computer-navigated TKA. Body The adoption of navigated TKA has slowly but steadily increased across the globe since its inception 25 years ago. It has been more rapid in some countries like Australia than others, like the UK. Contemporary, large console-based navigation systems help control almost every aspect of TKA, including the depth and orientation of femoral and tibial resections, soft-tissue release, and customization of femoral and tibial implant positions in order to obtain desired alignment and balance. Navigated TKA results in better limb and implant alignment and reduces outliers as compared to conventional TKA. However, controversy still exists over whether improved alignment provides superior function and longevity. Surgeons may also be hesitant to adopt this technology due to the associated learning curve, slightly increased surgical time, fear of pin site complications, and the initial set-up cost. Furthermore, the recent advent of robotic-assisted TKA which provides benefits like precision in bone resections and avoiding soft-tissue damage due to uncontrolled sawing, in addition to those of computer navigation, might be responsible for the latter technology taking a backseat. Conclusion This review summarizes the current state of computer-navigated TKA. The superiority of computer navigation to conventional TKA in improving accuracy is well established. Robotic-assisted TKA provides enhanced functionality as compared to computer navigation but is significantly more expensive. Whether robotic-assisted TKA offers any substantive advantages over navigation is yet to be conclusively proven. Irrespective of the form, the use of computer-assisted TKA is on the rise worldwide and is here to stay.

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A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

Osteoporosis International ◽

10.1007/s00198-021-05977-5 ◽

2021 ◽

Author(s):

H. E. Skibicki ◽

D. Y. Ponzio ◽

J. A. Brustein ◽

Z. D. Post ◽

A. C. Ong ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Femur Fracture ◽

Robotic Assisted ◽

Total Knee

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Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

The Knee ◽

10.1016/j.knee.2021.05.009 ◽

2021 ◽

Vol 31 ◽

pp. 64-76

Author(s):

Takao Kaneko ◽

Tadashi Igarashi ◽

Kazutaka Takada ◽

Shu Yoshizawa ◽

Hiroyasu Ikegami ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rotational Alignment ◽

Robotic Assisted ◽

Total Knee

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Robotic-assisted total knee arthroplasty with the OMNIBot platform: a review of the principles of use and outcomes

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04173-8 ◽

2021 ◽

Author(s):

J. Shatrov ◽

G. T. Murphy ◽

J. Duong ◽

B. Fritsch

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Robotic Assisted ◽

Total Knee

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Difficult Cases in Robotic Arm-Assisted Total Knee Arthroplasty: A Case Series

The Journal of Knee Surgery ◽

10.1055/s-0037-1608839 ◽

2017 ◽

Vol 31 (01) ◽

pp. 027-037 ◽

Cited By ~ 7

Author(s):

Robert Marchand ◽

Anton Khlopas ◽

Nipun Sodhi ◽

Caitlin Condrey ◽

Nicolas Piuzzi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Series ◽

Valgus Deformity ◽

Robotic Assisted ◽

Surgical Technology ◽

Flexion Contractures ◽

Total Knee ◽

Robotic Devices ◽

Sagittal Deformity

AbstractSagittal deformity of the knee is commonly corrected to neutral biomechanical axis (±3 degrees) during total knee arthroplasty (TKA), which is a widely accepted goal. Recent advances in surgical technology have made it possible to accurately plan and fulfill these goals. One of these is robotic-assisted TKA, which has been noted to help increase accuracy and precision of restoring a neutral mechanical axis. While there are data confirming the ability of robotic devices to better correct knee alignment than the manual technique, there is a lack of data concerning the use of the robotic devices in more complex cases, such as those in patients with severe varus or valgus deformity, as well as in flexion contractures. Therefore, the purpose of this case study is to present three cases in which the robotic-assisted TKA device was used to correct a severe varus and severe valgus deformities. Based on this case series, it should be noted that the robotic device can also help correct severe varus/valgus deformities and flexion contractures.

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The Learning Curve Associated with Robotic Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0037-1608809 ◽

2017 ◽

Vol 31 (01) ◽

pp. 017-021 ◽

Cited By ~ 28

Author(s):

Nipun Sodhi ◽

Anton Khlopas ◽

Nicolas Piuzzi ◽

Assem Sultan ◽

Robert Marchand ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Learning Curve ◽

Knee Arthroplasty ◽

Joint Arthroplasty ◽

Ease Of Use ◽

Similar Time ◽

Robotic Assisted ◽

Total Knee ◽

The Times ◽

Time Frames

AbstractAs with most new surgical technologies, there is an associated learning curve with robotic-assisted total knee arthroplasty (TKA) before surgeons can expect ease of use to be similar to that of manual cases. Therefore, the purpose of this study was to (1) assess robotic-assisted versus manual operative times of two joint reconstructive surgeons separately as well as (2) find an overall learning curve. A total of 240 robotic-assisted TKAs performed by two board-certified surgeons were analyzed. The cases were sequentially grouped into 20 cases and a learning curve was created based on mean operative times. For each surgeon, mean operative times for their first 20 and last 20 robotic-assisted cases were compared with 20 randomly selected manual cases performed by that surgeon as controls prior to the initiation of the robotic-assisted cases. Each of the surgeons first 20 robotic assisted, last 20 robotic assisted, and 20 controls were then combined to create 3 cohorts of 40 cases for analysis. Surgeon 1: First and last robotic cohort operative times were 81 and 70 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 81 versus 68 minutes (p < 0.05). Mean operative times for the last 20 robotic-assisted cases and manual cases were 70 versus 68 minutes (p > 0.05). Surgeon 2: First and last robotic cohort operative times were 117 and 98 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 117 versus 95 (p < 0.05). Mean operative times for the last 20 robotic-cohort cases and manual cases were 98 versus 95 (p > 0.05). A similar trend occurred when the times of two surgeons were combined. The data from this study effectively create a learning curve for the use of robotic-assisted TKA. As both surgeons completed their total cases numbers within similar time frames, these data imply that within a few months, a board-certified orthopaedic joint arthroplasty surgeon should be able to adequately perform robotic TKA without adding any operative times.

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Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0041-1731349 ◽

2021 ◽

Author(s):

Kevin B. Marchand ◽

Rachel Moody ◽

Laura Y. Scholl ◽

Manoshi Bhowmik-Stoker ◽

Kelly B. Taylor ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Physical Function ◽

Knee Arthroplasty ◽

Postoperative Outcomes ◽

Medical Complications ◽

Womac Pain ◽

Robotic Assisted ◽

Surgical Data ◽

Total Knee

AbstractRobotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) radiographic assessments for progressive radiolucencies. We compared 80 consecutive cementless robotic-assisted to 80 consecutive cementless manual TKAs. Patient preoperative r-WOMAC and demographics (e.g., age, sex, and body mass index) were not found to be statistically different. Surgical data and medical records were reviewed for aseptic survivorship, medical, and surgical complications. Patients were administered an r-WOMAC survey preoperatively and at 2-year postoperatively. Mean r-WOMAC pain, physical function, and total scores were tabulated and compared using Student's t-tests. Radiographs were reviewed serially throughout patient's postoperative follow-up. A p < 0.05 was considered significant. The aseptic failure rates were 1.25 and 5.0% for the robotic-assisted and manual cohorts, respectively. Patients in the robotic-assisted cohort had significantly improved 2-year postoperative r-WOMAC mean pain (1 ± 2 vs. 2 ± 3 points, p = 0.02), mean physical function (2 ± 3 vs. 4 ± 5 points, p = 0.009), and mean total scores (4 ± 5 vs, 6 ± 7 points, p = 0.009) compared with the manual TKA. Surgical and medical complications were similar in the two cohorts. Only one patient in the manual cohort had progressive radiolucencies on radiographic assessment. Robotic-assisted TKA patients demonstrated improved 2-year postoperative outcomes when compared with manual patients. Further studies could include multiple surgeons and centers to increase the generalizability of these results. The results of this study indicate that patients who undergo robotic-assisted TKA may have improved 2-year postoperative outcomes.

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Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

Bone and Joint Research ◽

10.1302/2046-3758.810.bjr-2019-0129.r1 ◽

2019 ◽

Vol 8 (10) ◽

pp. 495-501 ◽

Cited By ~ 15

Author(s):

Emily L. Hampp ◽

Nipun Sodhi ◽

Laura Scholl ◽

Matthew E. Deren ◽

Zachary Yenna ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Tissue Damage ◽

Soft Tissues ◽

Soft Tissue Damage ◽

Anatomical Structures ◽

Cruciate Retaining ◽

Robotic Assisted ◽

Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

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