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

2017 ◽  
Vol 31 (01) ◽  
pp. 027-037 ◽  
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.

Coronal Correction for Severe Deformity Using Robotic-Assisted Total Knee Arthroplasty

2017 ◽  
Vol 31 (01) ◽  
pp. 002-005 ◽  
Author(s):  
Robert Marchand ◽  
Nipun Sodhi ◽  
Anton Khlopas ◽  
Assem Sultan ◽  
Carlos Higuera ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Optical Tracking ◽  
Coronal Alignment ◽  
Robotic Assisted ◽  
Bony Landmarks ◽  
Total Knee ◽  
Neutral Alignment

AbstractAlthough robotic-assisted total knee arthroplasty (TKA) has the potential to accurately reproduce neutral alignment, it is still unclear if this correction is attainable in patients who have severe varus or valgus deformities. Therefore, the purpose of this study was to assess a single surgeon's experience with correcting coronal deformities using the robotic-assisted TKA device. Specifically, we looked at correction of varying degrees of varus and valgus deformity in patients who underwent robotic arm-assisted TKA. A total of 330 robotic-assisted TKA cases performed by a single surgeon were analyzed. Preoperative CT scans were registered to the robotic-assisted software to create a three-dimensional rendering from which coronal alignment was measured. Postoperative coronal alignment measurements were taken in the operating room using the robotic-assisted device after trial component placement. The robotic-assisted device uses optical tracking from navigation probes placed on the distal femur and proximal tibia. The robotic-assisted software can register these probes as bony landmarks to measure coronal alignment in the distal plane of the femoral component and proximal plane of the tibial component. A total of 261 cases were of varus knees, 46 cases were of valgus knees, and 23 cases had 0° preoperative alignment. Severe deformity was defined as 7° or greater deformity. Preoperative neutral alignment was defined as 0°, while postoperative neutral alignment was defined as 0° ± 3°. There were 129 patients with and initial severe varus and 7 patients with an initial severe valgus deformity of 7° or greater. Patients were divided into varus or valgus cohorts, and analysis was performed on the overall cohort, as well as nonsevere (<7°) and severe (7° or greater) deformity cohorts.All 132 knees with initial varus deformity of less than 7° were corrected to neutral (mean 1°, range -1–3°). A total of 82 knees (64%) with 7° or greater varus deformity were corrected to neutral (mean 2°, range 0–3°). However, roughly 30% of patients with severe deformity who were not corrected to neutral were still corrected within a couple of degrees of neutral. There were seven knees with 7° or greater valgus deformity, and all were corrected to neutral (mean 2°, range 0–3°). This study demonstrated that all knees were corrected in the appropriate direction within a few degrees of neutral, and no knees were overcorrected. The implication of this ability to achieve alignment goals on clinical outcomes will need to be evaluated in future studies. The results from this study demonstrate the potential for the robotic-assisted device during TKA in helping surgeons achieve a preoperatively planned desired neutral alignment.

Total Knee Arthroplasty for Fixed Valgus Deformity Correction Using a Modified Lateral Parapatellar Approach

2019 ◽  
Vol 33 (04) ◽  
pp. 372-377 ◽  
Author(s):  
Hu Li ◽  
Danielle Y. Ponzio ◽  
Alvin Ong ◽  
Wei Wei ◽  
Baicheng Wang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Case Series ◽  
Deformity Correction ◽  
Valgus Deformity ◽  
Radiographic Measurement ◽  
Functional Scores ◽  
Total Knee ◽  
The Mean

AbstractTotal knee arthroplasty (TKA) for patients with valgus deformity (> 10 degrees) is technically challenging and has produced variable clinical results in terms of deformity correction, instability, and overall outcomes. The lateral parapatellar approach (LPA) is an alternative to the traditional medial parapatellar approach with potential advantages of direct access for release of tight lateral ligamentous structures with preservation of the medial structures, optimized patellar tracking, preserved medial blood supply to the patella, and less use of constrained implants. We present a case series of a single institution's experience with use of a modified LPA using a Z-capsuloplasty for 35 primary TKA cases in 30 patients with osteoarthritis and Ranawat's type-II fixed valgus deformity with attenuation of medial soft tissues. The mean age of patients was 64.8 years (range: 42–78 years). Follow-up duration was a mean of 47.3 months (range: 3–130 months). The patients were assessed pre- and postoperatively using radiographic measurement of the anatomic femorotibial angle (FTA) and clinical measurement of range of motion (ROM) and the Chinese knee society score (KSS). Complications and reoperations were recorded. The mean coronal alignment was corrected from 20.4 degrees of valgus (range: 11.3–42 degrees) preoperatively to 7.0 degrees of valgus (range: 3.6–15.1 degrees) postoperatively. One case required use of a constrained condylar design implant. At a mean of 47.3 months, the mean Knee Society objective and functional scores improved to 91.8 ± 6.6 and 84.3 ± 18.2 points, respectively. Mean ROM was 94.9 degrees preoperatively and 105.7 degrees postoperatively. Three cases (8.6%) had postoperative complications, including transient common peroneal nerve palsy, hematoma, and deep infection. One patient underwent two-stage revision for infection. There were no cases of late instability. The modified LPA using a Z-capsuloplasty is a reproducible and effective surgical technique for performing TKA in the setting of osteoarthritis and severe valgus deformity.

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

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

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

The Knee ◽  
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

The Learning Curve Associated with Robotic Total Knee Arthroplasty

2017 ◽  
Vol 31 (01) ◽  
pp. 017-021 ◽  
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.

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

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.

TOTAL KNEE ARTHROPLASTY FOR SEVERE VALGUS DEFORMITY

2004 ◽  
Vol 86 (12) ◽  
pp. 2671-2676 ◽  
Author(s):  
MARK ELKUS ◽  
CHITRANJAN S. RANAWAT ◽  
VIJAY J. RASQUINHA ◽  
SUSHRUT BABHULKAR ◽  
ROBERTO ROSSI ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Valgus Deformity ◽  
Total Knee
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