Improved Component Placement Accuracy with Robotic-Arm Assisted Total Knee Arthroplasty

AbstractComponent position of total knee arthroplasty (TKA) has been shown to influence prosthetic survivorships and clinical outcomes. Our objective was to compare the three-dimensional accuracy to plan of robotic-arm assisted TKA (RATKA) with conventional TKA for component position. We conducted a nonrandomized, prospective study comparing 143 RATKA with 86 conventional TKA operated at four U.S. centers between July 2016 and October 2018. Computed tomography (CT) scans obtained approximately 6 weeks postoperatively were analyzed using anatomical landmarks. Absolute deviation from surgical plans were defined as the absolute value of the difference between the CT measurements and surgeons' femoral and tibial component mechanical varus/valgus alignment, tibial component posterior slope, and femoral component internal/external rotation. Differences of absolute deviations were tested using stratified Wilcoxon's tests that controlled for study center. Patient-reported outcome measures collected through 1 postoperative year were modeled using multiple regression controlling for age, sex, body mass index, study center, and the preoperative score. RATKA demonstrated greater accuracy for tibial component alignment (median [25th, 75th percentiles] absolute deviation from plan of all centers combined for conventional vs. RA, 1.7 [0.9, 2.9] vs. 0.9 [0.4, 1.9] degrees, p < 0.001), femoral component rotation (1.5 [0.9, 2.5] vs. 1.3 [0.6, 2.5] degrees, p = 0.015), and tibial slope (2.9 [1.5, 5.0] vs. 1.1 [0.6, 2.0] degrees, p < 0.001). In multivariable analyses, RATKA showed significantly greater Veterans RAND 12-item health survey (VR-12) physical component scores (adjusted mean difference [95% confidence interval (CI)]: 2.4 [0.2, 4.5] points, p = 0.034) and qualitatively greater Knee Society (KS) composite functional scores (3.5 [−1.3, 8.2] points, p = 0.159), though not statistically significant. Compared with conventional instrumentation, RATKA demonstrated greater three-dimensional accuracy to plan for various component positioning parameters and clinical improvements in physical status and function with no major safety concerns during the first postoperative year. These results may be attributed to the preoperative CT scan planning, real-time intraoperative feedback, and stereotactic-guided cutting that takes into consideration patient-specific bony anatomy. These findings support the use of RATKA for enhanced arthroplasty outcomes.

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Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy and Precision to Plan Compared with Manual Techniques

The Journal of Knee Surgery ◽

10.1055/s-0038-1641729 ◽

2018 ◽

Vol 32 (03) ◽

pp. 239-250 ◽

Cited By ~ 24

Author(s):

Emily Hampp ◽

Morad Chughtai ◽

Laura Scholl ◽

Nipun Sodhi ◽

Manoshi Bhowmik-Stoker ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Robotic Arm ◽

Component Position ◽

Absolute Deviation ◽

Positioning Errors ◽

Implant Positioning ◽

Accuracy And Precision ◽

Total Knee ◽

Left And Right

AbstractThis study determined if robotic-arm assisted total knee arthroplasty (RATKA) allows for more accurate and precise bone cuts and component position to plan compared with manual total knee arthroplasty (MTKA). Specifically, we assessed the following: (1) final bone cuts, (2) final component position, and (3) a potential learning curve for RATKA. On six cadaver specimens (12 knees), a MTKA and RATKA were performed on the left and right knees, respectively. Bone-cut and final-component positioning errors relative to preoperative plans were compared. Median errors and standard deviations (SDs) in the sagittal, coronal, and axial planes were compared. Median values of the absolute deviation from plan defined the accuracy to plan. SDs described the precision to plan. RATKA bone cuts were as or more accurate to plan based on nominal median values in 11 out of 12 measurements. RATKA bone cuts were more precise to plan in 8 out of 12 measurements (p ≤ 0.05). RATKA final component positions were as or more accurate to plan based on median values in five out of five measurements. RATKA final component positions were more precise to plan in four out of five measurements (p ≤ 0.05). Stacked error results from all cuts and implant positions for each specimen in procedural order showed that RATKA error was less than MTKA error. Although this study analyzed a small number of cadaver specimens, there were clear differences that separated these two groups. When compared with MTKA, RATKA demonstrated more accurate and precise bone cuts and implant positioning to plan.

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Midterm Comparison of Tibial Fixation between Posterior Cruciate-Retaining and Substituting Porous Tantalum Total Knee Arthroplasty: Three-Dimensional Computed Tomography Analysis

The Journal of Knee Surgery ◽

10.1055/s-0039-1693453 ◽

2019 ◽

Vol 34 (01) ◽

pp. 047-056

Author(s):

Takao Kaneko ◽

Norihiko Kono ◽

Yuta Mochizuki ◽

Masaru Hada ◽

Shinya Toyoda ◽

...

Keyword(s):

Computed Tomography ◽

Total Knee Arthroplasty ◽

Bone Quality ◽

Knee Arthroplasty ◽

Tibial Component ◽

Three Dimensional ◽

Porous Tantalum ◽

Cruciate Retaining ◽

Significant Difference ◽

Total Knee

AbstractPorous tantalum tibial component is durable with excellent bone ingrowth, higher knee scores, and long-term survivorship. However, to our knowledge, the effect of posterior cruciate-retaining (CR) and posterior cruciate-substituting (PS) porous tantalum tibial component has not been reported. The aim of the current study was to investigate the prosthetic bone quality between CR porous tantalum tibial component and PS using three-dimensional multi-detector-row computed tomography (3D-MDCT). Porous twenty-two (22) CR total knee arthroplasties and 22 PS received 3D-MDCT at every 6 months up to 5.5 years postoperatively to assess prosthetic bone quality (bone marrow contents/tissue volumes [BMC/TV, mg/cm3]) underneath the pegs of porous tantalum modular tibial component. Clinical outcomes (Knee Society score [KSS], Western Ontario and McMaster Universities (WOMAC), FJS-12, Patella score) were evaluated at a minimum follow-up period of 5.5 years. No statistically significant differences were found in age, gender, body mass index, KSS, and BMC/TV volumes in the proximal tibia between the two groups before total knee arthroplasty (TKA). There were also no significant differences between the CR and PS groups with regard to BMC/TV at every 6 months up to 5.5 years after TKA. At 5.5 years postoperatively, there was no significant difference between the two groups in terms of the KSS, WOMAC, forgotten joint score (FJS-12), and Patella score. The present study revealed that the prosthetic bone quality of the CR porous tantalum tibial component and PS were equivalent at every 6 months up to 5.5 years after TKA. This study reflects level II evidence.

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Adoption of Robotic-Arm-Assisted Total Knee Arthroplasty Is Associated with Decreased Use of Articular Constraint and Manipulation under Anesthesia Compared to a Manual Approach

The Journal of Knee Surgery ◽

10.1055/s-0040-1721123 ◽

2021 ◽

Author(s):

Jenny Zhang ◽

Chelsea N. Matzko ◽

Andrew Sawires ◽

Joseph O. Ehiorobo ◽

Michael A. Mont ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Robotic Arm ◽

Patient Specific ◽

Patient Centered ◽

Lengths Of Stay ◽

Ligament Balance ◽

Total Knee ◽

Early Cohort

AbstractHaptic robotic-arm-assisted total knee arthroplasty (RATKA) seeks to leverage three-dimensional planning, intraoperative assessment of ligament laxity, and guided bone preparation to establish and achieve patient-specific targets for implant position. We sought to compare (1) operative details, (2) knee alignment, (3) recovery of knee function, and (4) complications during adoption of this technique to our experience with manual TKA. We compared 120 RATKAs performed between December 2016 and July 2018 to 120 consecutive manual TKAs performed between May 2015 and January 2017. Operative details, lengths of stay (LOS), and discharge dispositions were collected. Tibiofemoral angles, Knee Society Scores (KSS), and ranges of motion were assessed until 3 months postoperatively. Manipulations under anesthesia, complications, and reoperations were tabulated. Mean operative times were 22 minutes longer in RATKA (p < 0.001) for this early cohort, but decreased by 27 minutes (p < 0.001) from the first 25 RATKA cases to the last 25 RATKA cases. Less articular constraint was used to achieve stability in RATKA (93 vs. 55% cruciate-retaining, p < 0.001; 3 vs. 35% posterior stabilized (PS), p < 0.001; and 4 vs. 10% varus-valgus constrained, p_ = _0.127). RATKA had lower LOS (2.7 vs. 3.4 days, p < 0.001). Discharge dispositions, tibiofemoral angles, KSS, and knee flexion angles did not differ, but manipulations were less common in RATKAs (4 vs. 17%, p = 0.013). We observed less use of constraint, shorter LOS, and fewer manipulations under anesthesia in RATKA, with no increase in complications. Operative times were longer, particularly early in the learning curve, but improved with experience. All measured patient-centered outcomes were equivalent or favored the newer technique, suggesting that RATKA with patient-specific alignment targets does not compromise initial quality. Observed differences may relate to improved ligament balance or diminished need for ligament release.

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Effect of tibial component position on patellar strain following total knee arthroplasty

The Journal of Arthroplasty ◽

10.1016/s0883-5403(05)80210-4 ◽

1995 ◽

Vol 10 (5) ◽

pp. 651-656 ◽

Cited By ~ 41

Author(s):

Robert Singerman ◽

Kingsbury G. Heiple ◽

Dwight T. Davy ◽

Victor M. Goldberg

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Component Position ◽

Total Knee

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The type of approach (medial versus lateral) influences TKA component rotation in total knee arthroplasty - a clinical study using 3D-CT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00010 ◽

2018 ◽

Vol 6 (4_suppl2) ◽

pp. 2325967118S0001

Author(s):

Filippo-Franco Schiapparelli ◽

Felix Amsler ◽

Michael Hirschmann

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Tibial Tubercle ◽

Component Position ◽

Tibial Tubercle Osteotomy ◽

Subvastus Approach ◽

Leg Axis ◽

Component Rotation ◽

Total Knee

The purpose of this study was to investigate if the type of approach (medial parapatellar approach (MPA) versus lateral parapatellar subvastus approach with tibial tubercle osteotomy (LPA)) influences the rotation of femoral and/or tibial component and leg axis in total knee arthroplasty (TKA). This study included 200 consecutive patients in whom TKA was performed using either a parapatellar medial (n=162, MPA) or parapatellar lateral subvastus approach with tibial tubercle osteotomy (n=38, LPA). All patients underwent clinical follow-up, standardised radiographs and computed radiography (CT). TKA components’ position and the whole leg axis were assessed on 3D reconstructed CT scans (sagittal, coronal and rotational). Mean values of TKA component position and the whole leg alignment of both groups were compared using a T-test. The tibial component was graded as internally rotated (< 3° of external rotation (ER)), neutral rotation (equal or between 3° and 6° of ER) and and externally rotated (>6° ER). The femoral component was graded as internally rotated (< 3° of internal rotation (IR)), neutral rotation (equal or between -3° IR and 3° of ER) and externally rotated (>3° ER). There was no significant difference in terms of whole leg axis after TKA between both groups (MPA: 0.2° valgus ± 3.4; LPA: 0.0° valgus ± 3.5). Means of tibial component position were 2.7° ER ± 6.1 (MPA) and 7.6° ER ± 5.4 (LPA). Patients of group LPA presented a significantly less internally rotated (LPA: 18.4%; MPA: 48.8%) and more externally rotated (LPA: 52.6%; MPA: 22.8%) tibial component (p<0.001). No significant differences were seen for the femoral component position, tibial valgus/varus and tibial slope. The type of approach significantly influences the tibial TKA component rotation. It appears that a MPA tends to internally rotate the tibial TKA component and a LPA tends to externally rotate the tibial TKA.

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Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Greater Accuracy to Plan Compared to Manual Technique

10.29007/sk23 ◽

2018 ◽

Author(s):

Emily Hampp ◽

Laura Scholl ◽

Michael Prieto ◽

Ta-Cheng Chang ◽

Abdullah Abbasi ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Clinical Success ◽

Robotic Arm ◽

Component Position ◽

Component Placement ◽

Accuracy And Precision ◽

Significant Difference ◽

Flexion Extension ◽

Total Knee

While total knee arthroplasty has demonstrated clinical success, final bone cut and final component alignment can be critical for achieving a desired overall limb alignment. This cadaver study investigated whether robotic-arm assisted total knee arthroplasty (RATKA) allows for accurate bone cuts and component position to plan, compared to manual technique. Six cadaveric specimens (12 knees) were prepared by an experienced user of manual total knee arthroplasty (MTKA), who was inexperienced in RATKA. For each cadaveric pair, a RATKA was prepared on the right leg and a MTKA was prepared on the left leg. Final bone cuts and final component position to plan were measured relative to fiducials, and mean and standard deviations were compared.Measurements of final bone cut error for each cut show that RATKA had greater accuracy and precision to plan for femoral anterior internal/external (0.8±0.5° vs. 2.7±1.9°) and flexion/extension* (0.5±0.4° vs. 4.3±2.3°), anterior chamfer varus/valgus* (0.5±0.1° vs. 4.1±2.2°) and flexion/extension (0.3±0.2° vs. 1.9±1.0°), distal varus/valgus (0.5±0.3° vs. 2.5±1.6°) and flexion/extension (0.8±0.5° vs. 1.1±1.1°), posterior chamfer varus/valgus* (1.3±0.4° vs. 2.8±2.0°) and flexion/extension (0.8±0.5° vs. 1.4±1.6°), posterior internal/external* (1.1±0.6° vs. 2.8±1.6°) and flexion/extension (0.7±0.6° vs. 3.7±4.0°), and tibial varus/valgus* (0.6±0.3° vs. 1.3±0.7°) rotations, compared to MTKA, respectively (where * indicates a significant difference between the two operative methods based on 2-Variances testing, with α at 0.05). Measurements of final component position error show that RATKA had greater accuracy and precision to plan for femoral varus/valgus* (0.6±0.3° vs. 3.0±1.4°), flexion/extension* (0.6±0.5° vs. 3.0±2.1°), internal/external (0.8±0.5° vs. 2.6±1.6°), and tibial varus/valgus (0.7±0.4° vs. 1.1±0.8°) than the MTKA control, respectively.In general, RATKA demonstrated greater accuracy and precision of bone cuts and component placement to plan, compared to MTKA in this cadaveric study. For further confirmation, RATKA accuracy of component placement should be investigated in a clinical setting.

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Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

The Journal of Knee Surgery ◽

10.1055/s-0038-1666829 ◽

2018 ◽

Vol 32 (07) ◽

pp. 642-648 ◽

Cited By ~ 5

Author(s):

J. R. T. Pietrzak ◽

F. E. Rowan ◽

B. Kayani ◽

M. J. Donaldson ◽

S. S. Huq ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Component ◽

Three Dimensional ◽

Two Dimensional ◽

Robot Assisted ◽

Ct Guided ◽

Digital Templating ◽

Preoperative Ct ◽

Total Knee

AbstractPatient dissatisfaction after total knee arthroplasty (TKA) is a concern. Surgical error is a common, avoidable cause of failed TKA. Correct femoral and tibial component sizing improves implant longevity, clinical outcomes, knee balance, and pain scores. We hypothesized that preoperative three-dimensional (3D) templating for robot-assisted TKA (RA-TKA) is more accurate than two-dimensional (2D) digital templating. Prospectively collected data from 31 RA-TKAs were assessed to determine accuracy pertaining to implant sizing and positioning. All cases undergoing RA-TKA undergo preoperative CT-scans as per protocol. Three blinded observers retrospectively templated these knees for TKA using standard radiographs. We compared whether 2D templating was as accurate as CT-guided templating. Postoperative radiographs were then evaluated for sizing and positioning. Intraclass correlation coefficients (ICCs) and the effect of learning curve were assessed. Preoperative femoral component 3D templating and retrospective blinded 2D templating accuracies were 96.6% and 52.9%, respectively (χ 2: 17.965; odds ratio [OR]: 24.957, 3.250–191.661; p < 0.001). Tibial component 3D and 2D templating accuracies were 93.1% and 28.7%, respectively (χ 2: 36.436; OR: 33.480, 7.400–151.481; p < 0.001). ICC for the three radiograph observers was 0.920 (95% confidence interval [CI]: 0.652–0.890; p < 0.001) for the femur and 0.833 (0.717–0.911; p < 0.001) for the tibia, showing excellent agreement. We conclude that preoperative CT-based templating for RA-TKA more accurately predicts the size of implants compared with traditional 2D digital templating. This may improve operating room efficiency and cost containment.

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Low-Degree Tibial Slope Angle Prevents Component Overhang by Enlarging the Lateral Plateau Surface Area in Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1718598 ◽

2020 ◽

Author(s):

Mehmet Emin Simsek ◽

Mustafa Akkaya ◽

Safa Gursoy ◽

Özgür Kaya ◽

Murat Bozkurt

Keyword(s):

Total Knee Arthroplasty ◽

Surface Area ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Slope Angle ◽

Three Dimensional ◽

Tibial Slope ◽

Total Knee ◽

Lateral Plateau ◽

Gender Groups

AbstractThis study aimed to investigate whether overhang or underhang around the tibial component that occurs during the placement of tibial baseplates was affected by different slope angles of the tibial plateau and determine the changes in the lateral and medial plateau diameters while changing the slope angle in total knee arthroplasty. Three-dimensional tibia models were reconstructed using the computed tomography scans of 120 tibial dry bones. Tibial plateau slope cuts were performed with 9, 7, 5, 3, and 0 degrees of slope angles 2-mm below the subchondral bone in the deepest point of the medial plateau. Total, lateral, and medial tibial plateau areas and overhang/underhang rates were measured at each cut level. Digital implantations of the asymmetric and symmetric tibial baseplates were made on the tibial plateau with each slope angles. Following the implantations, the slope angle that prevents overhang or underhang at the bone border and the slope angle that has more surface area was identified. A significant increase was noted in the total tibial surface area, lateral plateau surface area, and lateral anteroposterior distance, whereas the slope cut angles were changed from 9 to 0 degrees in both gender groups. It was found that the amount of posteromedial underhang and posterolateral overhang increased in both the asymmetric and symmetric tibial baseplates when the slope angle was changed from 0 to 9 degrees. Although the mediolateral diameter did not change after the proximal tibia cuts at different slope angles, the surface area and anteroposterior diameter of the lateral plateau could change, leading to increased lateral plateau area. Although prosthesis designs are highly compatible with the tibial surface area, it should be noted that the component overhangs, especially beyond the posterolateral edge, it can be prevented by changing the slope cut angle in males and females.

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