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

2019 ◽  
Vol 8 (10) ◽  
pp. 495-501 ◽  
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.

scholarly journals Less Iatrogenic Soft Tissue Damage Utilizing Robotic Assisted Total Knee Arthroplasty when Compared with a Manual Approach: A Blinded Assessment

10.29007/v7g9 ◽  
2019 ◽  
Author(s):  
Emily Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Hypothesis Test ◽  
Patellar Ligament ◽  
Robotic Arm ◽  
Soft Tissue Damage ◽  
Total Knee

While manual total knee arthroplasty (MTKA) has demonstrated excellent clinical results, occasionally intraoperative damage to soft tissues can occur. Robotic-arm assisted technology is designed to constrain a sawblade in a haptic zone to help ensure that only the desired bone cuts are made. The objective of this cadaver study was to quantify the extent of soft tissue damage sustained during TKA through a robotic-arm assisted (RATKA) haptically guided approach and conventional MTKA approach. Four surgeons each prepared 3 RATKA and 3 MTKA specimens for cruciate retaining TKAs. RATKA was performed on one knee, with MTKA on the other. Postoperatively, 2 additional blinded surgeons, assessed and graded damage to 14 key anatomic structures. A Kruskal-Wallis hypothesis test was performed to assess for statistical differences of soft tissue damages between RATKA and MTKA cases. A p-value &lt;0.05 was used as the threshold for statistical significance, and p-values were adjusted for ties. Significantly less damage occurred to the PCL in the RATKA than the MTKA specimens (p&lt;0.0001). RATKA specimens had less damage to the dMCL (p=.149), ITB (p=0.580), popliteus (p=0.248), and patellar ligament (p=0.317). The results of this study indicate that RATKA may result in less soft-tissue damage than MTKA, especially to the PCL.

Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty

2020 ◽  
Vol 102-B (10) ◽  
pp. 1324-1330
Author(s):  
Stijn Herregodts ◽  
Mathijs Verhaeghe ◽  
Rico Paridaens ◽  
Jan Herregodts ◽  
Hannes Vermue ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissue Damage ◽  
Iliotibial Band ◽  
Collateral Ligament ◽  
Tibial Resection ◽  
Total Knee ◽  
Oscillating Saw

Aims Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon’s experience level. Methods A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). Results The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. Conclusion This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324–1330.

Effects of Tourniquet Use on Blood Loss and Soft-Tissue Damage in Total Knee Arthroplasty

2012 ◽  
Vol 94 (24) ◽  
pp. 2209-2215 ◽  
Author(s):  
Ta-Wei Tai ◽  
Chih-Wei Chang ◽  
Kuo-An Lai ◽  
Chii-Jeng Lin ◽  
Chyun-Yu Yang
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissue Damage ◽  
Total Knee

scholarly journals Soft-tissue damage during total knee arthroplasty

2017 ◽  
Vol 14 (3) ◽  
pp. 347-353 ◽  
Author(s):  
Constantin Mayer ◽  
Alexander Franz ◽  
Jan-Frieder Harmsen ◽  
Fina Queitsch ◽  
Michael Behringer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissue Damage ◽  
Total Knee

scholarly journals The Incidence of Soft-Tissue Releases in Robotic-Assisted Total Knee Arthroplasty Technology

10.29007/lbgj ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Historical Cohort ◽  
Robotic Assisted ◽  
Total Knee

The incidence of formal soft tissues releases required in TKA surgery performed utilizing the NAVIO robotic-assisted (RA)-TKA technique was assessed and compared to a historical cohort of conventional, manually instrumented (CI) TKA’s.

scholarly journals The Effect of the PCL on Kinematics as it Relates to Soft-Tissue Preservation from Robotic-Arm Assisted Surgery

10.29007/vbqh ◽  
2019 ◽  
Author(s):  
Raga Rajaravivarma ◽  
Sally Liarno ◽  
Tatyana Kaverina ◽  
Sonia Donde ◽  
Emily Sneddon
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Robotic Arm ◽  
Soft Tissue Damage ◽  
Tissue Preservation ◽  
Soft Tissue Preservation ◽  
Total Knee ◽  
Tibial Translation

The use of haptic-based robotic-arm assisted total knee arthroplasty (hRATKA) has demonstrated a decrease in soft tissue damage. Hampp et al. [4] compared the soft tissue damage in a cadaveric study between manual total knee arthroplasty (MTKA) and hRATKA and found that the hRATKA specimens had significantly less damage to the PCL than the MTKA specimens [4]. The purpose of this study is to look at the effect of the posterior cruciate ligament (PCL) on kinematics, as defined by anterior-posterior (AP) tibial translation, during stair climb. Using a 6 degree-of-freedom (6-DOF) joint motion simulator, the stair climb profile was run on four cadaveric knee specimens with the PCL intact and the PCL cut. In the PCL deficient condition, there was more posterior tibial motion than when the PCL was intact, and this was more noticeable during the high flexion portion of the profile. These findings speak to the importance of soft tissue preservation, and the development of haptic-based robotic-arm assisted TKA can help prevent soft tissue damage to the PCL.

Intraoperative Soft Tissue Balance Reflects Minimum 5-Year Midterm Outcomes in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty

2012 ◽  
Vol 27 (9) ◽  
pp. 1723-1730 ◽  
Author(s):  
Tomoyuki Matsumoto ◽  
Hirotsugu Muratsu ◽  
Seiji Kubo ◽  
Takehiko Matsushita ◽  
Masahiro Kurosaka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Posterior Stabilized ◽  
Cruciate Retaining ◽  
Total Knee

scholarly journals Obliteration of Intercondylar Notch Mimicking Flexion-Extension Gap Imbalance in a Cruciate Retaining Total Knee Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Harun Resit Gungor ◽  
Esat Kiter ◽  
Semih Akkaya ◽  
Nusret Ok ◽  
Cagdas Yorukoglu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Early Postoperative Period ◽  
Intercondylar Notch ◽  
Cruciate Retaining ◽  
Flexion Extension ◽  
Total Knee

Following total knee arthroplasty (TKA), the most frequent cause of extension deficit and limitation of range of motion in early postoperative period is related to improper tensioning of soft tissues and failure to balance extension and flexion gaps. If a cruciate retaining (CR) prosthesis is the planned implant, then attention should be given to balancing the posterior cruciate ligament (PCL), and any factor that alters this balance may also cause deterioration of knee balance in postoperative period. Here, we report on an unusual case referred from another hospital because of continuous pain and restriction of knee motion in early postoperative period following CR-designed TKA that was initially thought to be due to flexion-extension imbalance. However, during the revision procedure, extruded cement to the intercondylar notch was found to be both mechanically blocking terminal extension and limiting flexion by possible mechanism of irritation of the synovial nerve endings around the stretched anterior fibers of PCL during flexion. This case was successfully treated by removal of extruded cement from intercondylar notch to decompress PCL, polyethylene exchange, and secondary patellar resurfacing.

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