scholarly journals Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection

10.29007/8bxp ◽  
2018 ◽  
Author(s):  
Emily Hampp ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Jason Otto ◽  
David Jacofsky ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Cadaver Study ◽  
Patellar Ligament ◽  
Robotic Arm ◽  
Collateral Ligament ◽  
Tissue Protection ◽  
Total Knee ◽  
Patellar Eversion

Total knee arthroplasty (TKA) typically addresses end-stage osteoarthritis. While TKA procedures have demonstrated clinical success, occasionally intraoperative complications can occur. This cadaver study examined the potential benefits of soft tissue protection in robotic-arm assisted TKA (RATKA). Six cadaver knees were prepared using RATKA by a single surgeon from a high-volume TKA joint center with no former clinical robotic experience, and compared to seven manually performed cases as a control. The presence of soft tissue disruption was assessed by having the surgeon perform visual evaluation and palpation of the medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior cruciate ligament (PCL), and the patellar ligament after the procedures. The amount of tibial subluxation and patellar eversion was recorded for each case.For all RATKA cases, there was no visible evidence of disruption of any of the ligaments. All RATKA cases were successfully left with a bone island on the tibial plateau, which protected the PCL. Tibial subluxation and patellar eversion were not required for visualization. In two of the seven MTKA cases, there was slight disruption noted of the PCL, although this did not lead to any apparent change in the functional integrity of the ligament. All MTKA cases required tibial subluxation and patellar eversion to achieve optimal visualization.Aspects of soft tissue protection were noted in this cadaver study for RATKA. Standard retraction techniques during cutting are recommended. This is the first study to have soft tissue injury parameters assessed for RATKA, and may serve as a platform for future studies.

Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection

2017 ◽  
Vol 14 (12) ◽  
pp. 925-927 ◽  
Author(s):  
Assem A. Sultan ◽  
Nicolas Piuzzi ◽  
Anton Khlopas ◽  
Morad Chughtai ◽  
Nipun Sodhi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Tissue Protection ◽  
Total Knee

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 <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<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.

Can isolated removal of osteophytes achieve correction of varus deformity and gap-balance in computer-assisted total knee arthroplasty?

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 49-58
Author(s):  
Arun Mullaji
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
Deformity Correction ◽  
Computer Assisted ◽  
Cruciate Ligaments ◽  
Collateral Ligament ◽  
Total Knee

Aims The aims of this study were to determine the effect of osteophyte excision on deformity correction and soft tissue gap balance in varus knees undergoing computer-assisted total knee arthroplasty (TKA). Methods A total of 492 consecutive, cemented, cruciate-substituting TKAs performed for varus osteoarthritis were studied. After exposure and excision of both cruciates and menisci, it was noted from operative records the corrective interventions performed in each case. Knees in which no releases after the initial exposure, those which had only osteophyte excision, and those in which further interventions were performed were identified. From recorded navigation data, coronal and sagittal limb alignment, knee flexion range, and medial and lateral gap distances in maximum knee extension and 90° knee flexion with maximal varus and valgus stresses, were established, initially after exposure and excision of both cruciate ligaments, and then also at trialling. Knees were defined as ‘aligned’ if the hip-knee-ankle axis was between 177° and 180°, (0° to 3° varus) and ‘balanced’ if medial and lateral gaps in extension and at 90° flexion were within 2 mm of each other. Results Of 50 knees (10%) with no soft tissue releases (other than cruciate ligaments), 90% were aligned, 81% were balanced, and 73% were aligned and balanced. In 288 knees (59%) only osteophyte excision was performed by subperiosteally releasing the deep medial collateral ligament. Of these, 98% were aligned, 80% were balanced, and 79% were aligned and balanced. In 154 knees (31%), additional procedures were performed (reduction osteotomy, posterior capsular release, and semimembranosus release). Of these, 89% were aligned, 68% were balanced, and 66% were aligned and balanced. The superficial medial collateral ligament was not released in any case. Conclusion Two-thirds of all knees could be aligned and balanced with release of the cruciate ligaments alone and excision of osteophytes. Excision of osteophytes can be a useful step towards achieving deformity correction and gap balance without having to resort to soft tissue release in varus knees while maintaining classical coronal and sagittal alignment of components. Cite this article: Bone Joint J 2020;102-B(6 Supple A):49–58.

scholarly journals Tibiofemoral dynamic stressed gap laxities correlate with compartment load measurements in robotic arm-assisted total knee arthroplasty

2021 ◽  
Vol 2 (11) ◽  
pp. 974-980
Author(s):  
Richard J. Allom ◽  
Jil A. Wood ◽  
Darren B. Chen ◽  
Samuel J. MacDessi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Strong Relationship ◽  
Soft Tissue Balance ◽  
Robotic Arm ◽  
Gap Symmetry ◽  
Load Sensor ◽  
Total Knee

Aims It is unknown whether gap laxities measured in robotic arm-assisted total knee arthroplasty (TKA) correlate to load sensor measurements. The aim of this study was to determine whether symmetry of the maximum medial and lateral gaps in extension and flexion was predictive of knee balance in extension and flexion respectively using different maximum thresholds of intercompartmental load difference (ICLD) to define balance. Methods A prospective cohort study of 165 patients undergoing functionally-aligned TKA was performed (176 TKAs). With trial components in situ, medial and lateral extension and flexion gaps were measured using robotic navigation while applying valgus and varus forces. The ICLD between medial and lateral compartments was measured in extension and flexion with the load sensor. The null hypothesis was that stressed gap symmetry would not correlate directly with sensor-defined soft tissue balance. Results In TKAs with a stressed medial-lateral gap difference of ≤1 mm, 147 (89%) had an ICLD of ≤15 lb in extension, and 112 (84%) had an ICLD of ≤ 15 lb in flexion; 157 (95%) had an ICLD ≤ 30 lb in extension, and 126 (94%) had an ICLD ≤ 30 lb in flexion; and 165 (100%) had an ICLD ≤ 60 lb in extension, and 133 (99%) had an ICLD ≤ 60 lb in flexion. With a 0 mm difference between the medial and lateral stressed gaps, 103 (91%) of TKA had an ICLD ≤ 15 lb in extension, decreasing to 155 (88%) when the difference between the medial and lateral stressed extension gaps increased to ± 3 mm. In flexion, 47 (77%) had an ICLD ≤ 15 lb with a medial-lateral gap difference of 0 mm, increasing to 147 (84%) at ± 3 mm. Conclusion This study found a strong relationship between intercompartmental loads and gap symmetry in extension and flexion measured with prostheses in situ. The results suggest that ICLD and medial-lateral gap difference provide similar assessment of soft-tissue balance in robotic arm-assisted TKA. Cite this article: Bone Jt Open 2021;2(11):974–980.

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.

scholarly journals Robotic Arm Assisted Total Knee Arthroplasty: Addressing 1-12 Degrees Valgus Knees

10.29007/wrvx ◽  
2019 ◽  
Author(s):  
Jingwei Zhang ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Caitlin Condrey ◽  
Kevin Marchand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Womac Pain ◽  
Case Review ◽  
Retrospective Case ◽  
Soft Tissue Envelope ◽  
Patient Reported ◽  
Total Knee

The purpose of this work was to determine the number of soft tissue releases and component orientation of valgus cases performed with Robotic-Arm Assisted total knee arthroplasty (RATKA).This study was a retrospective chart review of cases performed by a single surgeon from July 2016 to December 2017. 72 RATKA cases were defined as having a valgus deformity pre-operatively. Patient demographics and intraoperative surgical details were collected, including initial and final 3D component alignment, knee balancing gaps, full or partial releases. Post- operatively, radiographs, adverse events, and reduced WOMAC pain and KOOS Jr scores were collected at 6 months post-operatively.Pre-operatively, knee deformities ranged from 1o to 12° with fixed flexion contracture. All knees were corrected within 2.5 degrees of mechanical neutral. Medial and lateral gaps were balanced in extension 100% of cases and flexion 93% of cases.Radiographic evidence suggested well seated and well-fixed components. No revision and re- operation is reported. Patient reported outcomes measures collected at 6-month follow up indicated an improvement in WOMAC pain score from 9.6 to 3.2 and improvement in KOOS Jr from 44.7 to 74.4 points.In this retrospective case review, soft tissue releases were not needed to address valgus knees ranging from 1-12° of deformity. The surgeon was able to balance the knee with bone resections and avoid disturbing the soft tissue envelope. While this study has a number of limitations, RATKA for valgus knees should continue to be investigated in a multicenter study.

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