scholarly journals Robotic Assisted Total Knee Arthroplasty in Presence of Extra-Articular Deformity

10.29007/t61k ◽  
2019 ◽  
Author(s):  
Nipun Sodhi ◽  
Anton Khlopas ◽  
Joseph Ehiorobo ◽  
Caitlin Condrey ◽  
Robert Marchand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Fracture ◽  
Surgical Techniques ◽  
Robotic Arm ◽  
Operative Outcomes ◽  
Fracture Nonunion ◽  
Plateau Fracture ◽  
Total Knee ◽  
Complex Cases

Introduction:There is a lack of data concerning the use of the robotic device for patients with other potentially complex surgical factors. Therefore, the purpose of this series was to present cases in which the robotic-arm assisted TKA (RATKA) application was used in the setting of extra-articular deformities to educate the surgeon community on this potentially useful method to address these complex cases.Methods:Three cases of patients who underwent RATKA in the setting of pre-operative extra-articular deformities were identified. One had femoral and tibial fracture malunion, another had proximal tibial fracture nonunion, and another with a healed tibial plateau fracture. Patient clinical histories, intra-operative surgical techniques, and post-operative outcomes were obtained. Specific focus was placed on the surgical management of the patient’s pre-existing deformity.Results:The robotic software was able to appropriately consider the extra-articular deformity in the pre-operative and real-time updated intra-operative plans. Doing so, the surgeon achieved a balanced and aligned TKA. No intra-operative or post-operative complications occurred. Antero-posterior and lateral radiographs demonstrated well fixed and aligned femoral and tibial components with no signs of loosening or osteolysis. On physical exam, all patients had excellent range of motion with mean flexion of 122 degrees (range: 120 to 125 degrees of flexion) at final follow-up.Discussion:Utilizing pre-operative CT-scans with a 3D plan for robotic-arm assisted surgery allowed for appropriate assessment of the deformity pre-operatively and execution of a plan for a balanced and aligned total knee arthroplasty. We have demonstrated excellent results utilizing robotic-arm assisted TKA in these complex cases.

scholarly journals Interesting Cases in Robotic-Arm Assisted Total Knee Arthroplasty

10.29007/fxxg ◽  
2019 ◽  
Author(s):  
Luke Garbarino ◽  
Nipun Sodhi ◽  
Joseph Ehiorobo ◽  
Peter Gold ◽  
Kevin Marchand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Case Series ◽  
Clinical History ◽  
Robotic Arm ◽  
Preoperative Ct ◽  
Plateau Fracture ◽  
Physical Examinations ◽  
Total Knee

Introduction:Robotic-arm assisted surgery allows for the execution of well-aligned knee arthroplasty regardless of pre-existing deformity. This case series is presented to show the utility of robotic-arm assisted TKA in achieving well-balanced, well-aligned results in a variety of challenging scenarios.Methods:We present seven challenging cases of robotic-arm assisted total knee arthroplasty. There were two conversion TKAs following a previous surgery. One case featured a previous tibial plateau fracture treated with a plate and screws construct while another featured a prior femoral nail with significant bony overgrowth. Five cases of severe deformity were also identified, with one tibial nonunion, two valgus knees and one patient with two varus knees due psoriatic arthritis treated with staged bilateral TKAs. Patient clinical history, physical examinations, intraoperative surgical techniques and postoperative courses were recorded.Results:All cases were able to utilize effective preoperative planning to obtain precise intraoperative bone cuts and component positioning. Each of the seven cases achieved well-balanced, well-aligned arthroplasties. There were no intraoperative or postoperative complications. At latest follow up, all patients showed significant improvements in pain and ambulation compared to preoperative exams.Discussion:Robotic-arm assisted surgery allows for the integration of preoperative CT scans to establish and execute a surgical plan with precision. Despite the complexity of these cases, excellent results were achieved without the need for revision-type components. These cases display the ability of robotic-arm assisted surgery to achieve consistent well-aligned results with minimal bone loss in challenging total knee arthroplasty cases.

scholarly journals Management and results in periprosthetic tibial fracture after total knee arthroplasty: Two-center 15-case retrospective series at 2 years’ follow-up

2020 ◽  
Vol 106 (3) ◽  
pp. 449-458
Author(s):  
Camille Bauer ◽  
Bogdan Zaharia ◽  
Florent Galliot ◽  
Jauffrey Parot ◽  
Fayçal Houfani ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Fracture ◽  
Total Knee

scholarly journals Medial abrasion syndrome: a neglected cause of persistent pain after knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shaw-Ruey Lyu ◽  
Chia-Chen Hsu ◽  
Jung-Pin Hung
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Techniques ◽  
Varus Deformity ◽  
Outcome Study ◽  
Primary Arthroplasty ◽  
Post Operative Pain ◽  
Plateau Fracture ◽  
Advanced Stages ◽  
Total Knee ◽  
Medial Release

Abstract Introduction Persistent post-operative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty. The surgical techniques and outcomes of incorporating this concept into the management of both primary arthroplasty cases and patients suffering from unknown causes of PPOP after arthroplasties were presented. Materials and methods In a 1-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated medial abrasion phenomenon (MAP) on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasties were referred to the author for the arthroscopic medial release procedure (the AMR group) after being diagnosed as MAS. Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study. Results All 166 patients were followed for more than 3 years (mean 3.7 years, 3.1–4.2) for the outcome study. All knees receiving arthroplasty showed medial plicae with MAP at the time of surgery. Only 2 of them suffered from PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA, and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society Scores and all subscales of KOOS were statistically improved in all groups. Conclusions MAS is a cause of pain in patients who have received knee arthroplasties, and MAP should be eliminated to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.

scholarly journals Correction to: Robotic‑arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta‑analysis

2021 ◽  
Author(s):  
Junren Zhang ◽  
Wofhatwa Solomon Ndou ◽  
Nathan Ng ◽  
Paul Gaston ◽  
Philip M. Simpson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Meta Analysis ◽  
Robotic Arm ◽  
Patient Reported ◽  
Total Knee ◽  
Improved Accuracy

A correction to this paper has been published: https://doi.org/10.1007/s00167-021-06522-x

The Epidemiology of Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
John M. Tarazi ◽  
Zhongming Chen ◽  
Giles R. Scuderi ◽  
Michael A. Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Polyethylene Wear ◽  
Failure Mechanisms ◽  
Surgical Techniques ◽  
Index Procedure ◽  
Total Knee ◽  
Modern Era ◽  
Causes Of Failure

AbstractWith an expected increase in total knee arthroplasty (TKA) procedures, revision TKA (rTKA) procedures continue to be a burden on the United States health care system. The evolution of surgical techniques and prosthetic designs has, however, provided a paradigm shift in the etiology of failure mechanisms of TKA. This review can shed light on the current reasons for revision, which may lead to insights on how to improve outcomes and lower future revision risks. We will primarily focus on the epidemiology of rTKA in the present time, but we will also review this in the context of various time periods to see how the field has evolved. We will review rTKAs: 1) prior to 1997; 2) between 1997 and 2000; 3) between 2000 and 2012; and 3) in the modern era since 2012. We will further subdivide each of the sections into reasons for early (first 2 years after index procedure) versus late revisions (greater than 2 years after index procedure). In doing so, it was determined that prior to 1997, the most prevalent causes of failure were infection, patella failure, polyethylene wear, and aseptic loosening. After a major shift of failure mechanisms was described by Sharkey et al, polyethylene wear and aseptic loosening became the leading causes for revision. However, with the improved manufacturing technology and implant design, polyethylene wear was replaced with aseptic loosening and infection as the leading causes of failure between 2000 and 2012. Since that time, in the modern era of TKA, mechanical loosening and infection have taken over the most prevalent causes for failure. Hopefully, with continued developments in component design and surgical techniques, as well as increased focus on infection reduction methods, the amount of rTKA procedures will decline.

scholarly journals Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial

2020 ◽  
Vol 102-B (11) ◽  
pp. 1511-1518
Author(s):  
Matthew S. Banger ◽  
William D. Johnston ◽  
Nima Razii ◽  
James Doonan ◽  
Philip J. Rowe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Controlled Trial ◽  
Robotic Arm ◽  
Randomized Controlled ◽  
Unicompartmental Knee ◽  
Postoperative Changes ◽  
Total Knee

Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511–1518.

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