Image-free robotic arm assisted total knee arthroplasty

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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Robotic Arm-Assisted Total Knee Arthroplasty in the Setting of Combined Extra-articular Deformities of the Femur and Tibia

Case Reports in Orthopedics ◽

10.1155/2020/5489646 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Sharma Cook-Richardson ◽

Rasesh Desai

Keyword(s):

Total Knee Arthroplasty ◽

Surgical Treatment ◽

Treatment Option ◽

Knee Arthroplasty ◽

Mechanical Axis ◽

Robotic Arm ◽

Implant Positioning ◽

Total Knee ◽

Anatomical Axis ◽

Bone Deformities

In this case, we will describe a 68-year-old man with combined femoral and tibial bone deformities who underwent robotic arm-assisted total knee arthroplasty (RATKA) to treat his severe osteoarthritis in the setting of extra-articular deformities that altered the native anatomical axis and the kinematics of the deformed extra-articular bony structures which chronically generated a neomechanical axis. The combination of severe osteoarthritis with extra-articular deformities made the RATKA method the best surgical treatment option taking into account altered kinematics of the native joint which conventional jig-based total knee arthroplasty would not have prioritized during bony cuts and implant positioning. The patient underwent successful knee arthroplasty with robotic arm-assisted technology with restoration of the mechanical axis.

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Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes—A Single Surgeon Experience

The Journal of Knee Surgery ◽

10.1055/s-0040-1712984 ◽

2020 ◽

Author(s):

Connor A. King ◽

Mark Jordan ◽

Alexander T. Bradley ◽

Caroline Wlodarski ◽

Alexander Tauchen ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Emergency Department Visits ◽

Robotic Arm ◽

Robotic Assistance ◽

Procedure Time ◽

Short Term ◽

Total Knee

Abstract Background This study sought to evaluate the patient experience and short-term clinical outcomes associated with the hospital stay of patients who underwent robotic arm-assisted total knee arthroplasty (TKA). These results were compared with a cohort of patients who underwent TKA without robotic assistance performed by the same surgeon prior to the introduction of this technology. Materials and Methods A cohort of consecutive patients undergoing primary TKA for the diagnosis of osteoarthritis by a single fellowship trained orthopaedic surgeon over a 39-month period was identified. Patients who underwent TKA during the year that this surgeon transitioned his entire knee arthroplasty practice to robotic assistance were excluded to eliminate selection bias and control for the learning curve. All patients received the same prosthesis and postoperative pain protocol. Patients that required intubation for failed spinal anesthetic were excluded. A final population of 492 TKAs was identified. Of these, 290 underwent TKA without robotic assistance and 202 underwent robotic arm-assisted TKA. Patient demographic characteristics and short-term clinical data were analyzed. Results Robotic arm-assisted TKA was associated with shorter length of stay (2.3 vs. 2.6 days, p < 0.001), a 50% reduction in morphine milligram equivalent utilization (from 214 to 103, p < 0.001), and a mean increase in procedure time of 9.3 minutes (p < 0.001). There was one superficial infection in the nonrobotic cohort and there were no deep postoperative infections in either cohort. There were no manipulations under anesthesia in the robotic cohort while there were six in the nonrobotic cohort. Additionally, there were no significant differences in emergency department visits, readmissions, or return to the operating room. Conclusion This analysis corroborates existing literature suggesting that robotic arm-assisted TKA can be correlated with improved short-term clinical outcomes. This study reports on a single surgeon's experience with regard to analgesic requirements, length of stay, pain scores, and procedure time following a complete transition to robotic arm-assisted TKA. These results underscore the importance of continued evaluation of clinical outcomes as robotic arthroplasty technology continues to grow.

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A prospective double-blinded randomised control trial comparing robotic arm-assisted functionally aligned total knee arthroplasty versus robotic arm-assisted mechanically aligned total knee arthroplasty

Trials ◽

10.1186/s13063-020-4123-8 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Babar Kayani ◽

Sujith Konan ◽

Jenni Tahmassebi ◽

Sam Oussedik ◽

Peter D. Moriarty ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Robotic Arm ◽

Randomised Control Trial ◽

Total Knee ◽

Double Blinded

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Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation

The Journal of Knee Surgery ◽

10.1055/s-0037-1607450 ◽

2017 ◽

Vol 30 (09) ◽

pp. 849-853 ◽

Cited By ~ 26

Author(s):

Robert Marchand ◽

Nipun Sodhi ◽

Anton Khlopas ◽

Assem Sultan ◽

Steven Harwin ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Physical Function ◽

Knee Arthroplasty ◽

Robotic Arm ◽

Short Term ◽

Patient Satisfaction Score ◽

Total Patient ◽

Total Knee ◽

The Mean

AbstractRobotic arm-assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In today's health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high-volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Student's t-tests. A p-value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short-term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short-term outcomes when compared with patients who undergo manual TKA.

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

Expert Review of Medical Devices ◽

10.1080/17434440.2017.1392237 ◽

2017 ◽

Vol 14 (12) ◽

pp. 925-927 ◽

Cited By ~ 10

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

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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.

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