Clinical outcomes in TKA are enhanced by both robotic assistance and patient specific alignment: a comparative trial in 120 patients

Grave, Philip Winnock de; Kellens, Jonas; Tampere, Thomas; Vermue, Hannes; Luyckx, Thomas; Claeys, Kurt

doi:10.1007/s00402-022-04636-6

Cited by 12 publications

(8 citation statements)

References 34 publications

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“…A more anatomical knee reconstruction enhances soft‐tissue balance and minimizes the need for soft‐tissue release, thus better preserving native knee biomechanics [30]. The restoration of varus joint line obliquity leads to better clinical scores [37, 44]. These findings are consistent with our results indicating that patient‐reported outcomes were significantly better with iKA than aMA.…”

Section: Discussionsupporting

confidence: 87%

Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments

Grave

Criekinge

Luyckx

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Patient-speciic alignment in total knee arthroplasty (TKA) has shown promising patient-reported outcome measures; however, the clinical and biomechanical efects of restoring the native knee anatomy remain debated. The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment-aMA) and a patient-speciic alignment TKA cohort (inverse kinematic alignment-iKA). Methods At two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case-control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients' demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON). Data collection was conducted by a blinded investigator. The primary outcomes were knee lexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS). Results During walking, the maximum knee lexion did not difer between the iKA group (53.0°) and the control group (55.1°), whereas the aMA group showed lower amplitudes of sagittal motion (47.4°). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225 N mm/kg) compared to aMA group (276 N mm/kg). No signiicant diferences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs difered signiicantly between patients receiving aMA and healthy controls. The OKS was signiicantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; p = 0.05. The FJS was signiicantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; p = 0.002. Conclusion At two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 87%

Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments

Grave

Criekinge

Luyckx

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…The full-text version of the remaining 44 articles was assessed for eligibility; of these, 32 were excluded for the following reasons: 10 were not RCTs, 8 did not have data on the specified outcomes of interest, 8 were review articles, 3 included UKAs only, 2 did not have a control group, and 1 was not published in the English language. Ultimately, 12 RCTs 15-26 with a total of 2,591 patients with knee OA were included in the final analysis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty

Riantho,

Butarbutar,

Fidiasrianto

et al. 2023

JBJS Open Access

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Background: Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis.Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robotassisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA. Methods:We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models.Results: A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, 20.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups.Conclusions: Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles.

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“…KA relies solely on bone cuts to achieve alignment and seeks to maintain the knee’s ligamentous stability and kinematics. Knee balance is accomplished by modifying the tibial cut’s orientation [44]. In KA there are by definition no soft‐tissue releases and soft‐tissue malalignments are addressed through bone resection, aiming to preserve individual anatomy and potentially enhance functional and clinical outcomes [45, 46].…”

Section: Alignment Definitionsmentioning

confidence: 99%

“…In contrast, the inverse kinematic alignment (iKA) technique favors the restoration of tibial joint line obliquity as the initial step, followed by resections on the femur [44]. This process involves the restoration of the native tibial anatomy by precisely removing bone and cartilage from the medial and lateral tibial condyles, matching the thickness of the implant [44, 53]. Following the patient‐specific, anatomical tibial cut, the subsequent steps of the procedure remain identical to a conventional gap balancing technique.…”

Section: Alignment Definitionsmentioning

confidence: 99%

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Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) – there is no winner yet

Karasavvidis,

Pagan Moldenhauer,

Lustig

et al. 2023

J. exp. orthop.

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Dissatisfaction following total knee arthroplasty (TKA) has been extensively documented and it was attributed to numerous factors. In recent years, significant focus has been directed towards implant alignment and stability as potential causes and solutions to this issue. Surgeons are now exploring a more personalized approach to TKA, recognizing the importance of thoroughly understanding each individual patient’s anatomy and functional morphology. A more comprehensive preoperative analysis of alignment and knee morphology is essential to address the unresolved questions in knee arthroplasty effectively. The crucial task of determining the most appropriate alignment strategy for each patient arises, given the substantial variability in bone resection resulting from the interplay of phenotype and the alignment strategy chosen. This review aims to comprehensively present the definitions of different alignment techniques in all planes and discuss the consequences dependent on knee phenotypes.Level of evidence V.

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Clinical outcomes in TKA are enhanced by both robotic assistance and patient specific alignment: a comparative trial in 120 patients

Cited by 12 publications

References 34 publications

Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments

Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments

Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty

Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) – there is no winner yet

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