Concepts and techniques of a new robotically assisted technique for total knee arthroplasty: the ROSA knee system

Abstract

IntroductionThe ROSA (Robotic Surgical Assistant) Knee system (Zimmer Biomet, Warsaw, IN) for total knee arthroplasty (TKA) can be considered as collaborative robotics, where the surgeon remains in charge of the procedure and collaborates with a smart robotic tool, to perform the surgery with a high accuracy and reproducibility. The aim was to describe: (1) its concept and surgical technique; (2) its advantages and potential limits; (3) the early experience with this system. Materials and methods The goal during its development phase was to keep the surgeon active and at the center of the opera-tion: the surgeon handles the saw and performs the cuts while the robotic arm places and holds the guide at the right place. The ROSA knee platform assists the surgeon for the distal femoral cut, the femoral component sizing and positioning, the tibial cut and the ligament balance. This robotic system has two options: image-based with 3D virtual model; or image-less, based on intraoperative landmarks acquisition. All the classic surgical techniques can be used: measured resection, gap balancing, functional alignment, kinematic alignment. Some techniques recently developed are more ROSA-specific: Robotic personalized TKA, ROSA-FuZion technique. Results Its advantages as compared to other available systems include: radiographs in standing position, collaborative robotic system where the robot completes the surgeon skills, "off-the-shelf" implants, predictive robotic with concept of machine learning incorporated into the system. Two cadaveric studies have reported the high accuracy and reproducibility of this device. This robotic system is recent and currently no clinical series has enough follow-up to report clinical outcomes. Conclusion The ROSA knee system is a robotically assisted semi-autonomous surgical system with some specific characteristics. The aim of this collaborative robotic system is to improve the accuracy and reliability of the bone resections and the ligament balancing, without replacing the steps well performed by the surgeon.

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

“…The robot-assisted system is a new technology which uses computed tomography (CT) data of patients’ lower limb to make a preoperative plan and three -dimensional planning to orientate and size and uses the robotic arm to cut the bone and place for components [ 23 , 24 ]. Several robotic-assisted TKA systems, including CASPAR, Tsolution, ROSA, ROBODOC and Mako, have been implemented into clinical application [ [25] , [26] , [27] , [28] ]. Previous studies showed that robotic-assisted TKA can offer more accurate bone cuts, precise placement of implants and provide balanced extension and flexion gaps [ 29 , 30 ].…”

Introduction of ROSA robotic-arm system for total knee arthroplasty is associated with a minimal learning curve for operative time

“…In this study, there was no difference in operative times in ROSA TKA compared to those with a conventional jig-based TKA. In theory, RA TKA surgery should allow a more streamlined surgical approach by decreasing the need for alignment guides and cutting blocks and reducing the need for implant trialling [ 2 , 21 , 27 ]. Other studies with different RA TKA systems have found no difference between RA TKA and jig-based TKA after an initial learning phase [ 19 , 31 ].…”

“…The ROSA® (Robotic Surgical Assistant) Knee system (Zimmer Biomet, Warsaw, Indiana, USA) for TKA was recently introduced. ROSA can be considered collaborative robotics, where the surgeon remains in charge of the procedure but collaborates with a smart robotic tool to perform the surgery with high accuracy and reproducibility [ 2 , 21 , 22 ]. The advantages of ROSA compared with other RA TKA include: requiring only radiographs for pre-operative planning, a collaborative robotic system where the robot completes the surgeon skills, and predictive robotics with machine learning incorporated into the system [ 2 , 13 ].…”

“…We hypothesised that: [ 1 ] cumulative experience with ROSA TKA would lead to improved operative times; [ 2 ] surgeon’s learning curve would be more variable and longer than previously been reported in the current literature; and [ 3 ] the introduction of the ROSA TKA system would be associated with higher rates of robot-related complications including pin site infection and fractures.…”

The use and future perspective of Artificial Intelligence—A survey among German surgeons

“…The use of autonomous surgical robots, which independently perform surgical procedures on humans by means of AI-controlled systems, remains a vision at the present time ( 17 , 18 ). Some surgical fields, such as orthopedic surgery, have shown promising advances in the use of robotic devices for specific tasks: Active robotic devices can help perform more precise bone cuts for total knee arhtroplasty using preoperative CT imagery with very good results ( 19 – 21 ).…”