Initial Experience with the NAVIO Robotic-Assisted Total Knee Replacement—Coronal Alignment Accuracy and the Learning Curve

Abstract

One of the primary aim of total knee arthroplasty (TKA) is restoration of the mechanical axis of the lower limb. Maintenance of the mechanical axis within 3 degrees of neutral has been shown to result in improved clinical results and implant longevity. The aim of this study was to investigate the efficacy of this robotic-assisted system in coronal plane component positioning in TKA. We also describe the learning curve associated with adoption of this technology. A total of 72 total knee replacements were completed between November 2017 and September 2018 by a single surgeon using the robotic-assisted surgery (RAS) system. Cases were recorded from the time the study surgeon first adopted this technology and represent the “learning curve.” Pre- and postoperative coronal weight-bearing alignments were measured and intraoperative robotic-assisted registration data and duration of use were collected. Of the 72 TKAs in this series, 93.3% were corrected to the desired alignment of within 3 degrees of neutral. The knees that were not corrected to neutral had a mean preoperative alignment of 11.57 degrees of deformity as compared with 4.29 degrees for those that were corrected to neutral. A learning curve effect during adoption of this new technology was not found when analyzing RAS usage time. The RAS system produced accurate coronal alignment in TKA in more than 93% of cases with no learning curve effect. Our study suggests that this system is easily adopted, safe, and accurate.

A new robotically assisted system for total knee arthroplasty: A sheep model study

“…Collins et al. demonstrated that the NAVIO robotic‐assisted system could achieve accurate coronal alignment without learning curve effect 29 . Sires et al.…”

“…18 Collins et al demonstrated that the NAVIO robotic-assisted system could achieve accurate coronal alignment without learning curve effect. 29 Sires et al showed that MAKO robotic-assisted TKA system could improve bone resection accuracy. 30 Recently, Shaw et al 31 reported that robotic-assisted TKA showed comparable minimal clinically important difference to manual TKA in a larger cohort.…”

Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives

“…Robotic-assisted technique has proven reliable in improving the accuracy for component positioning and limb alignment compared to the conventional manual technique. [7][8][9]11,12,14,[16][17][18][19][20][21][22][23][24][25][26] Despite different alignment philosophies have been recently proposed, mechanical alignment (MA) remains the most frequently adopted and still considered the "safe-zone". 27 Target for MA have been typically considered within a cut-off of 2-3° from the neutral MA in the coronal plane, while errors >3° have been usually considered as radiographic outliers.…”

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

“…A new robotically assisted system for TKA (ROSA knee System; Zimmer Biomet; Warsaw, IN) has been recently introduced. The previous systems available in the market were either active: the surgeon sets the robotic arm close to the patient and then the robot autonomously performs the surgery [5][6][7][8], or haptic: the surgeon pushes the "Go Button" but the robot keeps the instrument within pre-determined boundaries [9][10][11][12][13][14]. During the last decade, these systems have shown their accuracy and safety, but they also have some limits in terms of usability, as the movements of the surgeon are constrained on a predefined surface.…”