Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

Abstract

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

Robotic Total Knee Arthroplasty vs Conventional Total Knee Arthroplasty: A Nationwide Database Study

“…Since the implementation of robot-assisted TKA, several studies have shown an improvement in alignment and precision with robotics; however, this was not shown to have a measurable effect in the short-term period despite no outliers in alignment in the robotic group and a range of 19%-24% of outliers in the conventional group [ 30 , 32 , 33 ]. There are advances with robotic arm–assisted surgery that have demonstrated less soft-tissue damage with saw precision [ 47 ], and balancing sensors being available on these platforms may allow for more surgeon feedback. There is also a potential confounding factor that low-volume total knee surgeons may not have the skill with conventional instrumentation as a high-volume fellowship-trained surgeon, such that previous studies performed by high-volume fellowship-trained surgeons comparing short-term results may not reflect the entire population of surgeons as well as a large database may capture.…”

Use of Fulcrum Positioning as a Balancing Tool During Total Knee Arthroplasty on a Robotic Platform

“…MAKO robotic arm–assisted surgery has demonstrated some advantages over conventional instrumentation, particularly in a reduction of soft tissue damage from the haptically bounded saw blade [ 18 ]. Early data have also demonstrated an improved accuracy of component placement and limb alignment compared with conventional techniques [ 19 ], although long-term data on survivorship have not yet been established.…”

The Effect of the PCL on Kinematics as it Relates to Soft-Tissue Preservation from Robotic-Arm Assisted Surgery

“…The cadaveric study from Hampp et al looking at soft tissue preservation in MTKA and hRATKA noted the stereotactic boundary constraint on the sawblade may help prevent soft tissue damage [4]. While many other robotic systems use cutting blocks or similar methods, new TKA robotic system applications that are haptic-based-such as the application used in Hampp et al [4]-help protect the PCL. Learning more about the effect of the PCL on knee kinematics highlights the advantages of using hRATKA to preserve physiological motion.…”

“…With computer assisted orthopaedic surgery, there are opportunities to preserve soft tissue in total knee arthroplasty (TKA). Hampp et al compared the soft tissue damage between manual total knee arthroplasty (MTKA) and haptic-based robotic-arm assisted total knee arthroplasty (hRATKA) in a cadaveric study and found that the hRATKA specimens had significantly less damage than the MTKA specimens [4]. This was particularly true for the posterior cruciate ligament (PCL) [4].…”

“…Hampp et al compared the soft tissue damage between manual total knee arthroplasty (MTKA) and haptic-based robotic-arm assisted total knee arthroplasty (hRATKA) in a cadaveric study and found that the hRATKA specimens had significantly less damage than the MTKA specimens [4]. This was particularly true for the posterior cruciate ligament (PCL) [4]. The PCL is the primary restraint to posterior translation of the tibia and plays a role in joint compression [2].…”