New Technologies in Knee Arthroplasty: Current Concepts

Abstract

Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.

The Effect of the COVID-19 Pandemic on Total Hip and Knee Arthroplasty Surgical Volume in 2020 in Poland

“…Total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been proven as the [1] methods of choice in the treatment of end-stage hip or knee pathologies [2][3][4][5]. Improvement in biomaterials, surgical techniques and implant designs has been the reason for more indications for THA and TKA [1,3,4,[6][7][8][9].…”

Potential New Treatments for Knee OA: A Prospective Review of Registered Trials

“…Current designs have matured over many years with minor adjustments. They produce 90-95% survival at 15-20% and good clinical outcomes measured by patient reported outcomes for the majority of the patients (approximately 85%) [15][16][17]. The multi radius was introduced many years ago and aims to restore the natural "J" shape of the femoral condyles.…”

“…The primary prosthetic implants are stabilized by the knee's envelope of ligaments and mobilized by the extensor mechanism. Accurate positioning of the implant will lead to improved function and longer survival [7,9,17]. Classic systems use anatomic guides and surgeon experience.…”

“…Navigation and patient specific cutting guides were later introduced but failed to prove their utility. We now can use 3D preoperative planning, integrate it together with intraoperative mapping of the bone contours and have the surgeons assisted by a robotic arm to make the bone cuts and establish ligamentous balance [9,17]. Several points have impaired the expansion of robotic surgery in knee arthroplasty.…”

“…Robotics are at the beginning but have not significantly improved these numbers. They may improve rotational and coronal alignment but with added hassle of having the cumbersome robot in the room, maybe a technician, additional steps for referencing the robot to the patient and most importantly added costs [17,[21][22][23].…”