Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

Pietrzak, J; Rowan, Fiachra; Kayani, Babar; Donaldson, Matthew J; Huq, S.; Haddad, Fares S.

doi:10.1055/s-0038-1666829

Cited by 36 publications

(30 citation statements)

References 40 publications

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“…22 Computed tomography is also examined for preoperative planning, in which 3D reconstructions were superior over 2D conventional radiographs to determine preoperative TKA implant size. 23 The width of the foot can change after adulthood secondary to hallux valgus or other pathology or deformity of the foot. This could bias our results.…”

Section: Discussionmentioning

confidence: 99%

The Correlation of Shoe Size and Component Size of Primary Total Knee Arthroplasty

et al. 2019

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Preoperative planning is an important phase of total joint arthroplasty. Current template programs and methods only provide moderate accuracy for implant size prediction. Recently, a relationship between shoe size and implant size was found. We hypothesized that shoe size shows a high percentage of agreement for implant size of both femoral and tibial component size in primary total knee arthroplasty (TKA). The aim of this study was to investigate the correlation and agreement between shoe size and TKA implant size. We performed a retrospective cohort study. Of all patients, who underwent primary TKA between September 2013 and March 2016, shoe size and knee implant sizes were collected. Cross-tabulation was used to determine the correlation and agreement between shoe size and implant size. A total of 489 patients (498 TKA) were included. The correlation coefficient for femoral and tibial component with shoe size was 0.751 and 0.759, respectively. When a deviation of ± 1 component size was allowed, shoe size gave at least 94% agreement score for femoral component and at least 86% agreement score in tibial component. We conclude that both femoral and tibial component size have a good correlation with shoe size. Therefore, shoe size may be used as a valuable predictor in preoperative implant size planning for primary TKA. The level of evidence for this study was Level IV.

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Section: Discussionmentioning

confidence: 99%

The Correlation of Shoe Size and Component Size of Primary Total Knee Arthroplasty

et al. 2019

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“…While custom cutting guides offer theoretical advantages, the majority of mid-to-long-term studies assessing their efficacy have demonstrated nonsuperiority [20][21][22][23][24][25][26] . Although the true value and cost-effectiveness of robotic technology have been debated, the use of robotic-arm assistance has demonstrated superiority to patient-specific instrumentation 27 and has shown the ability to improve TKA alignment in multiple studies 19,[28][29][30][31][32] . The findings of the current study, especially if alignment outlier status is linked to increases in implant failure in follow-up studies, may justify the increased use of these technologies in the future.…”

Section: Multivariate Analysismentioning

confidence: 99%

“…As a result of the link between implant alignment outliers and early implant failure, efforts have been made to optimize alignment with the use of robotic navigation and patient-specific instrumentation [19][20][21][22][23][24][25][26][27][28][29][30][31][32] . However, little work has been conducted to identify the primary surgeon-specific factors that drive these outliers in order to understand the optimal patient populations in which to utilize this expensive technology.…”

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confidence: 99%

The Impact of Surgeon Volume and Training Status on Implant Alignment in Total Knee Arthroplasty

Kazarian

Lawrie

Barrack

et al. 2019

The Journal of Bone and Joint Surgery

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Background: Implant malalignment may predispose patients to prosthetic failure following total knee arthroplasty (TKA). A more thorough understanding of the surgeon-specific factors that contribute to implant malalignment following TKA may uncover actionable strategies for improving implant survival. The purpose of this study was to determine the impact of surgeon volume and training status on malalignment. Methods: In this retrospective multicenter study, we performed a radiographic analysis of 1,570 primary TKAs performed at 4 private academic and state-funded centers in the U.S. and U.K. Surgeons were categorized as high-volume (‡50 TKAs/ year) or low-volume (<50 TKAs/year), and as a trainee (fellow/resident under the supervision of an attending surgeon) or a non-trainee (attending surgeon). On the basis of these designations, 3 groups were defined: high-volume non-trainee, lowvolume non-trainee, and trainee. The postoperative medial distal femoral angle (DFA), medial proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured. Outlier measurements were defined as follows: DFA, outside of 5°± 3°of valgus; PTA, >±3°deviation from the neutral axis; and PSA, <0°or >7°of flexion for cruciate-retaining or <0°or >5°of flexion for posterior-stabilized TKAs. "Far outliers" were defined as measurements falling >± 2°outside of these ranges. The proportions of outliers were compared between the groups using univariate and multivariate analyses. Results: When comparing the high and low-volume non-trainee groups using univariate analysis, the proportions of knees with outlier measurements for the PTA (5.3% versus 17.4%) and PSA (17.4% versus 28.3%) and the proportion of total outliers (11.8% versus 20.7%) were significantly lower in the high-volume group (all p < 0.001). The proportions of DFA (1.9% versus 6.5%), PTA (1.8% versus 5.7%), PSA (5.5% versus 12.6%), and total far outliers (3.1% versus 8.3%) were also significantly lower in the high-volume non-trainee group (all p < 0.001). Compared with the trainee group, the high-volume non-trainee group had significantly lower proportions of DFA (12.6% versus 21.6%), PTA (5.3% versus 12.0%), PSA (17.4% versus 33.3%), and total outliers (11.8% versus 22.3%) (all p < 0.001) as well as DFA (1.9% versus 3.9%; p = 0.027), PSA (5.5% versus 12.6%; p < 0.001), and total far outliers (3.1% versus 6.4%; p = 0.004). No significant differences were identified when comparing the low-volume non-trainee group and the trainee group, with the exception of PTA outliers (17.4% versus 12.0%; p = 0.041) and PTA far outliers (5.7% versus 2.6%; p = 0.033). Findings from multivariate analysis accounting for the effects of patient age, body mass index, and individual surgeon demonstrated similar results. Conclusions: Low surgical volume and trainee status were risk factors for outlier and far-outlier malalignment in primary TKA, even when accounting for differences in individual surgeon and patient characteristics. Trainee surgeons performed similarly, and certa...

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“…Several studies have validated many of the goals that robotic arm assisted surgery set out to accomplish. Although the literature is in its infancy, key advantages of RTKA which have been supported by the literature include improved component positioning and restoration of limb mechanical axis, improved preoperative templating with computed tomography (CT) technology, and early improvements in short-term clinical outcomes compared to conventional instrumentation [5], [6], [7], [8], [9], [10], [11], [12], [13]. Several studies have also shown equal or improved safety compared to conventional instruments.…”

Section: Introductionmentioning

confidence: 99%

Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve

et al. 2019

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Robotic arm assisted total knee arthroplasty (RTKA) has many potential benefits including advanced preoperative templating, restoration of mechanical alignment, accuracy of bony resection, robust safety mechanisms, and dynamic gap balancing. One of the most frequently quoted drawbacks preventing experienced surgeons from adopting this technology is the perceived increase in surgical time. This technique paper outlines the general concepts used to improve operating room efficiency as well as the step-by-step workflow to consistently perform RTKA with surgical times under 60 minutes. Although the clinical and functional results of RTKA are just beginning to be described in literature, this manuscript demonstrates that with proper technique and workflow, surgical time should not be a significant factor to deter surgeons from adopting this new technology.

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Preoperative CT-Based Three-Dimensional Templating in Robot-Assisted Total Knee Arthroplasty More Accurately Predicts Implant Sizes than Two-Dimensional Templating

Cited by 36 publications

References 40 publications

The Correlation of Shoe Size and Component Size of Primary Total Knee Arthroplasty

The Correlation of Shoe Size and Component Size of Primary Total Knee Arthroplasty

The Impact of Surgeon Volume and Training Status on Implant Alignment in Total Knee Arthroplasty

Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve

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