Robotic total knee arthroplasty

Kayani, Babar; Haddad, Fares S.

doi:10.1302/2046-3758.810.bjr-2019-0175

Cited by 69 publications

(30 citation statements)

References 37 publications

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“… 7 , 8 , 15 , 16 Kinematic alignment aims to restore native prearthritic alignment, but previous intraoperative techniques for executing this alignment have been limited by poor accuracy and reproducibility, and the acceptable safe ranges for limb alignment remain uncertain. 17 - 21 Anatomical alignment aims to restore predisease limb alignment and bone geometry, but it remains unknown how this technique translates to long-term functional outcomes and implant survivorship. 9 , 22 More recently, functional alignment has been introduced as a technique for providing patient-specific limb alignment within the safe ranges of mechanical alignment but the results of high-quality studies with long-term outcomes are still awaited.…”

Section: Introductionmentioning

confidence: 99%

“…The recent evolution of robotic technology may offer an avenue for accurately executing KA while helping to record intraoperative flexion-extension gaps, mediolateral soft-tissue tension, and range of motion in future studies. 21 , 30 This technology enables improved precision for performing the planned bone resections, implant positioning and limb alignment, which may help to better define the safe ranges for limb alignment in TKA. Future studies should focus on the safe thresholds for executing patient-specific alignment and restoring individualized knee biomechanics to optimize functional outcomes, while respecting the boundaries for mechanical alignment to preserve long-term implant durability.…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 22 In order to overcome this, several studies on AA in TKA have used robotic technology to accurately execute the planned bone resections and limb alignment. 21 , 30 , 54 …”

Section: Introductionmentioning

confidence: 99%

“…Computer software is used to virtually adjust the component positions with potential changes in limb alignment, flexion-extension gaps, and range of motion displayed on-screen. 21 , 30 , 51 , 53 , 54 Valgus correction may be applied to the distal femoral resection and varus correction to the tibial resection to restore the native obliquity of the joint line. The joint line height is preserved which increases knee flexion, aids patella tracking, and improves mid-flexion stability.…”

Section: Introductionmentioning

confidence: 99%

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Current concepts in total knee arthroplasty

et al. 2021

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Limb alignment in total knee arthroplasty (TKA) influences periarticular soft-tissue tension, biomechanics through knee flexion, and implant survival. Despite this, there is no uniform consensus on the optimal alignment technique for TKA. Neutral mechanical alignment facilitates knee flexion and symmetrical component wear but forces the limb into an unnatural position that alters native knee kinematics through the arc of knee flexion. Kinematic alignment aims to restore native limb alignment, but the safe ranges with this technique remain uncertain and the effects of this alignment technique on component survivorship remain unknown. Anatomical alignment aims to restore predisease limb alignment and knee geometry, but existing studies using this technique are based on cadaveric specimens or clinical trials with limited follow-up times. Functional alignment aims to restore the native plane and obliquity of the joint by manipulating implant positioning while limiting soft tissue releases, but the results of high-quality studies with long-term outcomes are still awaited. The drawbacks of existing studies on alignment include the use of surgical techniques with limited accuracy and reproducibility of achieving the planned alignment, poor correlation of intraoperative data to long-term functional outcomes and implant survivorship, and a paucity of studies on the safe ranges of limb alignment. Further studies on alignment in TKA should use surgical adjuncts (e.g. robotic technology) to help execute the planned alignment with improved accuracy, include intraoperative assessments of knee biomechanics and periarticular soft-tissue tension, and correlate alignment to long-term functional outcomes and survivorship.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 9 , 22 In order to overcome this, several studies on AA in TKA have used robotic technology to accurately execute the planned bone resections and limb alignment. 21 , 30 , 54 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Current concepts in total knee arthroplasty

et al. 2021

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“…Robotics has entered the field in total knee arthroplasty. Various robotic systems have been available to orthopedic surgeons, dating back to the ACROBOT system in the late 1980s up to both image-based and image-less systems in the market today [ 9 ]. One particular system, using a haptic-guided robotic arm, offers the surgeon 3D planning with a preoperative computed tomography (CT) scan, with intra-operative modifications based on the surgeon’s dynamic assessment.…”

Section: Introductionmentioning

confidence: 99%

Achieving a Balanced Knee in Robotic TKA

Gordon

Conditt

Verstraete

2021

Sensors

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Total knee arthroplasty (TKA) surgery with manual instruments provides a quantitatively balanced knee in approximately 50% of cases. This study examined the effect of combining robotics technology with real-time intra-operative sensor feedback on the number of quantitatively balanced cases in a consecutive series of 200 robotic-assisted primary TKAs. The robotics platform was used to plan the implant component position using correctable poses in extension and a manual, centrally pivoting the balancer in flexion, prior to committing to the femoral cuts. During the initial trialing, the quantitative state of balance was assessed using an instrumented tibial tray that measured the intra-articular loads in the medial and lateral compartments. These sensor readings informed a number of surgical corrections, including bone recuts, soft-tissue corrections, and cement adjustments. During initial trialing, a quantitatively balanced knee was achieved in only 65% of cases. After performing the relevant soft-tissue corrections, bone recuts, and cement adjustments, 87% of cases ended balanced through the range of motion. Meanwhile, this resulted in a wide range of coronal alignment conditions, ranging from 6° valgus to 9° varus. It is therefore concluded that gaps derived from robotics navigation are not indicative for a quantitatively balanced knee, which was only consistently achieved when combining the robotics platform with real-time feedback from intra-operative load sensors.

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Robotic‐arm‐assisted lateral unicompartmental knee arthroplasty leads to high implant survival and patient satisfaction at mean 10‐year follow‐up

Ruderman,

Bayoumi,

ten Noever de Brauw

et al. 2024

Knee surg. sports traumatol. arthrosc.

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BackgroundThere is a lack of literature reporting on long‐term outcomes following robotic‐arm‐assisted lateral unicompartmental knee arthroplasty (UKA). This study assessed the long‐term survivorship, patient‐reported satisfaction and pain scores following robotic‐arm‐assisted lateral UKA for lateral compartment osteoarthritis (OA).MethodsA single surgeon's database was reviewed to identify all patients who underwent robotic‐arm‐assisted lateral UKA with a cemented, fixed‐bearing prosthesis prior to May 2015. Patients were contacted to determine implant survivorship, satisfaction and pain. Kaplan–Meier models were applied to analyse survival.ResultsA total of 77 knees (70 patients) with a mean follow‐up of 10.2 ± 1.5 years (range: 8.1–13.3) were included. Five knees were revised, corresponding to a 10‐year survivorship of 96.1% and estimated survival time of 12.7 ± 0.3 years (95% confidence interval: 12.2–13.2) with all‐cause revision as the endpoint. Unexplained pain (40.0%) and progression of OA (40.0%) in contralateral compartments were the most reported reasons for revision. Among patients without revision, 94.4% were either satisfied or very satisfied with their lateral UKA and the average pain score was 1.1.ConclusionRobotic‐arm‐assisted lateral UKA led to high implant survivorship and patient satisfaction, and low pain scores at long‐term follow‐up. Progression of OA in contralateral compartments and unexplained pain were the most frequent reasons for revision. These findings support the continued use of robotic‐arm‐assisted lateral UKA for lateral compartment OA; however, its clinical value over conventional techniques remains to be established in prospective comparative studies.Level of EvidenceTherapeutic Level IV.

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Robotic total knee arthroplasty

Cited by 69 publications

References 37 publications

Current concepts in total knee arthroplasty

Current concepts in total knee arthroplasty

Achieving a Balanced Knee in Robotic TKA

Robotic‐arm‐assisted lateral unicompartmental knee arthroplasty leads to high implant survival and patient satisfaction at mean 10‐year follow‐up

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