Abstract
Background: Intraoperative surgical planning tools (ISPTs) used in current-generation robotic arm-assisted total knee arthroplasty (RTKA) systems (such as Navio® and MAKO®) involve employment of postoperative passive joint balancing. This results in improper ligament tension, which may negatively impact joint stability, which, in turn, may adversely affect patient function after TKA. Methods: A simulation-enhanced ISPT (SEISPT) that provides insights relating to postoperative active joint mechanics was developed. This involved four steps: 1) validation of a multi-body musculoskeletal model; 2) optimization of the validated model; 3) use of the validated and optimized model to derive knee performance equations (KPEs), which are equations that relate implant component characteristics to implant component biomechanical responses; and 4) optimization of the KPEs with respect to these responses. In a proof-of-concept study, KPEs that involved two com- ponent biomechanical responses that have been shown to strongly correlate with poor proprioception (a common patient complaint post-TKA) were used to calculate optimal positions and orientations of the femoral and tibial components in the TKA design implanted in one subject (as reported in a publicly-available dataset). Results: The differences between the calculated implant positions and orientations and the corresponding achieved values for the implant components in the subject were not similar to component position and orientation errors reported in biomechanical literature studies involving Navio® and MAKO®. Also, we indicate how SEISPT could be incorporated into the surgical workflow of Navio® with minimal disruption and increase in cost. Conclusion: SEISPT is a plausible alternative to current-gen- eration ISPTs.
Highlights
Total knee arthroplasty (TKA) is the most widely used surgical option for treatment/management of end-stage osteoarthritis [1] [2]
The knee performance equations” (KPEs) developed in the present study focused on outputs/responses that could have a possible effect on proprioception, leading to 11 input factors and 9 outcomes/responses (Table 1 and Table 2)
In the proof-of-concept study, the determined optimal positions and orientations of the femoral and tibial components of the TKA design implanted in Subject PS (“conceptual active surgical plan values”) are given in Table 3, together with the actual positions and orientations of the implant components in the TKA implanted in that subject (“achieved passive surgical values”)
Summary
Total knee arthroplasty (TKA) is the most widely used surgical option for treatment/management of end-stage osteoarthritis [1] [2]. Intraoperative surgical planning tools (ISPTs) used in current-generation robotic arm-assisted total knee arthroplasty (RTKA) systems (such as Navio® and MAKO®) involve employment of postoperative passive joint balancing. This results in improper ligament tension, which may negatively impact joint stability, which, in turn, may adversely affect patient function after TKA. Methods: A simulation-enhanced ISPT (SEISPT) that provides insights relating to postoperative active joint mechanics was developed This involved four steps: 1) validation of a multi-body musculoskeletal model; 2) optimization of the validated model; 3) use of the validated and optimized model to derive knee performance equations (KPEs), which are equations that relate implant component characteristics to implant component biomechanical responses; and 4) optimization of the KPEs with respect to these responses. Conclusion: SEISPT is a plausible alternative to current-generation ISPTs
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