Abstract
BackgroundThe reliability of robotic arm-assisted total knee arthroplasty (RA-TKA) has been previously reported. In this study, we evaluated the predictive accuracy of the RA-TKA system in determining the required bone resection and implant size preoperatively and its effect on intraoperative decision-making.MethodsData on the outcomes of RA-TKA procedures performed in our department were prospectively collected. A three-dimensional model of the femur, tibia, and fibula was reconstructed using standard computed tomography (CT) images. The model was used preoperatively to predict bone required resection for the femur and tibia and implant size. Intraoperatively, the images were registered to the local anatomy to create a patient-specific model for decision-making, including real-time measurement of the medial-to-lateral difference in the extension/flexion gap and TKA component alignment. Differences between predicted and real bone resections and implant size were evaluated, and the post-TKA mechanical axis of the lower limb and difference in medial-to-lateral flexion/extension gap were measured.ResultsThe analysis was based on the data of 28 patients who underwent TKA to treat severe osteoarthritis. The RA-TKA system successfully predicted the femoral and tibial component within one implant size in 28/28 cases (100%). For the 168 bone resections performed, including both femoral and tibial cuts, the resection was within 1 mm of the predicted value in 120/168 (71%) of the cuts. The actual versus predicted bone resection was statistically different only for the lateral tibial plateau (p = 0.018). The medial-to-lateral gap difference was between − 1 and 1 mm, except in one case. The achieved lower limb alignment was accurate overall, with the alignment being within < 1.0° of the neutral mechanical axis in 13/28 cases (46%) and within < 3.0° in 28/28 cases (100%).ConclusionsThe RA-TKA system provided considerable pre- and intraoperative surgical assistance to achieve accurate bone resection, appropriate component sizing, and postoperative alignment after RA-TKA.
Highlights
Total knee arthroplasty (TKA) is the standard treatment for patients with end-stage knee disease, with the annual number of TKA procedures expected to increase to 1.26 million by 2030 in the USA alone [1]
Based on three-dimensional (3D) computed tomography (CT), the robotic arm-assisted system is designed to minimize the margin of error associated with bone resection and to provide real-time guidance for intraoperative TKA component positioning prior to final implantation
Femoral implant Tibial implant successfully predicted using the robotic arm-assisted total knee arthroplasty (RA-TKA) in 26/28 (93%) cases, with the size predicted within one implant size in all cases (100%)
Summary
Total knee arthroplasty (TKA) is the standard treatment for patients with end-stage knee disease, with the annual number of TKA procedures expected to increase to 1.26 million by 2030 in the USA alone [1]. Surgical error leading to failed TKA can be avoided [8, 9], and focus has been placed on developing strategies to improve the accuracy of implant sizing and positioning to recreate the knee joint line and to appropriately balance soft tissue to achieve an accurate overall implant and lower limb alignment [10, 11]. In this regard, robotic arm-assisted TKA (RA-TKA) has emerged as a reliable method to achieve accurate and precise lower limb alignment after TKA [10, 11]. We evaluated the predictive accuracy of the RA-TKA system in determining the required bone resection and implant size preoperatively and its effect on intraoperative decision-making
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