Robotic Total Knee Replacement: Our Experience with First 200 Knees

Abstract

Total knee replacement (TKR) is a commonly done surgery in cases of high-grade arthritis of knee affecting activity of daily living in patients. Conventional zig based TKR (CTKR) with manual instruments provides a balanced knee according to the surgeons’ subjective assessment of ligament balance, still some percentages of patients are found to have dissatisfaction in regards to persistent pain, lack of range of motion and walking unaided. In this study we are sharing our experience in a consecutive series of 200 Robotic-Assisted Primary TKRs. Robotic assisted TKR (RATKR) has multiple advantages over conventional jig based TKR (CTKR), such as it improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment, minimal soft tissue dissection, thus reducing pain and need of analgesia, early recovery and giving a natural arc of motion postoperatively. Robotic assisted TKR is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKR. A clear advantage of robot-assisted TKR seems to be the ability to execute a highly precise preoperative plan based on computed tomography (CT) scans, minor modification up to submillimetre accuracy in implant positioning can be done which is impossible to differentiate with human eyes. Due to improved alignment of the prosthetic components and improved boneimplant fit, implant loosening is anticipated to be reduced. Limitations of robotic TKR include high installation costs, increased surgical time, implant specificity of the robots and nonavailability of long-term literature due to being a recently evolved technology.