Accuracies of bone resection, implant position, and limb alignment in robotic-arm-assisted total knee arthroplasty: a prospective single-centre study

Abstract

Objective This study assessed the accuracy of robotic-arm-assisted total knee arthroplasty (RATKA) for bone resection, component size prediction, implant placement, and limb alignment. Methods This prospective cohort study included 36 patients. All procedures were performed by a single experienced surgeon, using an identical approach and implant designs. The MAKO RIO Robotic Interactive Orthopaedic Arm (Stryker, Mahwah, NJ, USA) system was used. The actual bone resection, implant placement, component size, and postoperative mechanical alignment were recorded, then compared with the preoperative plan. Results The mean absolute differences from the plan for the distal (medial and lateral) and posterior (medial and lateral) femoral cuts were 0.39 mm (0.62), 0.49 mm (0.70), 0.62 mm (0.79), and 0.65 mm (0.81), respectively, with 0.57° (0.65) varus. The mean absolute differences in the medial and lateral tibial cuts were 0.56 mm (0.75) and 0.58 mm (0.76), with 0.48° (0.16) varus and 0.54° (0.25) anterior/posterior slope. Of 192 bone resections, 176 (91.7%) were within ≤ 1 mm of the preoperative plan. The accuracies of femoral and tibial component size prediction were 100% and 97.22%, respectively. The mean absolute difference in final limb coronal alignment was 0.92° (0.65). Of the alignments, 18 (75.0%) were within ≤ 1.00° of the plan, and 100% were within ≤ 3.00° of the plan. Conclusion RATKA could accurately predict the component size and execute a preoperative plan to achieve precise bone resection, and implant placement, thereby reducing alignment outliers.

Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments

“…The most important findings of the present study were that the difference between the accuracy of experienced and less experienced surgeons performing KA with manual instruments was smaller than the 0.5 mm resolution of the caliper and clinically unimportant, and experienced surgeons completed the resections 5 min faster. In addition, the accuracy of the experienced and less experienced surgeons cutting the resection to the femoral target was comparable or better than reported values from studies of mechanical alignment using robotic and patient‐specific instrumentation [4–7, 13, 22, 26, 30] (Table 4). Hence, this lends confidence to those surgeons considering a transition from MA and robotic instrumentation to unrestricted caliper verified KA that their lack of experience will not seriously compromise accuracy when performing the femoral resections with manual instruments.…”

“…In contrast, correcting a posterior over‐resection is more challenging, which some surgeons left under‐corrected. Even with this limitation, 91–100% of the corrected distal and posterior femoral resections were within ± 1.0 mm of the femoral target, which is comparable if not a higher percentage to target than reported values of robotic, navigation, and patient‐specific instrumentation [4–7, 13, 22, 26, 30] (Table 4).…”

A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon

“…However, the IE and E surgeons corrected over- and under-resection deviations from the planned resection thickness detected with a caliper, resulting in a more accurate component implantation. These validation checks and corrective steps could benefit robotic, navigational, and patient-specific instrumentation, as they have larger resection deviations than those of the present study [ 24 , 25 , 27 , 30 ]. Finally, a gate analysis could have provided an additional clinical outcome measure to compare the three patient groups of the IE surgeon and the patients between the IE and E surgeon [ 31 ].…”

Current status of robot‐assisted surgery in the clinical application of trauma orthopedics in China: A systematic review

“…In 1992, the first robot system (Robodoc) in the world was applied to hip replacement surgery, creating a precedent for the application of surgical robots in orthopedics. 3,4 In recent years, the types of orthopedic surgical robots were becoming more and more complete, and the application scope and scene were also gradually expanding. The robot systems such as Robodoc (Curexo Technology Company), SpineAssist (Mazor Robotic Company), Stryker-Nav (Stryker Corporation), and Renaissance (Mazor Robotic Company) had developed rapidly and had been successfully used in hip and knee arthroplasty, pedicle screw placement, and other operations.…”

“…Because of the advantages of good stability, flexible operation, and accurate movement, surgical robots were more and more used in clinical treatment. In 1992, the first robot system (Robodoc) in the world was applied to hip replacement surgery, creating a precedent for the application of surgical robots in orthopedics 3,4 . In recent years, the types of orthopedic surgical robots were becoming more and more complete, and the application scope and scene were also gradually expanding.…”