Accuracy assessment of a novel image-free handheld robot for Total Knee Arthroplasty in a cadaveric study

Abstract

Surgical navigation has been shown to improve the accuracy of bone preparation and limb alignment in total knee arthroplasty (TKA). Previous work has shown the effectiveness of various types of navigation systems. Here, for the first time, we assessed the accuracy of a novel imageless semiautonomous handheld robotic sculpting system in performing bone resection and preparation in TKA using cadaveric specimens. In this study, we compared the planned and final implant placement in 18 cadaveric specimens undergoing TKA using the new tool. Eight surgeons carried out the procedures using three types of implant designs. A quantitative analysis was performed to determine the translational, angular, and rotational differences between the planned and achieved positions of the implants. The mean femoral flexion, varus/valgus, and rotational error was −2.0°, −0.1°, and −0.5°, respectively. The mean tibial posterior slope, and varus/valgus error was −0.2°, and −0.2°, respectively. We obtained higher flexion errors for the femoral implant when using cut-guides as compared to using a bur for cutting the bones. The image-free robotic sculpting tool achieved accurate implementation of the surgical plan with small errors in implant placement. Future studies will focus on determining how well the accurate implant placement translates into a clinical and functional benefit for the patient.

Accuracy of a New Robotically Assisted Technique for Total Knee Arthroplasty: A Cadaveric Study

“…This higher risk of error for the femoral flexion was also observed in our study. The authors did not report the root mean square errors nor any prediction intervals; direct comparisons with our study are therefore limited [13]. Furthermore, the number of knees used was not sufficient to reach any level of significance [13].…”

“…The authors did not report the root mean square errors nor any prediction intervals; direct comparisons with our study are therefore limited [13]. Furthermore, the number of knees used was not sufficient to reach any level of significance [13]. Another publication reported a cadaveric study comparing TKA implanted on cadavers with either a robotic-arm technique or a conventional instrument system [14].…”

“…To date, there are limited published studies evaluating the results of the accuracy of robotically assisted TKA. The first study reported results of a robotically assisted TKA using a navigated burr [13]. Two techniques were used in this prior study: for 4 of 18 cadavers, the burr was used for the entire procedure and all the bone cuts were performed with the burr; for the remaining 14 cadavers, the burr was used to drill holes for the jigs, the jigs were applied, and then the cuts were performed like in a conventional technique using a standard saw [13].…”

“…The first study reported results of a robotically assisted TKA using a navigated burr [13]. Two techniques were used in this prior study: for 4 of 18 cadavers, the burr was used for the entire procedure and all the bone cuts were performed with the burr; for the remaining 14 cadavers, the burr was used to drill holes for the jigs, the jigs were applied, and then the cuts were performed like in a conventional technique using a standard saw [13]. The results showed that errors ranged from 0.6 to 2.4 mm or degrees for the femoral and tibial implants, with the higher errors observed for femoral flexion [13].…”

Intraoperative analysis of the kinematics of the native knee including two-dimensional translation of the femur using a navigation system : a cadaveric study

“…Recent technological innovations have led to the development of many computer-assisted surgical procedures, including those that include use of a navigation system (3). Using a navigation system, TKA procedures can now be performed more accurately with better reproducibility (4,5).…”