Component placement accuracy in two generations of handheld robotics-assisted knee arthroplasty

Abstract

Introduction Total knee arthroplasty (TKA) is the gold standard for treatment of end-stage osteoarthritis. Previous studies have shown that successful outcomes following TKA depend on accurate implant alignment and soft tissue balancing. Robotic-assisted TKA have demonstrated improved accuracy in component placement and have been associated with better outcomes and patient satisfaction. This study aims to report on the execution accuracy of two generations of handheld robotic-assisted surgical systems. Methods This was a retrospective analysis of TKA procedures with two sequential generations of the same handheld roboticassisted surgical system. Intra-operative data captured included pre-operative limb deformity, limb axes, range of motion, kinematic balance, and the resulting plan for component placement in three-dimensional space. Patients were stratified based on their preoperative coronal lower limb mechanical alignment (> 3° varus, < 3° varus, < 3° valgus, and ≥ 3° valgus). Measurements of component placement (overall lower limb alignment, medial and lateral flexion gaps, and tibial and femoral resection depths) were assessed using descriptive statistics. Results A total of 435 patients were included and stratified based on preoperative lower limb alignment: 229 with ≥ 3° varus, 78 with varus < 3° and 58 with valgus < 3°, and 70 with valgus > 3°. The mean difference between planned and achieved alignment in the lower limb valgus patients was < 1° across all groups. Mean differences between planned and achieved medial flexion gap was higher in the > 3° subgroup in the varus patient cohort ([< 3°]: 1.15 ± 1.92 vs. [> 3°]: 1.90 ± 2.57); this value was higher in the < 3° subgroup for valgus patients ([< 3°]: 1.34 ± 1.83 vs. [> 3°]: 0.956 ± 1.65). Average resection depth ranged from 9.46 to 10.4 mm in the posterior medial femur, 9.25 to 9.95 mm in the posterior lateral femur, 7.45 to 8.79 mm in the distal medial femur, 8.22 to 9.18 mm in the distal lateral femur, 6.70 to 7.07 mm in the medial tibial condyle and 6.40 to 7.19 mm in the lateral tibial condyle. Non-inferiority testing demonstrated the newer generation is non-inferior to the older generation. Conclusion Robotic-assisted knee replacement using handheld image-free systems is able to maintain accuracy of component placement. Further investigation of patient reported outcomes as well as long-term implant longevity are needed.

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

“…It took 12 and 17 min for experienced and less-experienced surgeons to perform the initial femoral resections and correct any deviations from the femoral target using manual instruments, which is more efficient than robotic and navigation instrumentation. In addition, manual instruments require less setup time than robotic and navigation systems that insert large diameter pins to rigidly attach marker arrays for registration with the risk of periprosthetic fracture [ 1 , 25 , 27 ]. In contrast, caliper verified KA with manual instrumentation sets the distal and femoral resections after assessing areas of cartilage wear on the femur without the potential error, expense, and inconvenience from referring to a pre-operative radiograph or advanced imaging study [ 8 ].…”

HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

“…Although new prosthesis and surgical instruments with more perfect design are constantly coming out, and the surgical technology of the operator is also improving year by year, TKA has not yet become a perfect operation, and its postoperative dissatisfaction rate is as high as 20% [ 39 , 40 ]. The main cause is that TKA has high requirements on the position of prosthesis placement, reconstruction of lower limb force line and maintenance of postoperative stability, while manual operation is difficult to ensure the accuracy and consistency of surgical operation [ [41] , [42] , [43] ]. Therefore, poor prosthesis position and poor alignment of lower limb occur from time to time, which seriously affects the stability of knee joint and recovery of motor function and the long-term survival rate and postoperative satisfaction of patients were reduced.…”

Surgical accuracy and clinical outcomes of image‐free robotic‐assisted total knee arthroplasty

“…CORI ® robotic surgical system is an upgraded version of Navio ® , it equips with new camera technology and cutting technology which provide faster robotic surgical procedure compared to the Navio ® Surgical System. Previous studies have demonstrated the efficacy of Navio ® /CORI ® in maintaining accuracy of component placement 6,7 . In this study, we evaluated the component position in the coronal and sagittal plane, the relationship with functional outcome and the complication comparing robotic‐assisted TKA and conventional TKA.…”

“…Previous studies have demonstrated the efficacy of Navio ® /CORI ® in maintaining accuracy of component placement. 6,7 In this study, we evaluated the component position in the coronal and sagittal plane, the relationship with functional outcome and the complication comparing robotic-assisted TKA and conventional TKA.…”