Computer and robotic – assisted total knee arthroplasty: a review of outcomes

Abstract

Background Total knee arthroplasty (TKA) is a successful treatment for tricompartmental knee arthritis. Computer navigation and robotic-assisted-surgery (RAS) have emerged as tools that aim to help plan and execute surgery with greater precision and consistency. We reviewed the most current literature to describe the historical background and outcomes compared to conventional TKA. Methods A review and synthesis of the literature comparing the patient reported outcomes (PROM’s) of RA TKA and computer-assisted (CA) TKA to conventional TKA was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results CAS TKA improves accuracy and consistency of implant position, and appears to provide a small improvement in PROMs and implant survival compared to conventional TKA. RTKA similarly improves implant accuracy compared to conventional techniques and early results suggest a similar small benefit in PROMs compared to conventional TKA. A strengthening trend is emerging showing CAS TKA has greatest benefit to implant survival in people under 65. RTKA survival analysis data is more limited and early results do not allow strong conclusions, however early trends are similar to CAS TKA. Conclusion Results for CAS-TKA show improvement in alignment, and early clinical outcomes have revealed promising results, with longer-term data and medium-term survival analysis recently emerging showing small benefits over conventional TKA. RTKA represents another phase of development. Early results show similar trends to that of CAS TKA with longer-term data still to come.

Is an x-ray of the knee sufficient to assess the alignment of the leg? A study of total joint replacement with surgical navigation.

“…Navigation has therefore made it possible to reduce the degree of dispersion and achieve a neutral mechanical axis. Recent meta-analyses 32 have shown that navigation increases the safety and consistency of implant position, and that this has a beneficial effect on clinical and functional outcomes. This technique reduces asymmetric polyethylene wear, mobilization and sinking in of prosthetic components, particularly in young and active people, and prevents complications derived from the use of manual instrumentation [33][34][35] .…”

Advances in Surgical Techniques for Robotic Computer-Navigated Total and Unicompartmental Knee Arthroplasty

“…Whether or not robotic total knee arthroplasty leads to improved radiographic and clinical outcomes remains the subject of significant controversy [36]. Stated broadly, outcomes after robotic-assisted TKA can be grouped into either those related to accuracy and precision of component positioning and alignment or those related to clinical improvement, patient-reported outcomes (PROs), and functionality metrics.…”

The Surgical Treatment of Osteoarthritis

“…PSI, CAN, and robotic-assisted techniques have also proved helpful in knee arthroplasty, where correct frontal, sagittal, and axial alignment of the prosthetic components is essential for the good function and longevity of the implant. New technologies allow more accurate and reproducible restoration of mechanical axis, component alignment, and soft tissue balance [ 113 ]. To shorten intraoperative radiation, the 3D-printed personalized guide in assisting the accurate drilling of K-wire has been developed in arthroscopic ankle arthrodesis [ 114 ].…”