Improved accuracy and reproducibility of a novel CT-free robotic surgical assistant for medial unicompartmental knee arthroplasty compared to conventional instrumentation: a cadaveric study

Abstract

Purpose Alignment errors in medial unicompartmental knee arthroplasty (UKA) predispose to premature implant loosening and polyethylene wear. The purpose of this study was to determine whether a novel CT-free robotic surgical assistant improves the accuracy and reproducibility of bone resections in UKA compared to conventional manual instrumentation. Methods Sixty matched cadaveric limbs received medial UKA with either the ROSA ® Partial Knee System or conventional instrumentation. Fifteen board-certiied orthopaedic surgeons with no prior experience with this robotic application performed the procedures with the same implant system. Bone resection angles in the coronal, sagittal and transverse planes were determined using optical navigation while resection depth was obtained using calliper measurements. Group comparison was performed using Student's t test (mean absolute error), F test (variance) and Fisher's exact test (% within a value), with signiicance at p < 0.05. Results Compared to conventional instrumentation, the accuracy of bone resections with CT-free robotic assistance was signiicantly improved for all bone resection parameters (p < 0.05), other than distal femoral resection depth, which did not difer signiicantly. Moreover, the variance was signiicantly lower (i.e. fewer chances of outliers) for ive of seven parameters in the robotic group (p < 0.05). All values in the robotic group had a higher percentage of cases within 2° and 3° of the intraoperative plan. No re-cuts of the proximal tibia were required in the robotic group compared with 40% of cases in the conventional group. ConclusionThe ROSA ® Partial Knee System was signiicantly more accurate, with fewer outliers, compared to conventional instrumentation. The data reported in our current study are comparable to other semiautonomous robotic devices and support the use of this robotic technology for medial UKA. Level of evidence Cadaveric study, Level V.

The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk?

“…Therefore, while the rapid evolution of CT technology has allowed for expanded clinical applications—such as its use in developing PSI for joint arthroplasty, computer-assisted surgery, and robotics, physicians and patients must consider the radiation risk vs medical benefit of these scans, particularly when there are alternative methods of assessment [ [62] , [63] , [64] , [65] ]. Preoperative CT for knee and hip arthroplasty requires special consideration given the nondiagnostic nature of the study, particularly with the availability of alternatives, such as conventional techniques, MRI-based methods for cutting guide customization, portable handheld accelerometer-based navigation, or image-free robotic technologies [ [66] , [67] , [68] , [69] , [70] ].…”

Evaluation of open reduction and internal fixation with closed reduction and external fixation in distal radial fracture

“…In contrast to most other injuries, many randomised trials have been carried out on the treatment of distal radial fractures. [7][8][9] However, after meta-analyses of all randomised radial fracture trials, as described. In addition, in the Cochrane review in which 48 randomized clinical trials and 25 different potential treatments are examined in 3,371 people.…”

“…5,7 A significant proportion of physicians cannot do surgery if the joint imbalance is greater than 2 mm. 8 Similarly, the medial angle is more than 10 degrees, or the radial reduction is more than 3 mm. To use the self-reported questionnaire as the research aim, and also physical function and radiological parameters make an excellent.…”