Moving beyond radiographic alignment: applying the Wald Principles in the adoption of robotic total knee arthroplasty

Abstract

The use of robotics in total knee arthroplasty (TKA) is growing at an exponential rate. Despite the improved accuracy and reproducibility of robotic-assisted TKA, consistent clinical benefits have yet to be determined, with most studies showing comparable functional outcomes and survivorship between robotic and conventional techniques. Given the success and durability of conventional TKA, measurable improvements in these outcomes with robotic assistance may be difficult to prove. Efforts to optimize component alignment within two degrees of neutral may be an attainable but misguided goal. Applying the “Wald Principles” of rationalization, it is possible that robotic technology may still prove beneficial, even when equivalent clinical outcomes as conventional methods, if we look beyond the obvious surrogate measures of success. Robotic systems may help to reduce inventory, streamline surgical trays, enhance workflows and surgical efficiency, optimize soft tissue balancing, improve surgeon ergonomics, and integrate artificial intelligence and machine learning algorithms into a broader digital ecosystem. This article explores these less obvious alternative benefits of robotic surgery in the field of TKA.

Problems and Opportunities of a Smartphone-Based Care Management Platform: Application of the Wald Principles to a Survey-Based Analysis of Patients’ Perception in a Pilot Center

“…These results present opportunities for improving the utilization of these platforms during the post-operative phase. Applying the Wald Criteria, as described by Lonner et al [19], entails examining the results from a distinct perspective and adopting a different perception of the problem. This approach aims to emphasize the opportunities arising from these results, facilitating the identification of solutions to enhance the outcomes of the current situation.…”

“…These platforms enable the passive collection of mobility metrics, which serve as potential indicators of early functional recovery. While pre-and post-operative mobility data can be valuable for remote monitoring, their correlation with patient-reported outcome measures (PROMs) has yielded mixed results [19][20][21]. Nevertheless, it is necessary to establish more objective and performance-based measures of mobility, as traditional PROMs have limitations due to ceiling effects [22].…”

Initial Learning Curve for Robot-Assisted Total Knee Arthroplasty in a Dedicated Orthopedics Center

“…In their study, Weber et al reached similar conclusions as they performed manual TKAs in an average of 77.3 min, while navigated TKAs took slightly longer, with an average of 84.1 min [37]. The similar operative times can be attributed to the fact that while RA-TKAs require some preparation, this can be performed concurrently with the surgical approach of the knee; moreover, while RA-TKA involves a series of specific steps such as pin placement, knee soft tissue evaluation, and bone reference acquisition and balancing, which are distinct from those performed during manual TKA, some surgical steps are not required, such as drilling the femoral canal or setting up an extra/intramedullary tibial guide [38][39][40]. Therefore, it is reasonable to obtain an overall similar operative time between the two methods.…”

Robotic systems in total knee arthroplasty: current surgical trauma perspectives

“…The use of robotics in TKA is growing at an exponential rate [ 25 ]. Despite the improved accuracy and reproducibility of robotic-assisted TKA, consistent clinical benefits have yet to be determined.…”