Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial

Abstract

PurposeCorrect positioning and alignment of the prosthesis is a very important factor for durability of prosthesis and implant survival which is improved with the use of technology in total knee arthroplasty. However, the long‐term functional outcomes and survivorship are unclear. For this study, it was hypothesized that mechanical axis alignment of lower limb, post‐operative joint line restoration, femoral and tibial component alignment is more accurate with the new handheld semi‐active robotic‐assisted TKA. MethodFrom April‐2019 to March‐2020, 60 patients with unilateral knee osteoarthritis who underwent total knee arthroplasties were included in this prospective randomised controlled study. Computer generated randomization was used. Study included 48 female patients and 12 male patients. Pre‐operative and post‐operative radiographic measurements were done and compared between the two groups. ResultsThere was a significant difference between two groups with respect to mechanical axis deviation, joint line deviation and coronal alignment of femoral and tibial prosthesis. Mechanical axis deviation > 3° was seen in eight cases (28.5%) in C‐TKA group compared to one case (3.1%) in RA‐TKA (p 0.019). Joint line deviation of 3.5 mm was noted in C‐TKA group as compared to 0.9 mm in RA‐TKA group (p < 0.001) which was statistically significant. However, whether this difference of 2.6 mm of joint line elevation between C‐TKA and RA‐TKA leads to any difference in clinical outcome in terms of knee kinematics and knee flexion needs to be investigated with further studies. Clinically restoring normal joint line is important for improved knee function after primary TKA. No significant difference was noted in femoral component rotation on post‐operative computed tomography (CT) scan. ConclusionThe novel imageless, handheld semi‐autonomous robotic system for TKA is highly accurate with respect to component positioning in coronal plane and mechanical alignment as compared to conventional TKA. Joint line is elevated in conventional TKA but is accurately restored using the robotic‐assisted TKA which may lead to better patellofemoral kinematics. Level of evidenceI.

A new robotically assisted system for total knee arthroplasty: A sheep model study

“…Multiple robotic‐assisted systems, including Navio, Mako and Robodoc, have been clinically used for TKA. In this connection, it has been reported that robotic‐assisted TKA resulted in better joint line restoration and prosthesis alignment compared to conventional TKA 18 . Collins et al.…”

“…Computer navigation, three‐dimensional (3D)‐printed individualized prostheses and robotic‐assisted TKA methods have been introduced to surgery to increase implantation accuracy, soft tissue preservation and mechanical axis alignment 15–19 . The first robotic system in orthopedic surgery is Robodoc, which has been used for TKA and total hip arthroplasty since 1992 20 .…”

Deep learning approach for guiding three‐dimensional computed tomography reconstruction of lower limbs for robotically‐assisted total knee arthroplasty

“…[22][23][24][25] For example, Sires et al 26 -5 of 11 TKA system in obtaining preoperatively planned coronal alignment of final limb and bone resection. Vaidya et al 27 also demonstrated that robotic-assisted TKA system acquired a better joint line restoration and prosthesis alignment as compared to the conventional TKA.…”

Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making

“…Inappropriate bone resection and associated flexion/extension gaps can result in suboptimal TKA component positioning, leading to component malalignment [ 6 , 7 ]. Surgical error leading to failed TKA can be avoided [ 8 , 9 ], and therefore, focus has been placed on developing strategies to improve the accuracy of implant sizing and positioning to recreate the knee joint line and to appropriately balance soft tissue to achieve an accurate overall implant and lower limb alignment [ 10 , 11 ]. In this regard, robotic arm-assisted TKA (RA-TKA) has emerged as a reliable method to achieve accurate and precise lower limb alignment after TKA [ 10 , 11 ].…”