Robotics versus personalized 3D preoperative planning in total knee arthroplasty: a propensity score-matched analysis

Abstract

Purpose Lower limb alignment is crucial in total knee arthroplasty (TKA). Previous studies have shown that robotics and personalized three-dimensional (3D) preoperative planning could improve postoperative alignment accuracy compared with conventional TKA, but comparison between the above two techniques has never been reported. The authors hypothesized that robotics may be superior to personalized 3D preoperative planning in terms of postoperative alignment in primary TKA, with similar patient-reported outcome measures (PROMs) but higher cost and longer operative time. Methods A consecutive series of patients who received TKA in our center from September 2020 to January 2021 were enrolled retrospectively. After 1:2 matching, 52 and 104 patients were included and divided into study group for robotics and control group for personalized 3D preoperative planning, respectively. Multiple postoperative alignment angles were measured, and clinical features such as operation and tourniquet time, length of hospital stay and hemoglobin (Hb) were recorded. Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate clinical results. Results Compared with control group, robotics group had significantly lower frontal femoral component angle (FFC) and frontal tibial component angle (FTC) absolute deviation (P < 0.05). It also had less outliers in hip–knee–ankle angle (HKA), FTC, lateral femoral component angle (LFC) and lateral tibial component angle (LTC) (P < 0.05). Hb loss of robotics group was significantly lower than control group (P < 0.001), while the operation and tourniquet time were longer (P < 0.001). There was no significant difference in KSS and WOMAC scores between two groups. Conclusion Compared with control group, patients in robotics group had significantly less malalignment, malposition, Hb loss, but similar PROMs. The operations in robotics group spent longer operation time and cost more compared with control group. Trial registration: The Chinese Clinical Trial Registry, ChiCTR2000036235. Registered 22 August 2020, http://www.chictr.org.cn/showproj.aspx?proj=59300. Level of evidence III.

Development and Validation of an Artificial Intelligence Preoperative Planning and Patient-Specific Instrumentation System for Total Knee Arthroplasty

“…Various digital technologies for orthopaedic surgeries, such as navigation, robot-assisted surgery, and PSI, have been used to improve the accuracy of component placement. Navigation and robot-assisted surgery can significantly improve surgical accuracy, but they are also disadvantageous in that they are expensive and prolong the operation time, so their generalizability is somewhat limited [14,15]. There is still controversy regarding the use of PSI in improving the accuracy of component alignment.…”

“…With a basis in CT-based preoperative planning, digital technologies, such as navigation, robot-assisted techniques, and patient-specific instrumentation (PSI), are being used in arthroplasty [14][15][16]. All these techniques have been reported to improve surgical accuracy, but navigation and robotic technologies require costly purchases and maintenance, increase the operating time, and require additional, sufficiently large spaces for application and storage.…”

Does Operative Time Modify Obesity-related Outcomes in THA?

“…The authors of this study use these options: using press-fit implants instead of cement automatically because they increase the surgical site incision, using Deaver and selfretaining retractors, and having a low threshold to release the gluteus maximus or psoas tendon or an anterior capsulectomy. Generally, the authors avoid minimally invasive approaches and are judicious about the use of robotics, as this will ultimately lengthen the procedure [20]. In the operating room, multidisciplinary teams, orthopaedic-specific surgical assistants, and decreasing operative room turnover can improve operative room cohesion and efficiency [5,15].…”

Robotic systems in total knee arthroplasty: current surgical trauma perspectives

“…One certain benefit of RA-TKA, which can decrease surgical trauma, is the avoidance of femoral medullary canal invasion. Most authors have reported that intraoperative and postoperative blood loss in RA-TKA is always significantly less [ 11 ]. The invaded femoral canal could bleed severely during surgery and be responsible for undetectable blood loss after surgery.…”