The rebirth of computer-assisted surgery. Precise prosthetic implantation should be considered when targeting individualized alignment goals in total knee arthroplasty

Vendittoli, Pascal‐André; Rivière, Charles; MacDessi, Samuel J.

doi:10.1007/s00167-020-06295-9

Cited by 10 publications

(8 citation statements)

References 39 publications

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“…Whether one personalized robotic assisted TKA technique is superior to the other or provides better patient outcomes is yet unclear, and further studies are needed. In addition, having such a powerful and precise tool as robotic assistance requires deeper comprehension to master the benefits and downsides of these newer approaches (21,46).…”

Section: Discussionmentioning

confidence: 99%

“…In order to achieve any of these personalized techniques, accuracy, precision and consistent needs and nowadays, robotic assistance availability makes these techniques accessible (21). This allows accurate lower limb alignment and bespoke soft tissue balancing information, thus facilitating precise component sizing, placement and prevents implantation in positions that may compromise long-term outcomes (22).…”

Section: Robotics Assistancementioning

confidence: 99%

“…Notably, using computer navigation to improve TKA alignment precision did not result in clinical improvements with a MA (28). When assessing the performance of precision tools such as computer navigation or robotic assistance, it is crucial to differentiate the terms "precision" and "accuracy" (21). Improved precision provided by these tools is valueless when aiming at the wrong target.…”

Section: Robotics Assistancementioning

confidence: 99%

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Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?

Morcos

Uhuebor²,

Vendittoli³

2023

Front. Surg.

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Current limitations in total knee arthroplasty (TKA) function and patient satisfaction stimulated us to question our practice. Our understanding of knee anatomy and biomechanics has evolved over recent years as we now consider that a more personalized joint reconstruction may be a better-targeted goal for TKA. Implant design and surgical techniques must be advanced to better reproduce the anatomy and kinematics of native knees and ultimately provide a forgotten joint. The availability of precision tools as robotic assistance surgery can help us recreate patient anatomy and ensure components are not implanted in a position that may compromise long-term outcomes. Robotic-assisted surgery is gaining in popularity and may be the future of orthopedic surgery. However, moving away from the concept of neutrally aligning every TKA dogma opens the door to new techniques emergence based on opinion and experience and leads to a certain amount of uncertainty among knee surgeons. Hence, it is important to clearly describe each technique and analyze their potential impacts and benefits. Personalized TKA techniques may be classified into 2 main families: unrestricted or restricted component orientation. In the restricted group, some will aim to reproduce native ligament laxity versus aiming for ligament isometry. When outside of their boundaries, all restricted techniques will induce anatomical changes. Similarly, most native knee having asymmetric ligaments laxity between compartments and within the same compartment during the arc of flexion; aiming for ligament isometry induces bony anatomy changes. In the current paper, we will summarize and discuss the impacts of the different robotic personalized alignment techniques, including kinematic alignment (KA), restricted kinematic alignment (rKA), inverse kinematic alignment (iKA), and functional alignment (FA). With every surgical technique, there are limitations and shortcomings. As our implants are still far from the native knee, it is primordial to understand the impacts and benefits of each technique. Mid to long data will help us in defining the new standards.

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Section: Discussionmentioning

confidence: 99%

Section: Robotics Assistancementioning

confidence: 99%

Section: Robotics Assistancementioning

confidence: 99%

See 1 more Smart Citation

Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?

Morcos

Uhuebor²,

Vendittoli³

2023

Front. Surg.

Self Cite

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“…This kind of alignment, called kinematic, could theoretically lead to better patient satisfaction and member function and increase the implant survival [6]. Residual symptoms of pain, instability and stiffness are observed in up to 50% of TKA were the mechanical alignment are the goal, what could be avoided by using the kinematic alignment [7].…”

Section: Literature Reviewmentioning

confidence: 99%

Robotically Assisted Total Knee Arthroplasty - Literature Review

Vinicius¹,

Fernandes²

2022

J Musculoskelet Disord Treat

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Despite the evolution in implant design, surgical technique, rehabilitation and better medical training, a great number of patients are not satisfied with the final result of Total Knee Arthroplasty (TKA). The conventional TKA technique could result in a high number of outliers in limb alignment and are related to a high rate of residual symptoms. Robotically assisted (RA) surgery was introduced to improve these results. Recent studies showed this technique is associated to lower costs, better accuracy in implant placement and limb alignment, improvement in function and patient satisfaction. RA technique is also related to less blood loss, less bone resection and smaller aggression to soft tissues. Besides that, this brings better ergonomics to the surgeon with less caloric waste. In this way, by the benefits showed, the adhesion to the robotic surgery must be encouraged.

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“…Furthermore, there are only very limited data on the consequences for the patient-in terms of alignment, stability, and outcome [8,9]. Additional to this, there now is the need for technological support of some sort to be able to (1) identify a situation that needs to be adapted, and (2) precisely transfer this plan to the patient [10].…”

Section: Introductionmentioning

confidence: 99%

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

Huber¹,

Christen²,

Calliess

et al. 2021

JPM

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Introduction: Image-based robotic assistance appears to be a promising tool for individualizing alignment in total knee arthroplasty (TKA). The patient-specific model of the knee enables a preoperative 3D planning of component position. Adjustments to the individual soft-tissue situation can be done intraoperatively. Based on this, we have established a standardized workflow to implement the idea of kinematic alignment (KA) for robotic-assisted TKA. In addition, we have defined limits for its use. If these limits are reached, we switch to a restricted KA (rKA). The aim of the study was to evaluate (1) in what percentage of patients a true KA or an rKA is applicable, (2) whether there were differences regarding knee phenotypes, and (3) what the differences of philosophies in terms of component position, joint stability, and early patient outcome were. Methods: The study included a retrospective analysis of 111 robotic-assisted primary TKAs. Based on preoperative long leg standing radiographs, the patients were categorized into a varus, valgus, or neutral subgroup. Initially, all patients were planned for KA TKA. When the defined safe zone had been exceeded, adjustments to an rKA were made. Intraoperatively, the alignment of the components and joint gaps were recorded by robotic software. Results and conclusion: With our indication for TKA and the defined boundaries, “only” 44% of the patients were suitable for a true KA with no adjustments or soft tissue releases. In the varus group, it was about 70%, whereas it was 0% in the valgus group and 25% in the neutral alignment group. Thus, significant differences with regard to knee morphotypes were evident. In the KA group, a more physiological knee balance reconstructing the trapezoidal flexion gap (+2 mm on average laterally) was seen as well as a closer reconstruction of the surface anatomy and joint line in all dimensions compared to rKA. This resulted in a higher improvement in the collected outcome scores in favor of KA in the very early postoperative phase.

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The rebirth of computer-assisted surgery. Precise prosthetic implantation should be considered when targeting individualized alignment goals in total knee arthroplasty

Cited by 10 publications

References 39 publications

Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?

Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?

Robotically Assisted Total Knee Arthroplasty - Literature Review

True Kinematic Alignment Is Applicable in 44% of Patients Applying Restrictive Indication Criteria—A Retrospective Analysis of 111 TKA Using Robotic Assistance

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