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Component placement accuracy in two generations of handheld robotics-assisted knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Total knee arthroplasty (TKA) is the gold standard for treatment of end-stage osteoarthritis. Previous studies have shown that successful outcomes following TKA depend on accurate implant alignment and soft tissue balancing. Robotic-assisted TKA have demonstrated improved accuracy in component placement and have been associated with better outcomes and patient satisfaction. This study aims to report on the execution accuracy of two generations of handheld robotic-assisted surgical systems.

Methods

This was a retrospective analysis of TKA procedures with two sequential generations of the same handheld robotic-assisted surgical system. Intra-operative data captured included pre-operative limb deformity, limb axes, range of motion, kinematic balance, and the resulting plan for component placement in three-dimensional space. Patients were stratified based on their preoperative coronal lower limb mechanical alignment (> 3° varus, < 3° varus, < 3° valgus, and ≥ 3° valgus). Measurements of component placement (overall lower limb alignment, medial and lateral flexion gaps, and tibial and femoral resection depths) were assessed using descriptive statistics.

Results

A total of 435 patients were included and stratified based on preoperative lower limb alignment: 229 with ≥ 3° varus, 78 with varus < 3° and 58 with valgus < 3°, and 70 with valgus > 3°. The mean difference between planned and achieved alignment in the lower limb valgus patients was < 1° across all groups. Mean differences between planned and achieved medial flexion gap was higher in the > 3° subgroup in the varus patient cohort ([< 3°]: 1.15 ± 1.92 vs. [> 3°]: 1.90 ± 2.57); this value was higher in the < 3° subgroup for valgus patients ([< 3°]: 1.34 ± 1.83 vs. [> 3°]: 0.956 ± 1.65). Average resection depth ranged from 9.46 to 10.4 mm in the posterior medial femur, 9.25 to 9.95 mm in the posterior lateral femur, 7.45 to 8.79 mm in the distal medial femur, 8.22 to 9.18 mm in the distal lateral femur, 6.70 to 7.07 mm in the medial tibial condyle and 6.40 to 7.19 mm in the lateral tibial condyle. Non-inferiority testing demonstrated the newer generation is non-inferior to the older generation.

Conclusion

Robotic-assisted knee replacement using handheld image-free systems is able to maintain accuracy of component placement. Further investigation of patient reported outcomes as well as long-term implant longevity are needed.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA

    Ran Schwarzkopf

  2. Orthopedic Institute of the West, Phoenix, AZ, USA

    James C. Chow

  3. Orthopedic Specialists of Scottsdale, Scottsdale, AZ, USA

    Bertrand Kaper

  4. Smith & Nephew, Memphis, TN, USA

    Riddhit Mitra & Jing Xie

  5. Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA

    Chelsea S. Sicat

Authors
  1. Chelsea S. Sicat
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Corresponding author

Correspondence to Chelsea S. Sicat.

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Conflict of interest

Financial interests: Chelsea S. Sicat, MSc has no financial interests to disclose. Dr. James C. Chow, MD has the following financial interests to disclose: (a) Axolotl Biologix: Stock or stock Options. (b) Microport Orthopedics: Paid consultant; Paid presenter or speaker. (c) Microport Orthopedics, Inc.: IP royalties; Research support. (d) Orthosensor, Inc.: Paid consultant; Paid presenter or speaker; Research support. (e) Pfizer: Stock or stock Options. (f) Smith & Nephew: IP royalties; Paid consultant; Paid presenter or speaker; Research support. (g) Stryker: Stock or stock Options. (h) Vomaris Innovations: Research support. (i) Vomaris Innovations, Inc.: Paid consultant; Stock or stock Options. Dr. Bertrand Kaper, MD has received research support from Smith & Nephew and is a paid consultant for Smith & Nephew. Riddhit Mitra, MSc receives a salary from Smith & Nephew where he is Director of Product Management, Robotics. Dr. Jing Xie, PhD receives a salary from Smith & Nephew where she is Senior Vice President of Cliincal & Medical Affairs. She has stocks in Smith & Nephew, Medtronic, and Zimmer. Dr. Ran Schwarzkopf, MD MSc has the following financial interests to disclose: (a) Gauss surgical: Stock or stock Options. (b) Intellijoint: Paid consultant; Stock or stock Options. (c) PSI: Stock or stock Options. (d) Smith & Nephew: IP royalties; Paid consultant; Research support. Non-financial interests: Chelsea S. Sicat, MSc, Dr. Bertrand Kaper, MD, Riddhit Mitra, MSc, and Dr. Jing Xie, PhD have no non-financial interests to disclose. Dr. James C. Chow, MD serves as a board/committee member for Chow Research Foundation. Dr. Ran Schwarzkopf, MD MSc serves as a board/committee member for the American Academy of Orthopedic Surgeons (AAOS) and American Association of Hip and Knee Surgeons (AAHKS); he is also on the editorial board for Arthroplasty Today and Journal of Arthroplasty.

Ethical approval

Ethical approval was waived in light of the retrospective nature of the study.

Informed consent

Informed consent was not required for this study as only images without identifying data were used.

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Sicat, C.S., Chow, J.C., Kaper, B. et al. Component placement accuracy in two generations of handheld robotics-assisted knee arthroplasty. Arch Orthop Trauma Surg 141, 2059–2067 (2021). https://doi.org/10.1007/s00402-021-04040-6

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  • DOI: https://doi.org/10.1007/s00402-021-04040-6

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