scholarly journals The Incidence of Soft-Tissue Releases in Robotic-Assisted Total Knee Arthroplasty Technology

10.29007/lbgj ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Historical Cohort ◽  
Robotic Assisted ◽  
Total Knee

The incidence of formal soft tissues releases required in TKA surgery performed utilizing the NAVIO robotic-assisted (RA)-TKA technique was assessed and compared to a historical cohort of conventional, manually instrumented (CI) TKA’s.

scholarly journals Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

2019 ◽  
Vol 8 (10) ◽  
pp. 495-501 ◽  
Author(s):  
Emily L. Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew E. Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Soft Tissue Damage ◽  
Anatomical Structures ◽  
Cruciate Retaining ◽  
Robotic Assisted ◽  
Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

Balancing of total knee arthroplasty by bone cuts achieves accurately balanced soft tissues without the need for soft tissue releases

2018 ◽  
Vol 3 (5) ◽  
pp. 263-268 ◽  
Author(s):  
Ponky Firer ◽  
Brad Gelbart
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Size Difference ◽  
Gap Size ◽  
X Rays ◽  
Coronal Alignment ◽  
Total Knee

IntroductionPatient satisfaction, after mechanically aligned Total Knee Arthroplasty (TKA) is only 80%-85%. There is an inabilty to consistently get perfect soft tissue balance with this technique. It is postulated that soft tissue balance within 2° can be achieved by the boney cuts (Bone Balancing) without soft tissue releases, accepting whatever coronal mechanical alignment (CMA) this produces; that the alignment produced would be similar to natural (constitutional) alignment and that balanced knees would improve patient satisfaction.MethodsWe report on 914 consecutive TKAs using Bone Balancing: the femoral rotation for the flexion gap; the distal femoral cut and valgus angle for the extension gap are adjusted to give equal gap sizes with soft tissue balanced within 2° of medio-lateral laxity. Long leg X-rays were used to measure post-operative coronal alignment. Satisfaction beyond 1 year post operation was assessed by an independent researcher, using a question on satisfaction and a VAS score.Results782(85.5%) TKAs with satisfactory x-rays were available at 2-7 years follow up. Their CMA had a similar distribution profile to reported natural alignment studies. Of these, 672 (86%) had a CMA of 0°±3° (’aligned' group). Overall patient satisfaction was 92.8%, with satisfied patients having a mean (range) VAS score of 9.53 (7.3-10.0) and the dissatisfied patients 3.78 (0.0-6.3) (p<0.0001). There was no difference in satisfaction between ’aligned' knees (92.7%) and those ’outliers', whose CMA was >±3° (93.6%) (p=0.853). All balance measurements were within 3° with 92.2% being ≤2°. Gap size difference between extension and 90° flexion was ≤2mm in 98.7% of cases. Midflexion (45° flexion) balance was within 3° in all cases and the gap size difference was ≤2mm in 89%.ConclusionBalancing by bone cuts is able to achieve accurately balanced soft tissues without the need for soft tissue releases. The coronal alignment profile produced matches that of the normal population. This technique improves satisfaction compared to the literature for mechanically aligned TKAs. Acurate and measured soft tissue balancing needs further consideration in TKAs.Level of EvidenceLevel IV.

scholarly journals Less Iatrogenic Soft Tissue Damage Utilizing Robotic Assisted Total Knee Arthroplasty when Compared with a Manual Approach: A Blinded Assessment

10.29007/v7g9 ◽  
2019 ◽  
Author(s):  
Emily Hampp ◽  
Nipun Sodhi ◽  
Laura Scholl ◽  
Matthew Deren ◽  
Zachary Yenna ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Tissue Damage ◽  
Soft Tissues ◽  
Hypothesis Test ◽  
Patellar Ligament ◽  
Robotic Arm ◽  
Soft Tissue Damage ◽  
Total Knee

While manual total knee arthroplasty (MTKA) has demonstrated excellent clinical results, occasionally intraoperative damage to soft tissues can occur. Robotic-arm assisted technology is designed to constrain a sawblade in a haptic zone to help ensure that only the desired bone cuts are made. The objective of this cadaver study was to quantify the extent of soft tissue damage sustained during TKA through a robotic-arm assisted (RATKA) haptically guided approach and conventional MTKA approach. Four surgeons each prepared 3 RATKA and 3 MTKA specimens for cruciate retaining TKAs. RATKA was performed on one knee, with MTKA on the other. Postoperatively, 2 additional blinded surgeons, assessed and graded damage to 14 key anatomic structures. A Kruskal-Wallis hypothesis test was performed to assess for statistical differences of soft tissue damages between RATKA and MTKA cases. A p-value &lt;0.05 was used as the threshold for statistical significance, and p-values were adjusted for ties. Significantly less damage occurred to the PCL in the RATKA than the MTKA specimens (p&lt;0.0001). RATKA specimens had less damage to the dMCL (p=.149), ITB (p=0.580), popliteus (p=0.248), and patellar ligament (p=0.317). The results of this study indicate that RATKA may result in less soft-tissue damage than MTKA, especially to the PCL.

scholarly journals Soft Tissue Imbalance Resulting from a Simulated Measured Resection Model as Predicted by the Use of Robotic-Assisted Total Knee Arthroplasty Technology

10.29007/mrbg ◽  
2020 ◽  
Author(s):  
Bertrand Kaper
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Soft Tissue Balance ◽  
Robotic Assisted ◽  
Accuracy And Precision ◽  
Measured Resection ◽  
Soft Tissue Laxity ◽  
Total Knee

In this study, patients undergoing RA-TKA were critically assessed to understand the accuracy and precision of a simulated MR model used historically in manually instrumented TKA surgery. Using a 3mm threshold of soft-tissue laxity, knees were identified that would have been expected to require the application of a “reactive” CI-TKA surgical technique to achieve adequate soft-tissue balance.

scholarly journals After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Siddharth M. Shah
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Computer Navigation ◽  
Soft Tissue Release ◽  
Computer Assisted ◽  
Robotic Assisted ◽  
Total Knee ◽  
Implant Alignment ◽  
Navigated Tka

Abstract Background Limb and implant alignment along with soft tissue balance plays a vital role in the outcomes after total knee arthroplasty (TKA). Computer navigation for TKA was first introduced in 1997 with the aim of implanting the prosthetic components with accuracy and precision. This review discusses the technique, current status, and scientific evidence pertaining to computer-navigated TKA. Body The adoption of navigated TKA has slowly but steadily increased across the globe since its inception 25 years ago. It has been more rapid in some countries like Australia than others, like the UK. Contemporary, large console-based navigation systems help control almost every aspect of TKA, including the depth and orientation of femoral and tibial resections, soft-tissue release, and customization of femoral and tibial implant positions in order to obtain desired alignment and balance. Navigated TKA results in better limb and implant alignment and reduces outliers as compared to conventional TKA. However, controversy still exists over whether improved alignment provides superior function and longevity. Surgeons may also be hesitant to adopt this technology due to the associated learning curve, slightly increased surgical time, fear of pin site complications, and the initial set-up cost. Furthermore, the recent advent of robotic-assisted TKA which provides benefits like precision in bone resections and avoiding soft-tissue damage due to uncontrolled sawing, in addition to those of computer navigation, might be responsible for the latter technology taking a backseat. Conclusion This review summarizes the current state of computer-navigated TKA. The superiority of computer navigation to conventional TKA in improving accuracy is well established. Robotic-assisted TKA provides enhanced functionality as compared to computer navigation but is significantly more expensive. Whether robotic-assisted TKA offers any substantive advantages over navigation is yet to be conclusively proven. Irrespective of the form, the use of computer-assisted TKA is on the rise worldwide and is here to stay.

Is Soft Tissue Laxity Associated with Tissue Metal Concentrations after Total Knee Arthroplasty?

2018 ◽  
Vol 28 (2) ◽  
pp. 79-85
Author(s):  
Meredith Perkins ◽  
Julie Lowell ◽  
Christina Arnholt ◽  
Daniel MacDonald ◽  
Anita L. Kerkhof ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Metal Concentrations ◽  
Soft Tissue Laxity ◽  
Total Knee

A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

2021 ◽  
Author(s):  
H. E. Skibicki ◽  
D. Y. Ponzio ◽  
J. A. Brustein ◽  
Z. D. Post ◽  
A. C. Ong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femur Fracture ◽  
Robotic Assisted ◽  
Total Knee

scholarly journals Postoperative laxity of the lateral soft tissue is largely negligible in total knee arthroplasty for varus osteoarthritis

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110020
Author(s):  
Seikai Toyooka ◽  
Hironari Masuda ◽  
Nobuhiro Nishihara ◽  
Takashi Kobayashi ◽  
Wataru Miyamoto ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Varus Deformity ◽  
Varus Knee ◽  
Before And After ◽  
Knee Deformity ◽  
Varus Stress ◽  
Total Knee

Purpose: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. Methods: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. Results: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. Conclusion: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.

scholarly journals Accuracy of soft tissue balancing in total knee arthroplasty using surgeon-defined assessment versus a gap-balancer or electronic sensor

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ran Zhao ◽  
Yanqing Liu ◽  
Hua Tian
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Sensor Data ◽  
Soft Tissue Balancing ◽  
Electronic Sensor ◽  
Prior Performance ◽  
Cumulative Summation ◽  
Total Knee ◽  
Sensitivity Specificity

Abstract Background Soft tissue balancing is essential for the success of total knee arthroplasty (TKA) and is mainly dependent on surgeon-defined assessment (SDA) or a gap-balancer (GB). However, an electronic sensor has been developed to objectively measure the gap pressure. This study aimed to evaluate the accuracy of soft tissue balancing using SDA and GB compared with a sensor. Methods Forty-eight patients undergoing TKA (60 knees) were prospectively enrolled. Soft tissue balancing was sequentially performed using SDA, a GB, and an electronic sensor. We compared the SDA, GB, and sensor data to calculate the sensitivity, specificity, and accuracy at 0°, 45°, 90°, and 120° flexion. Cumulative summation (CUSUM) analysis was performed to assess the surgeon’s performance during the sensor introductory phase. Results The sensitivity of SDA was 63.3%, 68.3%, 80.0%, and 80.0% at 0°, 45°, 90°, and 120°, respectively. The accuracy of the GB compared with sensor data was 76.7% and 71.7% at 0° and 90°, respectively. Cohen’s kappa coefficient for the accuracy of the GB was 0.406 at 0° (moderate agreement) and 0.227 at 90° (fair agreement). The CUSUM 0° line achieved good prior performance at case 45, CUSUM 90° and 120° showed a trend toward good prior performance, while CUSUM 45° reached poor prior performance at case 8. Conclusion SDA was a poor predictor of knee balance. GB improved the accuracy of soft tissue balancing, but was still less accurate than the sensor, particularly for unbalanced knees. SDA improved with ongoing use of the sensor, except at 45° flexion.

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