scholarly journals Robotic Arm Assisted Total Knee Arthroplasty: Addressing 1-12 Degrees Valgus Knees

10.29007/wrvx ◽  
2019 ◽  
Author(s):  
Jingwei Zhang ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Caitlin Condrey ◽  
Kevin Marchand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Womac Pain ◽  
Case Review ◽  
Retrospective Case ◽  
Soft Tissue Envelope ◽  
Patient Reported ◽  
Total Knee

The purpose of this work was to determine the number of soft tissue releases and component orientation of valgus cases performed with Robotic-Arm Assisted total knee arthroplasty (RATKA).This study was a retrospective chart review of cases performed by a single surgeon from July 2016 to December 2017. 72 RATKA cases were defined as having a valgus deformity pre-operatively. Patient demographics and intraoperative surgical details were collected, including initial and final 3D component alignment, knee balancing gaps, full or partial releases. Post- operatively, radiographs, adverse events, and reduced WOMAC pain and KOOS Jr scores were collected at 6 months post-operatively.Pre-operatively, knee deformities ranged from 1o to 12° with fixed flexion contracture. All knees were corrected within 2.5 degrees of mechanical neutral. Medial and lateral gaps were balanced in extension 100% of cases and flexion 93% of cases.Radiographic evidence suggested well seated and well-fixed components. No revision and re- operation is reported. Patient reported outcomes measures collected at 6-month follow up indicated an improvement in WOMAC pain score from 9.6 to 3.2 and improvement in KOOS Jr from 44.7 to 74.4 points.In this retrospective case review, soft tissue releases were not needed to address valgus knees ranging from 1-12° of deformity. The surgeon was able to balance the knee with bone resections and avoid disturbing the soft tissue envelope. While this study has a number of limitations, RATKA for valgus knees should continue to be investigated in a multicenter study.

scholarly journals Correction to: Robotic‑arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta‑analysis

2021 ◽  
Author(s):  
Junren Zhang ◽  
Wofhatwa Solomon Ndou ◽  
Nathan Ng ◽  
Paul Gaston ◽  
Philip M. Simpson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Meta Analysis ◽  
Robotic Arm ◽  
Patient Reported ◽  
Total Knee ◽  
Improved Accuracy

A correction to this paper has been published: https://doi.org/10.1007/s00167-021-06522-x

A Prospective Randomised Control Trial Comparing Functional with Mechanical Axis Alignment in Total Knee Arthroplasty: study protocol for an investigator initiated trial

2021 ◽  
Author(s):  
Richard Steer ◽  
Beth Tippett ◽  
R Nazim Khan ◽  
Dermot Collopy ◽  
Gavin Clark
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Medical Information ◽  
Randomised Control Trial ◽  
Computer Assisted ◽  
Patient Reported ◽  
Total Knee ◽  
Alternative Alignment

Abstract Background: A drive to improve functional outcomes for patients undergoing total knee arthroplasty (TKA) has led to alternative alignment being used. Functional alignment (FA) uses intraoperative soft tissue tension to determine the optimal position of the prosthesis within the patients soft tissue envelope. Angular limits for bone resections are followed to prevent long term prosthesis failure. This study will use the aid of robotic assistance to plan and implement the final prosthesis position. This method has yet to be compared to the traditional mechanically aligned (MA) knee in a randomised trial. Methods: A blinded randomised control trial with 100 patients will be undertaken via Perth Hip and Knee clinic. Fifty patients will undergo a MA TKA and fifty will undergo a FA TKA. Both alignment techniques will be balanced via computer assisted navigation to assess prosthetic gaps, being achieved via the initial bony resection and further soft tissue releases as required to achieve satisfactory balance. The primary outcome will be the forgotten joint score (FJS) two years after surgery, with secondary outcomes being other patient reported outcome measures, clinical functional assessment, radiographic position and complications. Other data that will be collected will be patient demography (Sex, Age, level of activity) and medical information (grade of knee injury, any other relevant medical information). The linear statistical model will be fitted to the response (FJS), including all the other variables as covariates. Discussion: Many surgeons are utilising alternative alignment techniques with a goal of achieving better functional outcomes for their patients. Currently MA TKA remains the gold standard with good outcomes and excellent longevity. There is no published RCTs comparing FA to MA yet and only two registered studies are planned or currently in progress. This study utilizes a FA technique which differs from the two studies. This study will help determine if FA TKA has superior functional results for patients.Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) http://www.anzctr.org.au: U1111-1257-2291, registered 25th Jan 2021. It is also listed on www.clinicaltrials.gov: NCT04748510

scholarly journals What is a balanced knee replacement?

2018 ◽  
Vol 3 (12) ◽  
pp. 614-619 ◽  
Author(s):  
Lucy C. Walker ◽  
Nick D. Clement ◽  
Kanishka M. Ghosh ◽  
David J. Deehan
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Current Evidence ◽  
Soft Tissue Envelope ◽  
Total Knee ◽  
Uneven Wear ◽  
Definition Of ◽  
Revision Tka

For multifactorial reasons an estimated 20% of patients remain unsatisfied after total knee arthroplasty (TKA). Appropriate tension of the soft tissue envelope encompassing the knee is important in total knee arthroplasty and soft tissue imbalance contributes to several of the foremost reasons for revision TKA, including instability, stiffness and aseptic loosening. There is debate in the literature surrounding the optimum way to achieve balancing of a total knee arthroplasty and there is also a lack of an accepted definition of what a balanced knee replacement is. It may be intuitive to use the native knee as a model for balancing; however, there are many difficulties with translating this into a successful prosthesis. One of the foundations of TKA, as described by Insall, was that although the native knee has more weight transmitted through the medial compartment this was to be avoided in a TKA as it would lead to uneven wear and early failure. There is a focus on achieving symmetrical tension and pressure and subsequent ‘balance’ in TKA, but the evidence from cadaveric studies is that the native knee is not symmetrically balanced. As we are currently trying to design an implant that is not based on its anatomical counterpart, is it possible to create a truly balanced prosthesis or to even to define what that balance is? The authors have reviewed the current evidence surrounding TKA balancing and its relationship with the native knee. Cite this article: EFORT Open Rev 2018;3:614-619. DOI: 10.1302/2058-5241.3.180008.

Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection

2017 ◽  
Vol 14 (12) ◽  
pp. 925-927 ◽  
Author(s):  
Assem A. Sultan ◽  
Nicolas Piuzzi ◽  
Anton Khlopas ◽  
Morad Chughtai ◽  
Nipun Sodhi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Tissue Protection ◽  
Total Knee

scholarly journals Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection

10.29007/8bxp ◽  
2018 ◽  
Author(s):  
Emily Hampp ◽  
Manoshi Bhowmik-Stoker ◽  
Laura Scholl ◽  
Jason Otto ◽  
David Jacofsky ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Cadaver Study ◽  
Patellar Ligament ◽  
Robotic Arm ◽  
Collateral Ligament ◽  
Tissue Protection ◽  
Total Knee ◽  
Patellar Eversion

Total knee arthroplasty (TKA) typically addresses end-stage osteoarthritis. While TKA procedures have demonstrated clinical success, occasionally intraoperative complications can occur. This cadaver study examined the potential benefits of soft tissue protection in robotic-arm assisted TKA (RATKA). Six cadaver knees were prepared using RATKA by a single surgeon from a high-volume TKA joint center with no former clinical robotic experience, and compared to seven manually performed cases as a control. The presence of soft tissue disruption was assessed by having the surgeon perform visual evaluation and palpation of the medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior cruciate ligament (PCL), and the patellar ligament after the procedures. The amount of tibial subluxation and patellar eversion was recorded for each case.For all RATKA cases, there was no visible evidence of disruption of any of the ligaments. All RATKA cases were successfully left with a bone island on the tibial plateau, which protected the PCL. Tibial subluxation and patellar eversion were not required for visualization. In two of the seven MTKA cases, there was slight disruption noted of the PCL, although this did not lead to any apparent change in the functional integrity of the ligament. All MTKA cases required tibial subluxation and patellar eversion to achieve optimal visualization.Aspects of soft tissue protection were noted in this cadaver study for RATKA. Standard retraction techniques during cutting are recommended. This is the first study to have soft tissue injury parameters assessed for RATKA, and may serve as a platform for future studies.

scholarly journals 1-Year Patient Outcomes for Robotic-Arm Assisted vs. Manual Total Knee Arthroplasty

10.29007/nrl3 ◽  
2019 ◽  
Author(s):  
Robert Marchand ◽  
Nipun Sodhi ◽  
Hiba Anis ◽  
Joseph Ehiorobo ◽  
Jared Newman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Pain Scores ◽  
Patient Reported ◽  
Beta Coefficient ◽  
Total Knee

Introduction:Robotic-arm assisted (RAA) total knee arthroplasty (TKA) has been shown to potentially have certain pre- and intra-operative advantages over manual techniques. Although there are many studies on the alignment advantages when using the robotic-arm assisted (RAA) system for total knee arthroplasty (TKA), there have been questions regarding patient-reported outcomes. Therefore, the purpose of this study was to use this index to compare: 1) total; 2) physical function; and 3) pain scores for manual vs. RAA patients.Methods:We compared 53 consecutive robotic-arm assisted to 53 consecutive manual TKAs. No differences in pre-operative scores were found between the cohorts. Patients were administered a modified WOMAC satisfaction survey pre-operatively, and at 1-year post-operatively. Univariate analyses and multivariate models with stepwise backward linear regression were utilized to evaluate the associations between outcome scores and surgical technique, age, sex, as well as body mass index (BMI).Results:The RAA cohort had significantly improved mean total (6±6 vs. 9±8 points, p=0.03) and physical function scores (4±4 vs. 6±5 points, p=0.02) when compared to the manual cohort. The mean pain score for the RAA cohort [2±3 points (range, 0 to 14 points)], was also lower than that for the manual cohort [3±4 points (range, 0 to 11 points) (p=0.06)].On backward linear regression analyses, RAA was found to be significantly associated with more improved total (beta coefficient [β]-0.208, SE [standard error] 1.401, p<0.05), function (β=0.216, SE=0.829, p<0.05), and pain scores (β-0.181, SE=0.623, p=0.063). The RAA technique was found to have the strongest association with improved scores.Conclusion:With newer surgical technologies constantly being introduced, it is imperative to continue to evaluate these new modalities, particularly in their abilities to improve patient satisfaction outcomes. This study suggests that RAA patients may have short term improvements at minimum 1-year post-operative. However, longer-term follow up with greater sample sizes are needed to further validate these findings.

scholarly journals Tibiofemoral dynamic stressed gap laxities correlate with compartment load measurements in robotic arm-assisted total knee arthroplasty

2021 ◽  
Vol 2 (11) ◽  
pp. 974-980
Author(s):  
Richard J. Allom ◽  
Jil A. Wood ◽  
Darren B. Chen ◽  
Samuel J. MacDessi
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Strong Relationship ◽  
Soft Tissue Balance ◽  
Robotic Arm ◽  
Gap Symmetry ◽  
Load Sensor ◽  
Total Knee

Aims It is unknown whether gap laxities measured in robotic arm-assisted total knee arthroplasty (TKA) correlate to load sensor measurements. The aim of this study was to determine whether symmetry of the maximum medial and lateral gaps in extension and flexion was predictive of knee balance in extension and flexion respectively using different maximum thresholds of intercompartmental load difference (ICLD) to define balance. Methods A prospective cohort study of 165 patients undergoing functionally-aligned TKA was performed (176 TKAs). With trial components in situ, medial and lateral extension and flexion gaps were measured using robotic navigation while applying valgus and varus forces. The ICLD between medial and lateral compartments was measured in extension and flexion with the load sensor. The null hypothesis was that stressed gap symmetry would not correlate directly with sensor-defined soft tissue balance. Results In TKAs with a stressed medial-lateral gap difference of ≤1 mm, 147 (89%) had an ICLD of ≤15 lb in extension, and 112 (84%) had an ICLD of ≤ 15 lb in flexion; 157 (95%) had an ICLD ≤ 30 lb in extension, and 126 (94%) had an ICLD ≤ 30 lb in flexion; and 165 (100%) had an ICLD ≤ 60 lb in extension, and 133 (99%) had an ICLD ≤ 60 lb in flexion. With a 0 mm difference between the medial and lateral stressed gaps, 103 (91%) of TKA had an ICLD ≤ 15 lb in extension, decreasing to 155 (88%) when the difference between the medial and lateral stressed extension gaps increased to ± 3 mm. In flexion, 47 (77%) had an ICLD ≤ 15 lb with a medial-lateral gap difference of 0 mm, increasing to 147 (84%) at ± 3 mm. Conclusion This study found a strong relationship between intercompartmental loads and gap symmetry in extension and flexion measured with prostheses in situ. The results suggest that ICLD and medial-lateral gap difference provide similar assessment of soft-tissue balance in robotic arm-assisted TKA. Cite this article: Bone Jt Open 2021;2(11):974–980.

One-Year Patient Outcomes for Robotic-Arm-Assisted versus Manual Total Knee Arthroplasty

2019 ◽  
Vol 32 (11) ◽  
pp. 1063-1068 ◽  
Author(s):  
Robert C. Marchand ◽  
Nipun Sodhi ◽  
Hiba K. Anis ◽  
Joseph Ehiorobo ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Linear Regression ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Univariate Analysis ◽  
Robotic Arm ◽  
Pain Scores ◽  
Patient Reported ◽  
Total Knee ◽  
One Year

AbstractAlthough there are many studies on the alignment advantages when using the robotic arm–assisted (RAA) system for total knee arthroplasty (TKA), there have been questions regarding patient-reported outcomes. Therefore, the purpose of this study was to use this index to compare: (1) total, (2) physical function, and (3) pain scores for manual versus RAA patients. We compared 53 consecutive RAA to 53 consecutive manual TKAs. No differences in preoperative scores were found between the cohorts. Patients were administered a modified Western Ontario and McMaster Universities Osteoarthritis Index satisfaction survey preoperatively and at 1-year postoperatively. The results were broken down to: (1) total, (2) physical function, and (3) pain scores. Univariate analysis with independent samples t-tests was used to compare 1-year postoperative scores. Multivariate models with stepwise backward linear regression were utilized to evaluate the associations between scores and surgical technique, age, sex, as well as body mass index (BMI). Statistical analyses were performed with a p < 0.05 to determine significance. The RAA cohort had significantly improved mean total (6 ± 6 vs. 9 ± 8 points, p = 0.03) and physical function scores (4 ± 4 vs. 6 ± 5 points, p = 0.02) when compared with the manual cohort. The mean pain score for the RAA cohort (2 ± 3 points [range, 0–14 points]) was also lower than that for the manual cohort (3 ± 4 points [range, 0–11 points]) (p = 0.06). On backward linear regression analyses, RAA was found to be significantly associated with more improved total (β coefficient [β] −0.208, standard error [SE] 1.401, p < 0.05), function (β = 0.216, SE = 0.829, p < 0.05), and pain scores (β −0.181, SE = 0.623, p = 0.063). The RAA technique was found to have the strongest association with improved scores when compared with age, gender, and BMI. This study suggests that RAA patients may have short-term improvements at minimum 1-year postoperatively. However, longer term follow-up with greater sample sizes is needed to further validate these results.

scholarly journals The influence of tibiofemoral joint forces on patient-reported outcome measurements after bicruciate stabilized total knee arthroplasty

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091510
Author(s):  
Takao Kaneko ◽  
Norihiko Kono ◽  
Yuta Mochizuki ◽  
Masaru Hada ◽  
Shinya Toyoda ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Patient Reported Outcome ◽  
Neutral Position ◽  
Positive Correlation ◽  
Outcome Measurements ◽  
Patient Reported ◽  
Total Knee ◽  
The Relationship

Objective: Insall advocated that a successful clinical outcome of total knee arthroplasty (TKA) depends on soft tissue balance procedure. Spacer blocks, balancer, and instrumented tibial sensor (VERESENSE, OrthoSensor, Dania, Florida, USA) are the current methods of soft tissue balancing during TKA. The purpose of the study is to assess intraoperative medial and lateral tibiofemoral compressive force (TFCF) using novel insert sensor and investigate the relationship between TFCF and patient-reported outcome measurements (PROMs). Methods: Twenty-five patients who underwent bicruciate stabilized (BCS) TKA were evaluated retrospectively. We measured intraoperative medial and lateral TFCF in neutral position as well as the force ratio (FR %:medial TFCF/medial + lateral TFCF) in varus and valgus position using the novel insert sensor throughout the range of motion (ROM) and assessed the relationship between intraoperative medial and lateral TFCF and PROM at 6 months after TKA. Results: Medial TFCF increased and lateral TFCF decreased throughout ROM. The mean FR was 0.44% ± 0.22 throughout ROM. Medial and lateral TFCF differences at 60° of ROM in neutral position showed a positive correlation with physical function in Western Ontario and McMaster Universities scores ( r = 0.60, p < 0.05). Medial and lateral TFCF differences at 30° and 140° of ROM in valgus stress test showed a positive correlation with symptoms in 2011 Knee Society Scores ( r = 0.49, p < 0.05; r = 0.51, p < 0.05). Conclusion: The present study revealed that BCS TKA reproduces the coronal laxity, which is similar to healthy knee. These results suggest that intraoperative medial stability is important for function and symptoms, therefore, surgeons should not release medial soft tissue for achieving better clinical outcomes after BCS TKA. Level of Evidence: II

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