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J Knee Surg 2022; 35(03): 337-344
DOI: 10.1055/s-0040-1715571
Original Article

Improved Component Placement Accuracy with Robotic-Arm Assisted Total Knee Arthroplasty

Ormonde Mahoney
1   Department of Orthopaedic Surgery, Athens Orthopaedic Clinc, Athens, Georgia
,
Tracey Kinsey
1   Department of Orthopaedic Surgery, Athens Orthopaedic Clinc, Athens, Georgia
,
Nipun Sodhi
2   Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, New York
,
Michael A. Mont
3   Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
,
Antonia F. Chen
4   Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, Pennsylvania
,
Fabio Orozco
4   Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, Pennsylvania
,
William Hozack
4   Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, Pennsylvania
› Author Affiliations Funding This study was funded by Stryker Orthopaedics.
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Abstract

Component position of total knee arthroplasty (TKA) has been shown to influence prosthetic survivorships and clinical outcomes. Our objective was to compare the three-dimensional accuracy to plan of robotic-arm assisted TKA (RATKA) with conventional TKA for component position. We conducted a nonrandomized, prospective study comparing 143 RATKA with 86 conventional TKA operated at four U.S. centers between July 2016 and October 2018. Computed tomography (CT) scans obtained approximately 6 weeks postoperatively were analyzed using anatomical landmarks. Absolute deviation from surgical plans were defined as the absolute value of the difference between the CT measurements and surgeons' femoral and tibial component mechanical varus/valgus alignment, tibial component posterior slope, and femoral component internal/external rotation. Differences of absolute deviations were tested using stratified Wilcoxon's tests that controlled for study center. Patient-reported outcome measures collected through 1 postoperative year were modeled using multiple regression controlling for age, sex, body mass index, study center, and the preoperative score. RATKA demonstrated greater accuracy for tibial component alignment (median [25th, 75th percentiles] absolute deviation from plan of all centers combined for conventional vs. RA, 1.7 [0.9, 2.9] vs. 0.9 [0.4, 1.9] degrees, p < 0.001), femoral component rotation (1.5 [0.9, 2.5] vs. 1.3 [0.6, 2.5] degrees, p = 0.015), and tibial slope (2.9 [1.5, 5.0] vs. 1.1 [0.6, 2.0] degrees, p < 0.001). In multivariable analyses, RATKA showed significantly greater Veterans RAND 12-item health survey (VR-12) physical component scores (adjusted mean difference [95% confidence interval (CI)]: 2.4 [0.2, 4.5] points, p = 0.034) and qualitatively greater Knee Society (KS) composite functional scores (3.5 [−1.3, 8.2] points, p = 0.159), though not statistically significant. Compared with conventional instrumentation, RATKA demonstrated greater three-dimensional accuracy to plan for various component positioning parameters and clinical improvements in physical status and function with no major safety concerns during the first postoperative year. These results may be attributed to the preoperative CT scan planning, real-time intraoperative feedback, and stereotactic-guided cutting that takes into consideration patient-specific bony anatomy. These findings support the use of RATKA for enhanced arthroplasty outcomes.

Keywords

robotic-arm assisted - TKA - component position

Ethical Approval

The institutional review boards at each center approved this study. Written informed consent was obtained from all participants. All devices and instruments used in this study were cleared by the Food and Drug Administration.




Publication History

Received: 07 March 2020

Accepted: 25 June 2020

Article published online:
31 August 2020

© 2020. Thieme. All rights reserved.

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