Difficult Cases in Robotic Arm-Assisted Total Knee Arthroplasty: A Case Series

Abstract

Sagittal deformity of the knee is commonly corrected to neutral biomechanical axis (±3 degrees) during total knee arthroplasty (TKA), which is a widely accepted goal. Recent advances in surgical technology have made it possible to accurately plan and fulfill these goals. One of these is robotic-assisted TKA, which has been noted to help increase accuracy and precision of restoring a neutral mechanical axis. While there are data confirming the ability of robotic devices to better correct knee alignment than the manual technique, there is a lack of data concerning the use of the robotic devices in more complex cases, such as those in patients with severe varus or valgus deformity, as well as in flexion contractures. Therefore, the purpose of this case study is to present three cases in which the robotic-assisted TKA device was used to correct a severe varus and severe valgus deformities. Based on this case series, it should be noted that the robotic device can also help correct severe varus/valgus deformities and flexion contractures.

Keywords

total knee arthroplasty - robotic total knee arthroplasty - difficult cases - varus - valgus

• References

• 1 Rahm S, Camenzind RS, Hingsammer A. , et al. Postoperative alignment of TKA in patients with severe preoperative varus or valgus deformity: is there a difference between surgical techniques?. BMC Musculoskelet Disord 2017; 18 (01) 272
• 2 Green GV, Berend KR, Berend ME, Glisson RR, Vail TP. The effects of varus tibial alignment on proximal tibial surface strain in total knee arthroplasty: the posteromedial hot spot. J Arthroplasty 2002; 17 (08) 1033-1039
• 3 Liau JJ, Cheng CK, Huang CH, Lo WH. The effect of malalignment on stresses in polyethylene component of total knee prostheses--a finite element analysis. Clin Biomech (Bristol, Avon) 2002; 17 (02) 140-146
• 4 Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 2007; 22 (08) 1097-1106
• 5 Ismailidis P, Kernen R, Mueller SA. Total knee arthroplasty in severe valgus osteoarthritis excellent early results in a 90-year-old patient with a valgus deformity of 47°. Case Rep Orthop 2017; 2017: 9301017
• 6 Kim SM, Park YS, Ha CW, Lim SJ, Moon YW. Robot-assisted implantation improves the precision of component position in minimally invasive TKA. Orthopedics 2012; 35 (09) e1334-e1339
• 7 Song EK, Seon JK, Park SJ, Jung WB, Park HW, Lee GW. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2011; 19 (07) 1069-1076
• 8 Siebert W, Mai S, Kober R, Heeckt PF. Technique and first clinical results of robot-assisted total knee replacement. Knee 2002; 9 (03) 173-180
• 9 Decking J, Theis C, Achenbach T, Roth E, Nafe B, Eckardt A. Robotic total knee arthroplasty: the accuracy of CT-based component placement. Acta Orthop Scand 2004; 75 (05) 573-579
• 10 Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 2007; 464 (464) 111-116
• 11 Hampp EL, Chughtai M, Scholl LY, Bhowmik-Stoker M, Jacofsky DJ, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Improved Accuracy and Precision Compared to Manual Technique. Poster presented at: Orthopaedic Research Society; March 19–22, 2017; San Diego, CA