J Knee Surg 2019; 32(08): 742-749
DOI: 10.1055/s-0038-1668122
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does the Robotic Arm and Preoperative CT Planning Help with 3D Intraoperative Total Knee Arthroplasty Planning?

Robert C. Marchand
1   Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
,
Nipun Sodhi
2   Department of Orthopaedics, Lenox Hill Hospital, New York, New York
,
Manoshi Bhowmik-Stoker
3   Department of Orthopaedics, Stryker Orthopaedics, Mahwah, New Jersey
,
Laura Scholl
3   Department of Orthopaedics, Stryker Orthopaedics, Mahwah, New Jersey
,
Caitlin Condrey
1   Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
,
Anton Khlopas
4   Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio
,
Assem A. Sultan
2   Department of Orthopaedics, Lenox Hill Hospital, New York, New York
,
Jared M. Newman
5   Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
,
Michael A. Mont
2   Department of Orthopaedics, Lenox Hill Hospital, New York, New York
› Institutsangaben
Weitere Informationen

Publikationsverlauf

22. Januar 2018

24. Juni 2018

Publikationsdatum:
15. August 2018 (online)

Abstract

Although several studies highlight the advantages of robotic arm-assisted total knee arthroplasty (RA-TKA), few investigate its intraoperative outcome. Therefore, the purpose of this study was to analyze the RA-TKA's ability to assist with intraoperative correction of: (1) flexion and (2) extension gaps, as well as its ability to (3) accurately predict implant sizes. Additionally, in this RA-TKA cohort, length of stay, complications, and readmissions were assessed. A total of 335 patients who underwent RA-TKA were included. The robotic software virtually measured the intraoperative prebone cut extension and flexion gaps. Differences in medial versus lateral prebone cut extension and flexion gaps were calculated. A total of 155 patients (46%) had an extension gap difference of between –2 and 2 mm (mean, –0.3 mm), while 119 patients (36%) had a flexion gap difference of between –2 and 2 mm (mean, –0.6 mm). Postbone cut differences in medial versus lateral flexion and extension gaps were measured. Balanced knees were considered to have a medial and lateral flexion gap difference within 2 mm. The robot-predicted implant size was also compared with the final implant size. Additionally, lengths of stay, complications, and readmissions were assessed. All patients achieved a postbone cut extension gap difference between –1 and 1 mm (mean, –0.1 mm). A total of 332 patients (99%) achieved a postbone cut flexion gap difference of between –2 and 2 mm (mean, 0 mm). For 98% of prostheses, the robotic software predicted within 1 implant size the actual tibial or femoral implant size used.

The mean length of stay was found to be 2 days. No patients suffered from superficial skin infection, pin site infections or fractures, soft tissue damage, and no robotic cases were converted to manual TKA due to intraoperative complications. A total of 8 patients (2.2%) were readmitted; however, none were directly related to robotic use. The robotic software and use of a preoperative computed tomography (CT) substantially helped with intraoperative planning and accurate prediction of implant sizes. Therefore, based on the results of this study, the RA-TKA device does, in fact, provide considerable intraoperative assistance.

 
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