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DOI: 10.1055/s-0040-1716983
How Does Robotic-Arm Assisted Technology Influence Total Knee Arthroplasty Implant Placement for Surgeons in Fellowship Training?
Funding None.![](https://www.thieme-connect.de/media/jks/202202/lookinside/thumbnails/10-1055-s-0040-1716983_200131oa-1.jpg)
Abstract
Implant malalignment during total knee arthroplasty (TKA) may lead to suboptimal postoperative outcomes. Accuracy studies are typically performed with experienced surgeons; however, it is important to study less experienced surgeons when considering teaching hospitals where younger surgeons operate. Therefore, this study assessed whether robotic-arm assisted TKA (RATKA) allowed for more accurate and precise implant position to plan when compared with manual techniques when the surgery is performed by in-training orthopaedic surgical fellows. Two surgeons, currently in their fellowship training and having minimal RATKA experience, performed a total of six manual TKA (MTKA) and six RATKAs on paired cadaver knees. Computed tomography scans were obtained for each knee pre- and postoperatively. These scans were analyzed using a custom autosegmentation and autoregistration process to compare postoperative implant position with the preoperative planned position. Mean system errors and standard deviations were compared between RATKA and MTKA for the femoral component for sagittal, coronal, and axial planes and for the tibial component in the sagittal and coronal planes. A 2-Variance testing was performed using an α = 0.05. Although not statistically significant, RATKA was found to have greater accuracy and precision to plan than MTKA for: femoral axial plane (1.1° ± 1.1° vs. 1.6° ± 1.3°), coronal plane (0.9° ± 0.7° vs. 2.2° ± 1.0°), femoral sagittal plane (1.5° ± 1.3° vs. 3.1° ± 2.1°), tibial coronal plane (0.9° ± 0.5° vs. 1.9° ± 1.3°), and tibial sagittal plane (1.7° ± 2.6° vs. 4.7° ± 4.1°). There were no statistical differences between surgical groups or between the two surgeons performing the cases. With limited RATKA experience, fellows showed increased accuracy and precision to plan for femoral and tibial implant positions. Furthermore, these results were comparable to what has been reported for an experienced surgeon performing RATKA.
Publication History
Received: 24 March 2020
Accepted: 25 May 2020
Article published online:
09 September 2020
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References
- 1 Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med 2014; 7 (02) 89-95
- 2 Rajgopal A, Vasdev A, Dahiya V, Tyagi VC, Gupta H. Total knee arthroplasty in extra articular deformities: a series of 36 knees. Indian J Orthop 2013; 47 (01) 35-39
- 3 Apostolopoulos AP, Nikolopoulos DD, Polyzois I. et al. Total knee arthroplasty in severe valgus deformity: interest of combining a lateral approach with a tibial tubercle osteotomy. Orthop Traumatol Surg Res 2010; 96 (07) 777-784
- 4 Thiele K, Perka C, Matziolis G, Mayr HO, Sostheim M, Hube R. Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 2015; 97 (09) 715-720
- 5 Lombardi Jr AVJ, Berend KR, Adams JB. Why knee replacements fail in 2013: patient, surgeon, or implant?. Bone Joint J 2014; 96-B (11) (suppl A): 101-104
- 6 Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today—has anything changed after 10 years?. J Arthroplasty 2014; 29 (09) 1774-1778
- 7 Malkani AL, Roche MW, Kolisek FR. et al. New technology for total knee arthroplasty provides excellent patient-reported outcomes: a minimum two-year analysis. Surg Technol Int 2019; 36: 36
- 8 Khlopas A, Sodhi N, Hozack WJ. et al. Patient-reported functional and satisfaction outcomes after robotic-arm-assisted total knee arthroplasty: early results of a prospective multicenter investigation. J Knee Surg 2020; 33 (07) 685-690
- 9 Marchand RC, Sodhi N, Khlopas A. et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J Knee Surg 2017; 30 (09) 849-853
- 10 Marchand RC, Sodhi N, Anis HK. et al. One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 2019; 32 (11) 1063-1068
- 11 Malkani AL, Roche MW, Kolisek FR. et al. Manipulation under anesthesia rates in technology-assisted versus conventional-instrumentation total knee arthroplasty. Surg Technol Int 2019; 36: 36
- 12 Mathew KK, Marchand KB, Tarazi JM. et al. Computer-assisted navigation in total knee arthroplasty. Surg Technol Int 2020; 36: 36
- 13 Sodhi N, Jacofsky DJ, Chee A, Mont MA. Benefits of CT Scanning for the Management of Knee Arthritis and Arthroplasty. J Knee Surg 2021; 34 (12) 1296-1303
- 14 Marchand RC, Sodhi N, Khlopas A. et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg 2018; 31 (01) 2-5
- 15 Marchand RC, Sodhi N, Bhowmik-Stoker M. et al. Does the robotic arm and preoperative CT planning help with 3D intraoperative total knee arthroplasty planning?. J Knee Surg 2019; 32 (08) 742-749
- 16 Hampp EL, Chughtai M, Scholl LY. et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019; 32 (03) 239-250
- 17 Hampp EL, Sodhi N, Scholl L. et al. Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach: a blinded assessment. Bone Joint Res 2019; 8 (10) 495-501
- 18 Khlopas A, Chughtai M, Hampp EL. et al. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg Technol Int 2017; 30: 441-446
- 19 Sodhi N, Khlopas A, Piuzzi NS. et al. Erratum to: the learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018; 31 (04) 370
- 20 Sodhi N, Khlopas A, Piuzzi NS. et al. The learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018; 31 (01) 17-21
- 21 Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sport Traumatol Arthrosc 2019; 27 (04) 1132-1141