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DOI: 10.1055/s-0040-1721412
Effect of Manual versus Robotic-Assisted Total Knee Arthroplasty on Cervical Spine Static and Dynamic Postures
Funding None.![](https://www.thieme-connect.de/media/jks/202209/lookinside/thumbnails/10-1055-s-0040-1721412_200547oa-1.jpg)
Abstract
This study compared surgeon cervical (C) spine postures and repetitive motions when performing traditional manual total knee arthroplasty (MTKA) versus robotic-assisted TKA (RATKA). Surgeons wore motion trackers on T3 vertebra and the occiput anatomical landmarks to obtain postural and repetitive motion data during MTKA and RATKA performed on cadavers. We assessed (1) flexion–extension at T3 and the occiput anatomical landmarks, (2) range of motion (ROM) as the percentage of time in the flexion–extension angle, (3) repetition rate, defined as the number of the times T3 and the occiput flexion-extension angle exceeded ±10°; and (4) static posture, where T3 or occiput postures exceed 10° for more than 30 seconds. The average T3 flexion–extension angle for MTKA cases was 5-degree larger than for RATKA cases (19 ± 8 vs. 14 ± 8 degrees). The surgeons who performed MTKA cases spent 15% more time in nonneutral C-spine ROM than those who performed RATKA cases (78 ± 25 vs. 63 ± 36%, p < 0.01). The repetition rate at T3 was 4% greater for MTKA than RATKA (14 ± 5 vs. 10 ± 6 reps/min). The percentage of time spent in static T3 posture was 5% greater for overall MTKA cases than for RATKA cases (15 ± 3 vs. 10 ± 3%). In this cadaveric study, we found differences in cervical and thoracic ergonomics between manual and robotic–assisted TKA. Specifically, we found that RATKA may reduce a surgeon's ergonomic strain at both the T3 and occiput locations by reducing the time the surgeon spends in a nonneutral position.
Publikationsverlauf
Eingereicht: 02. Oktober 2020
Angenommen: 17. Oktober 2020
Artikel online veröffentlicht:
28. Januar 2021
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References
- 1 Raine S, Twomey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil 1997; 78 (11) 1215-1223
- 2 Leroux I, Dionne CE, Bourbonnais R, Brisson C. Prevalence of musculoskeletal pain and associated factors in the Quebec working population. Int Arch Occup Environ Health 2005; 78 (05) 379-386
- 3 Palmer KT, Walker-Bone K, Griffin MJ. et al. Prevalence and occupational associations of neck pain in the British population. Scand J Work Environ Health 2001; 27 (01) 49-56
- 4 Bernaards CM, Ariëns GAM, Hildebrandt VH. The (cost-)effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on the recovery from neck and upper limb symptoms in computer workers. BMC Musculoskelet Disord 2006; 7: 80
- 5 Côté P, Kristman V, Vidmar M. et al. The prevalence and incidence of work absenteeism involving neck pain: a cohort of Ontario lost-time claimants. Spine 2008; 33 (4, suppl): S192-S198
- 6 Mirbod SM, Yoshida H, Miyamoto K, Miyashita K, Inaba R, Iwata H. Subjective complaints in orthopedists and general surgeons. Int Arch Occup Environ Health 1995; 67 (03) 179-186
- 7 Epstein S, Sparer EH, Tran BN. et al. Prevalence of work-related musculoskeletal disorders among surgeons and interventionalists: a systematic review and meta-analysis. JAMA Surg 2018; 153 (02) e17494
- 8 Auerbach JD, Weidner ZD, Milby AH, Diab M, Lonner BS. Musculoskeletal disorders among spine surgeons: results of a survey of the Scoliosis Research Society membership. Spine 2011; 36 (26) E1715-E1721
- 9 Knudsen ML, Ludewig PM, Braman JP. Musculoskeletal pain in resident orthopaedic surgeons: results of a novel survey. Iowa Orthop J 2014; 34: 190-196
- 10 Heng H-YC, Bin Abd Razak HR, Mitra AK. Radiographic grading of the patellofemoral joint is more accurate in skyline compared to lateral views. Ann Transl Med 2015; 3 (18) 263
- 11 Braun BL, Amundson LR. Quantitative assessment of head and shoulder posture. Arch Phys Med Rehabil 1989; 70 (04) 322-329
- 12 Watson DH, Trott PH. Cervical headache: an investigation of natural head posture and upper cervical flexor muscle performance. Cephalalgia 1993; 13 (04) 272-284 , discussion 232
- 13 Refshauge K, Goodsell M, Lee M. Consistency of cervical and cervicothoracic posture in standing. Aust J Physiother 1994; 40 (04) 235-240
- 14 Winkel J, Mathiassen SE. Assessment of physical work load in epidemiologic studies: concepts, issues and operational considerations. Ergonomics 1994; 37 (06) 979-988
- 15 Lanfranco AR, Castellanos AE, Desai JP, Meyers WC. Robotic surgery: a current perspective. Ann Surg 2004; 239 (01) 14-21
- 16 Yu D, Lowndes B, Morrow M, Kaufman K, Bingener J, Hallbeck S. Impact of novel shift handle laparoscopic tool on wrist ergonomics and task performance. Surg Endosc 2016; 30 (08) 3480-3490
- 17 Yu D, Lowndes B, Thiels C. et al. Quantifying intraoperative workloads across the surgical team roles: room for better balance?. World J Surg 2016; 40 (07) 1565-1574
- 18 Soueid A, Oudit D, Thiagarajah S, Laitung G. The pain of surgery: pain experienced by surgeons while operating. Int J Surg 2010; 8 (02) 118-120
- 19 McAtamney L, Nigel Corlett E. RULA: a survey method for the investigation of work-related upper limb disorders. Appl Ergon 1993; 24 (02) 91-99
- 20 Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int 2014; 25: 277-279
- 21 Colombini D, Occhipinti E, Delleman N, Fallentin N, Kilbom A, Grieco A. Technical Committee on Musculoskeletal Disorders of International Ergonomics Association. Exposure assessment of upper limb repetitive movements: a consensus document developed by the Technical Committee on Musculoskeletal Disorders of International Ergonomics Association (IEA) endorsed by International Commission on Occupational Health (ICOH). G Ital Med Lav Ergon 2001; 23 (02) 129-142
- 22 Li G, Buckle P. Current techniques for assessing physical exposure to work-related musculoskeletal risks, with emphasis on posture-based methods. Ergonomics 1999; 42 (05) 674-695
- 23 Elhage O, Murphy D, Challacombe B, Shortland A, Dasgupta P. Ergonomics in minimally invasive surgery. Int J Clin Pract 2007; 61 (02) 186-188
- 24 Sugano N. Computer-assisted orthopedic surgery. J Orthop Sci 2003; 8 (03) 442-448
- 25 Bargar WL, Bauer A, Börner M. Primary and revision total hip replacement using the Robodoc system. Clin Orthop Relat Res 1998; (354) 82-91
- 26 Murphy D, Challacombe B, Khan MS, Dasgupta P. Robotic technology in urology. Postgrad Med J 2006; 82 (973) 743-747
- 27 Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, Mont MA. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2018
- 28 Mont MA, Cool C, Gregory D, Coppolecchia A, Sodhi N, Jacofsky DJ. Health care utilization and payer cost analysis of robotic arm assisted total knee arthroplasty at 30, 60, and 90 days. J Knee Surg 2019