Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making

Abstract Background The reliability of robotic arm-assisted total knee arthroplasty (RA-TKA) has been previously reported. In this study, we evaluated the predictive accuracy of the RA-TKA system in determining the required bone resection and implant size preoperatively and its effect on intraoperat...

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Autores principales:	Xufeng Wan, Qiang Su, Duan Wang, Mingcheng Yuan, Yahao Lai, Hong Xu, Zongke Zhou
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Total knee arthroplasty Robot-assisted surgery Preoperative TKA planning TKA implant sizing Orthopedic surgery RD701-811 Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/49d26046498b4efbb66263a631c6d5cd
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spelling	oai:doaj.org-article:49d26046498b4efbb66263a631c6d5cd2021-11-21T12:29:51ZRobotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making10.1186/s13018-021-02815-61749-799Xhttps://doaj.org/article/49d26046498b4efbb66263a631c6d5cd2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13018-021-02815-6https://doaj.org/toc/1749-799XAbstract Background The reliability of robotic arm-assisted total knee arthroplasty (RA-TKA) has been previously reported. In this study, we evaluated the predictive accuracy of the RA-TKA system in determining the required bone resection and implant size preoperatively and its effect on intraoperative decision-making. Methods Data on the outcomes of RA-TKA procedures performed in our department were prospectively collected. A three-dimensional model of the femur, tibia, and fibula was reconstructed using standard computed tomography (CT) images. The model was used preoperatively to predict bone required resection for the femur and tibia and implant size. Intraoperatively, the images were registered to the local anatomy to create a patient-specific model for decision-making, including real-time measurement of the medial-to-lateral difference in the extension/flexion gap and TKA component alignment. Differences between predicted and real bone resections and implant size were evaluated, and the post-TKA mechanical axis of the lower limb and difference in medial-to-lateral flexion/extension gap were measured. Results The analysis was based on the data of 28 patients who underwent TKA to treat severe osteoarthritis. The RA-TKA system successfully predicted the femoral and tibial component within one implant size in 28/28 cases (100%). For the 168 bone resections performed, including both femoral and tibial cuts, the resection was within 1 mm of the predicted value in 120/168 (71%) of the cuts. The actual versus predicted bone resection was statistically different only for the lateral tibial plateau (p = 0.018). The medial-to-lateral gap difference was between − 1 and 1 mm, except in one case. The achieved lower limb alignment was accurate overall, with the alignment being within < 1.0° of the neutral mechanical axis in 13/28 cases (46%) and within < 3.0° in 28/28 cases (100%). Conclusions The RA-TKA system provided considerable pre- and intraoperative surgical assistance to achieve accurate bone resection, appropriate component sizing, and postoperative alignment after RA-TKA.Xufeng WanQiang SuDuan WangMingcheng YuanYahao LaiHong XuZongke ZhouBMCarticleTotal knee arthroplastyRobot-assisted surgeryPreoperative TKA planningTKA implant sizingOrthopedic surgeryRD701-811Diseases of the musculoskeletal systemRC925-935ENJournal of Orthopaedic Surgery and Research, Vol 16, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Total knee arthroplasty Robot-assisted surgery Preoperative TKA planning TKA implant sizing Orthopedic surgery RD701-811 Diseases of the musculoskeletal system RC925-935
spellingShingle	Total knee arthroplasty Robot-assisted surgery Preoperative TKA planning TKA implant sizing Orthopedic surgery RD701-811 Diseases of the musculoskeletal system RC925-935 Xufeng Wan Qiang Su Duan Wang Mingcheng Yuan Yahao Lai Hong Xu Zongke Zhou Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
description	Abstract Background The reliability of robotic arm-assisted total knee arthroplasty (RA-TKA) has been previously reported. In this study, we evaluated the predictive accuracy of the RA-TKA system in determining the required bone resection and implant size preoperatively and its effect on intraoperative decision-making. Methods Data on the outcomes of RA-TKA procedures performed in our department were prospectively collected. A three-dimensional model of the femur, tibia, and fibula was reconstructed using standard computed tomography (CT) images. The model was used preoperatively to predict bone required resection for the femur and tibia and implant size. Intraoperatively, the images were registered to the local anatomy to create a patient-specific model for decision-making, including real-time measurement of the medial-to-lateral difference in the extension/flexion gap and TKA component alignment. Differences between predicted and real bone resections and implant size were evaluated, and the post-TKA mechanical axis of the lower limb and difference in medial-to-lateral flexion/extension gap were measured. Results The analysis was based on the data of 28 patients who underwent TKA to treat severe osteoarthritis. The RA-TKA system successfully predicted the femoral and tibial component within one implant size in 28/28 cases (100%). For the 168 bone resections performed, including both femoral and tibial cuts, the resection was within 1 mm of the predicted value in 120/168 (71%) of the cuts. The actual versus predicted bone resection was statistically different only for the lateral tibial plateau (p = 0.018). The medial-to-lateral gap difference was between − 1 and 1 mm, except in one case. The achieved lower limb alignment was accurate overall, with the alignment being within < 1.0° of the neutral mechanical axis in 13/28 cases (46%) and within < 3.0° in 28/28 cases (100%). Conclusions The RA-TKA system provided considerable pre- and intraoperative surgical assistance to achieve accurate bone resection, appropriate component sizing, and postoperative alignment after RA-TKA.
format	article
author	Xufeng Wan Qiang Su Duan Wang Mingcheng Yuan Yahao Lai Hong Xu Zongke Zhou
author_facet	Xufeng Wan Qiang Su Duan Wang Mingcheng Yuan Yahao Lai Hong Xu Zongke Zhou
author_sort	Xufeng Wan
title	Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
title_short	Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
title_full	Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
title_fullStr	Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
title_full_unstemmed	Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
title_sort	robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making
publisher	BMC
publishDate	2021
url	https://doaj.org/article/49d26046498b4efbb66263a631c6d5cd
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Robotic arm-assisted total knee arthroplasty improves preoperative planning and intraoperative decision-making

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