Accuracy of a New Robotically Assisted Technique for Total Knee Arthroplasty: A Cadaveric Study

      Abstract

      Background

      Although the utility of robotic surgery has already been proven in cadaveric studies, it is our hypothesis that this newly designed robotically assisted system will achieve a high level of accuracy for bone resection. Therefore, we aimed to analyze in a cadaveric study the accuracy to achieve targeted angles and resection thickness.

      Methods

      For this study, 15 frozen cadaveric specimens (30 knees) were used. In this study, Zimmer Biomet (Warsaw, IN) knees, navigation system, and robot (ROSA Knee System; Zimmer Biomet) were used. Eight trained, board-certified orthopedic surgeons performed robotically assisted total knee arthroplasty implantation using the same robotic protocol with 3 different implant designs. The target angles obtained from the intraoperative planning were then compared to the angles of the bone cuts performed using the robotic system and measured with the computer-assisted system considered to be the gold standard. For each bone cut the resection thickness was measured 3 times by 2 different observers and compared to the values for the planned resections.

      Results

      All angle mean differences were below 1° and standard deviations below 1°. For all 6 angles, the mean differences between the target angle and the measured values were not significantly different from 0 except for the femoral flexion angle which had a mean difference of 0.95°. The mean hip-knee-ankle axis difference was −0.03° ± 0.87°. All resection mean differences were below 0.7 mm and standard deviations below 1.1mm.

      Conclusion

      Despite the fact that this study was funded by Zimmer Biomet and only used Zimmer Biomet implants, robot, and navigation tools, the results of our in vitro study demonstrated that surgeons using this new surgical robot in total knee arthroplasty can perform highly accurate bone cuts to achieve the planned angles and resection thickness as measured using conventional navigation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Halawi M.J.
        • Jongbloed W.
        • Baron S.
        • Savoy L.
        • Williams V.J.
        • Cote M.P.
        Patient dissatisfaction after primary total joint arthroplasty: the patient perspective.
        J Arthroplasty. 2019; 34: 1093-1096https://doi.org/10.1016/j.arth.2019.01.075
        • Parratte S.
        • Pagnano M.W.
        Instability after total knee arthroplasty.
        J Bone Joint Surg Am. 2008; 90: 184-194
        • Springer B.D.
        • Parratte S.
        • Abdel M.P.
        Measured resection versus gap balancing for total knee arthroplasty.
        Clin Orthop Relat Res. 2014; 472: 2016-2022https://doi.org/10.1007/s11999-014-3524-y
        • Parratte S.
        • Pagnano M.W.
        • Trousdale R.T.
        • Berry D.J.
        Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements.
        J Bone Joint Surg Am. 2010; 92: 2143-2149https://doi.org/10.2106/JBJS.I.01398
        • Abdel M.P.
        • Oussedik S.
        • Parratte S.
        • Lustig S.
        • Haddad F.S.
        Coronal alignment in total knee replacement: historical review, contemporary analysis, and future direction.
        Bone Joint J. 2014; 96-B: 857-862https://doi.org/10.1302/0301-620X.96B7.33946
        • Rivière C.
        • Iranpour F.
        • Auvinet E.
        • Howell S.
        • Vendittoli P.A.
        • Cobb J.
        • et al.
        Alignment options for total knee arthroplasty: a systematic review.
        Orthop Traumatol Surg Res. 2017; 103: 1047-1056https://doi.org/10.1016/j.otsr.2017.07.010
        • Bautista M.
        • Manrique J.
        • Hozack W.J.
        Robotics in total knee arthroplasty.
        J Knee Surg. 2019; 32: 600-606https://doi.org/10.1055/s-0039-1681053
        • Scholes C.
        • Sahni V.
        • Lustig S.
        • Parker D.A.
        • Coolican M.R.
        Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 660-665https://doi.org/10.1007/s00167-013-2670-1
        • Lustig S.
        • Scholes C.J.
        • Oussedik S.
        • Coolican M.R.
        • Parker D.A.
        Unsatisfactory accuracy with VISIONAIRE patient-specific cutting jigs for total knee arthroplasty.
        J Arthroplasty. 2014; 29: 249-250https://doi.org/10.1016/j.arth.2013.05.020
        • Biant L.C.
        • Yeoh K.
        • Walker P.M.
        • Bruce W.J.
        • Walsh W.R.
        The accuracy of bone resections made during computer navigated total knee replacement. Do we resect what the computer plans we resect?.
        Knee. 2008; 15: 238-241https://doi.org/10.1016/j.knee.2008.01.012
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Galaud B.
        • Beaufils P.
        • Michaut M.
        • Abadie P.
        • Fallet L.
        • Boisrenoult P.
        Distal femoral torsion: comparison of CT scan and intra operative navigation measurements during total knee arthroplasty. A report of 70 cases.
        Rev Chir Orthop Reparatrice Appar Mot. 2008; 94: 573-579https://doi.org/10.1016/j.rco.2008.03.039
        • Casper M.
        • Mitra R.
        • Khare R.
        • Jaramaz B.
        • Hamlin B.
        • McGinley B.
        • et al.
        Accuracy assessment of a novel image-free handheld robot for Total Knee Arthroplasty in a cadaveric study.
        Comput Assist Surg (Abingdon). 2018; 23: 14-20https://doi.org/10.1080/24699322.2018.1519038
        • Hampp E.L.
        • Chughtai M.
        • Scholl L.Y.
        • Sodhi N.
        • Bhowmik-Stoker M.
        • Jacofsky D.J.
        • et al.
        Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques.
        J Knee Surg. 2018; 32: 239-250https://doi.org/10.1055/s-0038-1641729
        • Kim T.K.
        • Chang C.B.
        • Kang Y.G.
        • Chung B.J.
        • Cho H.J.
        • Seong S.C.
        Execution accuracy of bone resection and implant fixation in computer assisted minimally invasive total knee arthroplasty.
        Knee. 2010; 17: 23-28https://doi.org/10.1016/j.knee.2009.06.004
        • Hetaimish B.M.
        • Khan M.M.
        • Simunovic N.
        • Al-Harbi H.H.
        • Bhandari M.
        • Zalzal P.K.
        Meta-analysis of navigation vs conventional total knee arthroplasty.
        J Arthroplasty. 2012; 27: 1177-1182https://doi.org/10.1016/j.arth.2011.12.028