Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment
Purpose Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bon...
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| Veröffentlicht in: | Archives of orthopaedic and trauma surgery 2023-06, Vol.143 (6), p.3471-3479 |
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| creator | Schrednitzki, Daniel Horn, Christoph Eckhard Lampe, Ute Anne Halder, Andreas M. |
| description | Purpose
Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bone resections. Several systems requiring preoperative imaging have shown a higher degree of precision compared to conventional instrumentation. An imageless system needs less preoperative time and preparation and is more cost effective. Aim of this study was to find out whether this system is as precise, reproduces accurately the surgeon's planning and reduces the occurrence of outliers.
Methods
This retrospective study included the first 71 robotic-assisted TKA and 308 conventional TKA in 374 patients. Intraoperatively planned and actual bone resections were compared. Postoperative alignment, measured on full leg weight bearing radiographs, was related to the respective planning and statistically compared between the groups.
Results
Baseline characteristics (age, BMI, ASA, preoperative Knee Society Score and deformity) between both groups were comparable. According to the planned alignment, the postoperative mean difference was – 1.01° in the robotic versus 2.05° in the conventional group. The maximum deviation was − 2/+ 2.5° in the robotic and – 6.6/ + 6.8° in the conventional group. According to the plan, there were no outliers above ± 3° in the robotic versus 24% in the conventional group.
The mean difference between planned and measured bone resection was 0.21 mm with a maximum of 2 mm. The 95% confidence interval was at each position 1 mm or below.
Conclusions
The described imageless robotic system is accurate in terms of coronal alignment and bone resections. In precision, it is superior to conventional instrumentation and could therefore be used to evaluate new alignment concepts. |
| doi_str_mv | 10.1007/s00402-022-04648-2 |
| format | Article |
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Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bone resections. Several systems requiring preoperative imaging have shown a higher degree of precision compared to conventional instrumentation. An imageless system needs less preoperative time and preparation and is more cost effective. Aim of this study was to find out whether this system is as precise, reproduces accurately the surgeon's planning and reduces the occurrence of outliers.
Methods
This retrospective study included the first 71 robotic-assisted TKA and 308 conventional TKA in 374 patients. Intraoperatively planned and actual bone resections were compared. Postoperative alignment, measured on full leg weight bearing radiographs, was related to the respective planning and statistically compared between the groups.
Results
Baseline characteristics (age, BMI, ASA, preoperative Knee Society Score and deformity) between both groups were comparable. According to the planned alignment, the postoperative mean difference was – 1.01° in the robotic versus 2.05° in the conventional group. The maximum deviation was − 2/+ 2.5° in the robotic and – 6.6/ + 6.8° in the conventional group. According to the plan, there were no outliers above ± 3° in the robotic versus 24% in the conventional group.
The mean difference between planned and measured bone resection was 0.21 mm with a maximum of 2 mm. The 95% confidence interval was at each position 1 mm or below.
Conclusions
The described imageless robotic system is accurate in terms of coronal alignment and bone resections. In precision, it is superior to conventional instrumentation and could therefore be used to evaluate new alignment concepts.</description><identifier>ISSN: 1434-3916</identifier><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-022-04648-2</identifier><identifier>PMID: 36269397</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Arthroplasty, Replacement, Knee - methods ; Humans ; Joint replacement surgery ; Knee Arthroplasty ; Knee Joint - surgery ; Knee Prosthesis ; Medicine ; Medicine & Public Health ; Orthopedics ; Osteoarthritis, Knee - surgery ; Postoperative period ; Retrospective Studies ; Robotic Surgical Procedures ; Robotics ; Surgery, Computer-Assisted - methods</subject><ispartof>Archives of orthopaedic and trauma surgery, 2023-06, Vol.143 (6), p.3471-3479</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-83daf0fb23d461918be635b8cb619a005f75ee73aed2d2cd7a5a94b69025dfac3</citedby><cites>FETCH-LOGICAL-c375t-83daf0fb23d461918be635b8cb619a005f75ee73aed2d2cd7a5a94b69025dfac3</cites><orcidid>0000-0003-2696-1769</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00402-022-04648-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00402-022-04648-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36269397$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schrednitzki, Daniel</creatorcontrib><creatorcontrib>Horn, Christoph Eckhard</creatorcontrib><creatorcontrib>Lampe, Ute Anne</creatorcontrib><creatorcontrib>Halder, Andreas M.</creatorcontrib><title>Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>Purpose
Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bone resections. Several systems requiring preoperative imaging have shown a higher degree of precision compared to conventional instrumentation. An imageless system needs less preoperative time and preparation and is more cost effective. Aim of this study was to find out whether this system is as precise, reproduces accurately the surgeon's planning and reduces the occurrence of outliers.
Methods
This retrospective study included the first 71 robotic-assisted TKA and 308 conventional TKA in 374 patients. Intraoperatively planned and actual bone resections were compared. Postoperative alignment, measured on full leg weight bearing radiographs, was related to the respective planning and statistically compared between the groups.
Results
Baseline characteristics (age, BMI, ASA, preoperative Knee Society Score and deformity) between both groups were comparable. According to the planned alignment, the postoperative mean difference was – 1.01° in the robotic versus 2.05° in the conventional group. The maximum deviation was − 2/+ 2.5° in the robotic and – 6.6/ + 6.8° in the conventional group. According to the plan, there were no outliers above ± 3° in the robotic versus 24% in the conventional group.
The mean difference between planned and measured bone resection was 0.21 mm with a maximum of 2 mm. The 95% confidence interval was at each position 1 mm or below.
Conclusions
The described imageless robotic system is accurate in terms of coronal alignment and bone resections. In precision, it is superior to conventional instrumentation and could therefore be used to evaluate new alignment concepts.</description><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Humans</subject><subject>Joint replacement surgery</subject><subject>Knee Arthroplasty</subject><subject>Knee Joint - surgery</subject><subject>Knee Prosthesis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Postoperative period</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures</subject><subject>Robotics</subject><subject>Surgery, Computer-Assisted - methods</subject><issn>1434-3916</issn><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctuFDEQRS0EIiHwAyyQJTZsGvzqFzsU8YgUiQ2srWq7etKh225c7pHmS_hdPJnwEAsWll3yubdKdRl7LsVrKUT7hoQwQlVClWMa01XqATuXRptK97J5-Nf7jD0huhVCqq4Xj9mZblTT6749Zz-uFtjhjEQ8xSHmyVVANFFGz3PMMPNvAZFDyjcprjNQPvCJODi3JcjIp8D30z6-5cAT5hRpRZenPXLKmz8UC74g0JaQ5xvka6QcVyzKIzLEgEVFR0UMHILnME-7sGDIT9mjEWbCZ_f3Bfv64f2Xy0_V9eePV5fvriun2zpXnfYwinFQ2ptG9rIbsNH10LmhVCBEPbY1YqsBvfLK-RZq6M3Q9ELVfgSnL9irk--a4vcNKdtlIofzDAHjRla1qm2M6FRb0Jf_oLdxS6FMZ1UnS_vO3FHqRLmyDEo42jVNC6SDlcIeY7On2GyJzd7FZlURvbi33oYF_W_Jr5wKoE8Ala-ww_Sn939sfwJ_t6bH</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Schrednitzki, Daniel</creator><creator>Horn, Christoph Eckhard</creator><creator>Lampe, Ute Anne</creator><creator>Halder, Andreas M.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2696-1769</orcidid></search><sort><creationdate>20230601</creationdate><title>Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment</title><author>Schrednitzki, Daniel ; Horn, Christoph Eckhard ; Lampe, Ute Anne ; Halder, Andreas M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-83daf0fb23d461918be635b8cb619a005f75ee73aed2d2cd7a5a94b69025dfac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Arthroplasty, Replacement, Knee - methods</topic><topic>Humans</topic><topic>Joint replacement surgery</topic><topic>Knee Arthroplasty</topic><topic>Knee Joint - surgery</topic><topic>Knee Prosthesis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Postoperative period</topic><topic>Retrospective Studies</topic><topic>Robotic Surgical Procedures</topic><topic>Robotics</topic><topic>Surgery, Computer-Assisted - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schrednitzki, Daniel</creatorcontrib><creatorcontrib>Horn, Christoph Eckhard</creatorcontrib><creatorcontrib>Lampe, Ute Anne</creatorcontrib><creatorcontrib>Halder, Andreas M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of orthopaedic and trauma surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schrednitzki, Daniel</au><au>Horn, Christoph Eckhard</au><au>Lampe, Ute Anne</au><au>Halder, Andreas M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment</atitle><jtitle>Archives of orthopaedic and trauma surgery</jtitle><stitle>Arch Orthop Trauma Surg</stitle><addtitle>Arch Orthop Trauma Surg</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>143</volume><issue>6</issue><spage>3471</spage><epage>3479</epage><pages>3471-3479</pages><issn>1434-3916</issn><issn>0936-8051</issn><eissn>1434-3916</eissn><abstract>Purpose
Conventional instruments for total knee arthroplasty (TKA) have limited accuracy. The occurrence of outliers can negatively influence the clinical outcome and long-term survival of the implant. Orthopaedic robotic systems were developed to increase the accuracy of implant positioning and bone resections. Several systems requiring preoperative imaging have shown a higher degree of precision compared to conventional instrumentation. An imageless system needs less preoperative time and preparation and is more cost effective. Aim of this study was to find out whether this system is as precise, reproduces accurately the surgeon's planning and reduces the occurrence of outliers.
Methods
This retrospective study included the first 71 robotic-assisted TKA and 308 conventional TKA in 374 patients. Intraoperatively planned and actual bone resections were compared. Postoperative alignment, measured on full leg weight bearing radiographs, was related to the respective planning and statistically compared between the groups.
Results
Baseline characteristics (age, BMI, ASA, preoperative Knee Society Score and deformity) between both groups were comparable. According to the planned alignment, the postoperative mean difference was – 1.01° in the robotic versus 2.05° in the conventional group. The maximum deviation was − 2/+ 2.5° in the robotic and – 6.6/ + 6.8° in the conventional group. According to the plan, there were no outliers above ± 3° in the robotic versus 24% in the conventional group.
The mean difference between planned and measured bone resection was 0.21 mm with a maximum of 2 mm. The 95% confidence interval was at each position 1 mm or below.
Conclusions
The described imageless robotic system is accurate in terms of coronal alignment and bone resections. In precision, it is superior to conventional instrumentation and could therefore be used to evaluate new alignment concepts.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36269397</pmid><doi>10.1007/s00402-022-04648-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2696-1769</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1434-3916 |
| ispartof | Archives of orthopaedic and trauma surgery, 2023-06, Vol.143 (6), p.3471-3479 |
| issn | 1434-3916 0936-8051 1434-3916 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Arthroplasty, Replacement, Knee - methods Humans Joint replacement surgery Knee Arthroplasty Knee Joint - surgery Knee Prosthesis Medicine Medicine & Public Health Orthopedics Osteoarthritis, Knee - surgery Postoperative period Retrospective Studies Robotic Surgical Procedures Robotics Surgery, Computer-Assisted - methods |
| title | Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment |
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