Clinical Orthopaedics and Related Research®

, Volume 473, Issue 1, pp 206–212 | Cite as

High Degree of Accuracy of a Novel Image-free Handheld Robot for Unicondylar Knee Arthroplasty in a Cadaveric Study

  • Jess H. LonnerEmail author
  • Julie R. Smith
  • Frederic Picard
  • Brian Hamlin
  • Philip J. Rowe
  • Philip E. Riches
Symposium: 2014 Knee Society Proceedings



Surgical robotics has been shown to improve the accuracy of bone preparation and soft tissue balance in unicondylar knee arthroplasty (UKA). However, although extensive data have emerged with regard to a CT scan-based haptically constrained robotic arm, little is known about the accuracy of a newer alternative, an imageless robotic system.


We assessed the accuracy of a novel imageless semiautonomous freehand robotic sculpting system in performing bone resection and preparation in UKA using cadaveric specimens.


In this controlled study, we compared the planned and final implant placement in 25 cadaveric specimens undergoing UKA using the new tool. A quantitative analysis was performed to determine the translational, angular, and rotational differences between the planned and achieved positions of the implants.


The femoral implant rotational mean error was 1.04° to 1.88° and mean translational error was 0.72 to 1.29 mm across the three planes. The tibial implant rotational mean error was 1.48° to 1.98° and the mean translational error was 0.79 to 1.27 mm across the three planes.


The image-free robotic sculpting tool achieved accurate implementation of the surgical plan with small errors in implant placement. The next step will be to determine whether accurate implant placement translates into a clinical and functional benefit for the patient.


Root Mean Square Error Femoral Component Robotic System Tibial Component Robotic Technology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the technicians in the Anatomy Laboratory at Strathclyde University for their help during the project.


  1. 1.
    Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten year follow-up study. J Bone Joint Surg Am. 2002;84:2235–2239.PubMedGoogle Scholar
  2. 2.
    Australian Orthopaedic Association National Joint Replacement Registry. Available at: Accessed September 13, 2013.
  3. 3.
    Berger RA, Meneghine RM, Jacobs JJ, Sheinkop MB, Della Valle CJ, Rosenberg AG, Galante JO. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2005;87:999–1006.PubMedCrossRefGoogle Scholar
  4. 4.
    Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery: 10-year minimum follow-up period. J Arthroplasty. 1996;11:782–788.PubMedCrossRefGoogle Scholar
  5. 5.
    Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the Acrobot system. J Bone Joint Surg Br. 2006;88:188–197.PubMedCrossRefGoogle Scholar
  6. 6.
    Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty. 2006;21(Suppl):108–115.PubMedCrossRefGoogle Scholar
  7. 7.
    Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA. Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. J Arthroplasty. 2012;27:803–808.e1.Google Scholar
  8. 8.
    Gioe TJ, Killeen KK, Hoeffel DP, Bert JM, Comfort T, Scheltema K, Mehle S, Grimm K. Analysis of unicompartmental knee arthroplasty in a community-based implant registry. Clin Orthop Relat Res. 2003;416:111–119.PubMedCrossRefGoogle Scholar
  9. 9.
    Gioe TJ, Novak C, Sinner P, Ma W, Mehle S. Knee arthroplasty in the young patient: survival in a community registry. Clin Orthop Relat Res. 2007;464:83–87.PubMedGoogle Scholar
  10. 10.
    Hamilton WG, Collier MB, Tarabee E, McAuley JP, Engh CA Jr, Engh GA. Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty. J Arthroplasty. 2006;21(Suppl):98–107.PubMedCrossRefGoogle Scholar
  11. 11.
    Heck DA, Marmor L, Gibson A, Rougraff BT. Unicompartmental knee arthroplasty: a multicenter investigation with long-term follow-up evaluation. Clin Orthop Relat Res. 1993;286:154–159.PubMedGoogle Scholar
  12. 12.
    Hernigou P. Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res. 2004;423:161–165.PubMedCrossRefGoogle Scholar
  13. 13.
    Jenny JY, Boeri C. Unicompartmental knee prosthesis implantation with a non-image-based navigation system: rationale, technique, case-control comparative study with a conventional instrumented implantation. Knee Surg Sports Traumatol Arthrosoc. 2003;11:40–45.Google Scholar
  14. 14.
    Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. Clin Orthop Relat Res. 1991;273:151–156.PubMedGoogle Scholar
  15. 15.
    Lewold S, Robertsson O, Knutson K, Lidgren L. Revision of unicompartmental knee arthroplasty Outcome in 1,135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand. 1998;69:469–474.PubMedCrossRefGoogle Scholar
  16. 16.
    Lombardi AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res. 2009;467:1450–1457.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res. 2010;468:141–146.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Lustig S, Paillot JL, Servien E, Henry J, Ait Si Selmi T, Neyret P. Cemented all polyethylene tibial insert unicompartmental knee arthroplasty: a long term follow-up study. Orthop Traumatol Surg Res. 2009;95:12–21.Google Scholar
  19. 19.
    Marmor L. Unicompartmental arthroplasty of the knee with a minimum of 10 year follow up. Clin Orthop Relat Res. 1988;228:171–177.PubMedGoogle Scholar
  20. 20.
    Murray DW, Goodfellow JW, O’Connor JJ. The Oxford medial unicompartmental arthroplasty: a ten-year survival study. J Bone Joint Surg Br. 1998;80:983–989.PubMedCrossRefGoogle Scholar
  21. 21.
  22. 22.
    New Zealand Joint Registry. Available at: Accessed September 13, 2013.
  23. 23.
    Norwegian Arthroplasty Register. Available at: Accessed September 13, 2013.
  24. 24.
    Noticewala MS, Geller JA, Lee JH, Macaulay W. Unicompartmental knee arthroplasty relieves pain and improves function more than total knee arthroplasty. J Arthroplasty. 2012;27(Suppl):99–105.PubMedCrossRefGoogle Scholar
  25. 25.
    Orthopedic Network News. 2013 Hip and Knee Implant Review. Available at: 2013;24. Accessed September 14, 2013.
  26. 26.
    Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplasty. 2008;23:408–412.PubMedCrossRefGoogle Scholar
  27. 27.
    Ridgeway SR, McAuley PJ, Ammeen DJ, Engh GA. The effect of alignment of the knee on the outcome of unicompartmental knee replacement. J Bone Joint Surg Br. 2002;84:351–355.PubMedCrossRefGoogle Scholar
  28. 28.
    Smith JR, Picard F, Rowe PJ, Deakin A, Riches PE. The accuracy of a robotically-controlled freehand sculpting tool for unicondylar knee arthroplasty. J Bone Joint Surg Br. 2013;95(Suppl):68.Google Scholar
  29. 29.
    Smith JR, Riches PE, Rowe PJ. Accuracy of a freehand sculpting tool for unicondylar knee replacement. Int J Med Robot. 2013 Aug 11 [Epub ahead of print].Google Scholar
  30. 30.
    SooHoo NF, Sharifi H, Kominski G, Lieberman JR. Cost effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am. 2006;88:1975–1982.PubMedCrossRefGoogle Scholar
  31. 31.
    Squire MW, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Unicompartmental knee replacement: a minimum 15 year follow up study. Clin Orthop Relat Res. 1999;367:61–72.PubMedCrossRefGoogle Scholar
  32. 32.
    Swedish Knee Arthroplasty Register. Available at: Accessed September 13, 2013.
  33. 33.
    Thornhill TS, Scott RD. Unicompartmental total knee arthroplasty. Orthop Clin North Am. 1989;20:245–256.PubMedGoogle Scholar
  34. 34.
    Wiles AD, Thompson DG, Frantz DD. Accuracy assessment and interpretation for optical tracking systems. Medical Imaging. 2004;5367:421–432.Google Scholar
  35. 35.
    Willis-Owen CA, Brust K, Alsopa H, Miraldo M, Cobb JP. Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. Knee. 2009;16:473–478.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Jess H. Lonner
    • 1
    Email author
  • Julie R. Smith
    • 2
    • 3
  • Frederic Picard
    • 4
  • Brian Hamlin
    • 5
  • Philip J. Rowe
    • 2
  • Philip E. Riches
    • 2
  1. 1.Department of Orthopaedic Surgery, Rothman InstituteThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Biomedical Engineering DepartmentUniversity of StrathclydeGlasgowUK
  3. 3.Blue Belt Technologies IncPlymouthUSA
  4. 4.Department of OrthopaedicsGolden Jubilee National HospitalGlasgowUK
  5. 5.The Bone & Joint CenterMagee-Womens Hospital of UPMCPittsburghUSA

Personalised recommendations