Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study

Abstract

Purpose

The authors performed this study to compare the outcomes of robotic-assisted and conventional TKA in same patient simultaneously. It was hypothesized that the robotic-assisted procedure would produce better leg alignment and component orientation, and thus, improve patient satisfaction and clinical and radiological outcomes.

Methods

Thirty patients underwent bilateral sequential total knee replacement. One knee was replaced by robotic-assisted implantation and the other by conventional implantation.

Results

Radiographic results showed significantly more postoperative leg alignment outliers of conventional sides than robotic-assisted sides (mechanical axis, coronal inclination of the femoral prosthesis, and sagittal inclination of the tibial prosthesis). Robotic-assisted sides had non-significantly better postoperative knee scores and ROMs. Robotic-assisted sides needed longer operation times (25 min, SD ± 18) and longer skin incisions. Nevertheless, postoperative bleeding was significantly less for robotic-assisted sides.

Conclusion

The better alignment accuracy of robotic TKA and the good clinical results achieved may favorably influence clinical and radiological outcomes.

Level of evidence

I.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Bathis H, Perlick L, Tingart M, Perlick C, Luring C, Grifka J (2005) Intraoperative cutting errors in total knee arthroplasty. Arch Orthop Trauma Surg 125:16–20

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Bellemans J, Vandenneucker H, Vanlauwe J (2007) Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 464:111–116

    PubMed  Google Scholar 

  3. 3.

    Decking J, Theis C, Achenbach T, Roth E, Nafe B, Eckardt A (2004) Robotic total knee arthroplasty: the accuracy of CT-based component placement. Acta Orthop Scand 75:573–579

    PubMed  Article  Google Scholar 

  4. 4.

    Delp SL, Stulberg SD, Davies B, Picard F, Leitner F (1998) Computer assisted knee replacement. Clin Orthop Relat Res 354:49–56

    PubMed  Article  Google Scholar 

  5. 5.

    Fadda M, Marcacci M, Toksvig-Larsen S, Wang T, Meneghello R (1998) Improving accuracy of bone resections using robotics tool holder and a high speed milling cutting tool. J Med Eng Technol 22:280–284

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Griffin FM, Insall JN, Scuderi GR (2000) Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 15:970–973

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73:709–714

    PubMed  CAS  Google Scholar 

  8. 8.

    Jenny JY, Clemens U, Kohler S, Kiefer H, Konermann W, Miehlke RK (2005) Consistency of implantation of a total knee arthroplasty with a non-image-based navigation system: a case-control study of 235 cases compared with 235 conventionally implanted prostheses. J Arthroplasty 20:832–839

    PubMed  Article  Google Scholar 

  9. 9.

    Laskin RS (2001) The Genesis total knee prosthesis: a 10-year followup study. Clin Orthop Relat Res 388:95–102

    PubMed  Article  Google Scholar 

  10. 10.

    Laskin RS (2003) New techniques and concepts in total knee replacement. Clin Orthop Relat Res 416:151–153

    PubMed  Article  Google Scholar 

  11. 11.

    Laskin RS, Rieger MA (1989) The surgical technique for performing a total knee replacement arthroplasty. Orthop Clin North Am 20:31–48

    PubMed  CAS  Google Scholar 

  12. 12.

    Lutzner J, Krummenauer F, Wolf C, Gunther KP, Kirschner S (2008) Computer-assisted and conventional total knee replacement: a comparative, prospective, randomised study with radiological and CT evaluation. J Bone Joint Surg Br 90:1039–1044

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Mahaluxmivala J, Bankes MJ, Nicolai P, Aldam CH, Allen PW (2001) The effect of surgeon experience on component positioning in 673 press fit condylar posterior cruciate-sacrificing total knee arthroplasties. J Arthroplasty 16:635–640

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Maniar RN, Johorey AC, Pujary CT, Yadava AN (2011) Margin of error in alignment: a study undertaken when converting from conventional to computer-assisted total knee arthroplasty. J Arthroplasty 26:82–87

    Google Scholar 

  15. 15.

    Matsen FA 3rd, Garbini JL, Sidles JA, Pratt B, Baumgarten D, Kaiura R (1993) Robotic assistance in orthopaedic surgery. A proof of principle using distal femoral arthroplasty. Clin Orthop Relat Res 296:178–186

    PubMed  Google Scholar 

  16. 16.

    Mielke RK, Clemens U, Jens JH, Kershally S (2001) Navigation in knee endoprosthesis implantation–preliminary experiences and prospective comparative study with conventional implantation technique. Z Orthop Ihre Grenzgeb 139:109–116

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Novotny J, Gonzalez MH, Amirouche FML, Li YC (2001) Geometric analysis of potential error in using femoral intramedullary guides in total knee arthroplasty. J Arthroplasty 16:641–647

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Park SE, Lee CT (2007) Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty 22:1054–1059

    PubMed  Article  Google Scholar 

  19. 19.

    Petersen TL, Engh GA (1988) Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty 3:67–72

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Plaskos C, Hodgson AJ, Inkpen K, McGraw RW (2002) Bone cutting errors in total knee arthroplasty. J Arthroplasty 17:698–705

    PubMed  Article  Google Scholar 

  21. 21.

    Rand JA, Coventry MB (1988) Ten-year evaluation of geometric total knee arthroplasty. Clin Orthop Relat Res 232:168–173

    PubMed  Google Scholar 

  22. 22.

    Reed SC, Gollish J (1997) The accuracy of femoral intramedullary guides in total knee arthroplasty. J Arthroplasty 12:677–682

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156

    PubMed  Google Scholar 

  24. 24.

    Rodriguez JA, Bhende H, Ranawat CS (2001) Total condylar knee replacement: a 20-year followup study. Clin Orthop Relat Res 388:10–17

    PubMed  Article  Google Scholar 

  25. 25.

    Saragaglia D, Picard F, Chaussard C, Montbarbon E, Leitner F, Cinquin P (2001) Computer-assisted knee arthroplasty: comparison with a conventional procedure. Results of 50 cases in a prospective randomized study. Rev Chir Orthop Reparatrice Appar Mot 87:18–28

    PubMed  CAS  Google Scholar 

  26. 26.

    Scott WN, Rubinstein M, Scuderi G (1988) Results after knee replacement with a posterior cruciate-substituting prosthesis. J Bone Joint Surg Am 70:1163–1173

    PubMed  CAS  Google Scholar 

  27. 27.

    Siebert W, Mai S, Kober R, Heeckt PF (2002) Technique and first clinical results of robot-assisted total knee replacement. Knee 9:173–180

    PubMed  Article  Google Scholar 

  28. 28.

    Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support—A prospective, randomised study. J Bone Joint Surg Br 85B:830–835

    Google Scholar 

  29. 29.

    Takahashi T, Wada Y, Yamamoto H (1997) Soft-tissue balancing with pressure distribution during total knee arthroplasty. J Bone Joint Surg Br 79B:235–239

    Article  Google Scholar 

  30. 30.

    Van Ham G, Denis K, Vander Sloten J, Van Audekercke R, Van der Perre G, De Schutter J, Aertbelien E, Demey S, Bellemans J (1998) Machining and accuracy studies for a tibial knee implant using a force-controlled robot. Comput Aided Surg 3:123–133

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

None of the authors received financial support for this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jong-Keun Seon.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Song, EK., Seon, JK., Park, SJ. et al. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 19, 1069–1076 (2011). https://doi.org/10.1007/s00167-011-1400-9

Download citation

Keywords

  • Total knee arthroplasty
  • Surgical robot
  • Mechanical axis
  • Inclination of component
  • Clinical outcome