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Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Correct positioning and alignment of the prosthesis is a very important factor for durability of prosthesis and implant survival which is improved with the use of technology in total knee arthroplasty. However, the long-term functional outcomes and survivorship are unclear. For this study, it was hypothesized that mechanical axis alignment of lower limb, post-operative joint line restoration, femoral and tibial component alignment is more accurate with the new handheld semi-active robotic-assisted TKA.

Method

From April-2019 to March-2020, 60 patients with unilateral knee osteoarthritis who underwent total knee arthroplasties were included in this prospective randomised controlled study. Computer generated randomization was used. Study included 48 female patients and 12 male patients. Pre-operative and post-operative radiographic measurements were done and compared between the two groups.

Results

There was a significant difference between two groups with respect to mechanical axis deviation, joint line deviation and coronal alignment of femoral and tibial prosthesis. Mechanical axis deviation > 3° was seen in eight cases (28.5%) in C-TKA group compared to one case (3.1%) in RA-TKA (p 0.019). Joint line deviation of 3.5 mm was noted in C-TKA group as compared to 0.9 mm in RA-TKA group (p < 0.001) which was statistically significant. However, whether this difference of 2.6 mm of joint line elevation between C-TKA and RA-TKA leads to any difference in clinical outcome in terms of knee kinematics and knee flexion needs to be investigated with further studies. Clinically restoring normal joint line is important for improved knee function after primary TKA. No significant difference was noted in femoral component rotation on post-operative computed tomography (CT) scan.

Conclusion

The novel imageless, handheld semi-autonomous robotic system for TKA is highly accurate with respect to component positioning in coronal plane and mechanical alignment as compared to conventional TKA. Joint line is elevated in conventional TKA but is accurately restored using the robotic-assisted TKA which may lead to better patellofemoral kinematics.

Level of evidence

I.

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Abbreviations

RA-TKA:

Robotic-assisted total knee arthroplasty

C-TKA:

Conventional total knee arthroplasty

CT:

Computed tomography

TKA:

Total knee arthroplasty

CAS:

Computer-assisted surgery

HKA:

Hip–knee–ankle

SD:

Standard deviation

ICC:

Interobserver correlation coefficient

MAD:

Mechanical axis deviation

FCA:

Femoral coronal alignment

TCA:

Tibial coronal alignment

FSA:

Femoral sagittal alignment

TSA:

Tibial sagittal alignment

FCR:

Femoral component rotation

rTEA:

Radiographic trans-epicondylar axis

FPPCL:

Femoral prosthesis posterior condylar line

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Acknowledgements

The authors acknowledge Dr. Nidhi Nagar for helping with ethical committee and institutional review board approval, Dr. Vikas Sonale, Dr. Nilesh Kulkarni, Dr. Mukund Dhaniwala, Dr. Dhruva Chikara, Dr. Vijay Kamble, and Dr. Ravnik Bansod for their contribution in collecting the data required for the study.

Funding

No funding was received to conduct this study.

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Authors

Contributions

AD is the first reviewer, did all data collection and analysis, and drafted the manuscript. TP was the second reviewer, helped with the data analysis, and performed the statistical analysis and edited the manuscript. PP and TJ helped with acquisition of data and helped in editing the manuscript. NV and RP critically proof read the entire manuscript and made the required changes. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Ajinkya N. Deshpande.

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No competing interests to declare.

Ethical approval

This study was approved by the ethics committee and institutional review board.

Informed consent

Informed consents were obtained from all the patients.

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Vaidya, N.V., Deshpande, A.N., Panjwani, T. et al. Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 30, 621–626 (2022). https://doi.org/10.1007/s00167-020-06353-2

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