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High degree of alignment precision associated with total knee arthroplasty performed using a surgical robot or handheld navigation

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the precision of bony resections during total knee arthroplasty (TKA) performed using different computer-assisted technologies.

Methods

Patients who underwent a primary TKA using an imageless accelerometer-based handheld navigation system (KneeAlign2®, OrthAlign Inc.) or computed tomography-based large-console surgical robot (Mako®, Stryker Corp.) from 2017 to 2020 were retrospectively reviewed. Templated alignment targets and demographic data were collected. Coronal plane alignment of the femoral and tibial components and tibial slope were measured on postoperative radiographs. Patients with excessive flexion or rotation preventing accurate measurement were excluded.

Results

A total of 240 patients who underwent TKA using either a handheld (n = 120) or robotic (n = 120) system were included. There were no statistically significant differences in age, sex, and BMI between groups. A small but statistically significant difference in the precision of the distal femoral resection was observed between the handheld and robotic cohorts (1.5° vs. 1.1° difference between templated and measured alignments, p = 0.024), though this is likely clinically insignificant. There were no significant differences in the precision of the tibial resection between the handheld and robotic groups (coronal plane 0.9° vs. 1.0°, n.s.; sagittal plane 1.2° vs. 1.1°, n.s.). There were no significant differences in the rate of overall precision between cohorts (n.s.).

Conclusions

A high degree of component alignment precision was observed for both imageless handheld navigation and CT-based robotic cohorts. Surgeons considering options for computer-assisted TKA should take other important factors, including surgical principles, templating software, ligament balancing, intraoperative adjustability, equipment logistics, and cost, into account.

Level of evidence

III.

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Data availability

The data that support the findings of this study are not openly accessible, but may be made available from the corresponding author upon request.

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Funding

No funding was obtained for the current study.

Author information

Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Tony S. Shen, Tyler J. Uppstrom, Ryan Cheng, David J. Mayman, Seth A. Jerabek & Michael P. Ast

  2. Department of Orthopaedic Surgery, UCLA, Los Angeles, CA, USA

    Paul J. Walker & Jonathan S. Yu

Authors
  1. Tony S. Shen
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  2. Tyler J. Uppstrom
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  3. Paul J. Walker
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  4. Jonathan S. Yu
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  5. Ryan Cheng
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  6. David J. Mayman
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  7. Seth A. Jerabek
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  8. Michael P. Ast
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Contributions

TSS study conception, methodology, data acquisition, statistical analysis, supervision, manuscript preparation. TJU data acquisition, statistical analysis, supervision, manuscript preparation. PJW data acquisition, statistical analysis, supervision, manuscript preparation. JSY data acquisition, statistical analysis, supervision, manuscript preparation. RC data acquisition, statistical analysis, supervision, manuscript preparation. DAM study conception, methodology, supervision, writing of initial manuscript, manuscript revision. SAJ study conception, methodology, supervision, writing of initial manuscript, manuscript revision. MPA study conception, methodology, supervision, writing of initial manuscript, manuscript revision.

Corresponding author

Correspondence to Tony S. Shen.

Ethics declarations

Conflict of interest

DJM receives royalties from Stryker, Smith and Nephew and OrthoAlign, and hold stock in OrthoAlign. SAJ receives royalties from Stryker. MPA is a paid consultant for Stryker, Smith and Nephew and OrthoAlign and recieved royalties from OrthoAlign. The remainder of the authors certify that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This study was approved by the Hospital for Special Surgery Institutional Review Board (IRB).

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Shen, T.S., Uppstrom, T.J., Walker, P.J. et al. High degree of alignment precision associated with total knee arthroplasty performed using a surgical robot or handheld navigation. Knee Surg Sports Traumatol Arthrosc 31, 4735–4740 (2023). https://doi.org/10.1007/s00167-023-07495-9

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  • DOI: https://doi.org/10.1007/s00167-023-07495-9

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