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Preliminary experience with an image-free handheld robot for total knee arthroplasty: 77 cases compared with a matched control group

Abstract

Background

Achieving an optimal limb alignment is an important factor affecting the long-term survival of total knee arthroplasty (TKA). This is the first study to look at the limb alignment and orientation of components in TKA using a novel image-free handheld robotic sculpting system.

Methods

This case-controlled study retrospectively compared limb and component alignment of 77 TKAs performed with a robot (Robot-group) with a matched control group of patients who received conventional alignment with intramedular rods (Control group). Alignment and component positioning was measured on full-leg weight-bearing and standard lateral X-rays by two independent observers. The image-free handheld robotic sculpting system calculated the planned and achieved mechanical axis (MA). Outliers were defined as > 3° deviation from planned alignment.

Results

Mean MA was 180.1° (SD = 1.9) in the Robot-group, compared to the Control group with a mean MA of 179.1° (SD = 3.1, p = 0.028). We observed 5 outliers (6%) in the Robot-group and 14 outliers (18%, p = 0.051) in the Control group. Fraction of outliers of the frontal tibial component was 0% in the Robot-group versus 8% in the Control group (p = 0.038). There were no other statistical differences regarding the implant positioning between both groups.

Conclusion

The Robot-group showed significantly less outliers compared to the conventional technique. Whether these differences are clinically relevant is questionable and should be investigated on the long term. Randomized controlled trials with larger patient series will be needed in the future to confirm our preliminary results.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

Authors

Contributions

PB conceived, designed, coordinated the study and drafted the manuscript. AB coordinated the study, collected data and drafted the manuscript. JM conceived the study and critically reviewed the manuscript. SK analyzed the data and drafted the manuscript. MS participated in the design of the study, analyzed the data and critically reviewed the manuscript. DJ participated in the design of the study, coordinated the study and critically reviewed the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to P. Bollars.

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Conflict of interest

PB and JM are consultants on the NAVIO Robotic technique for Smith & Nephew, Europe. The other authors certify that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted abstract.

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Ethical approval by the local ethical committee was obtained for this study.

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Informed consent was not necessary since it was a retrospective study.

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Bollars, P., Boeckxstaens, A., Mievis, J. et al. Preliminary experience with an image-free handheld robot for total knee arthroplasty: 77 cases compared with a matched control group. Eur J Orthop Surg Traumatol 30, 723–729 (2020). https://doi.org/10.1007/s00590-020-02624-3

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  • DOI: https://doi.org/10.1007/s00590-020-02624-3

Keywords

  • Total knee arthroplasty
  • Total knee replacement
  • Knee
  • Robot
  • Image-free handheld
  • NAVIO
  • Precision freehand sculpting system
  • Outliers
  • Alignment