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In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

There is great interest in providing reliable and durable treatments for one- and two-compartment arthritic degeneration of the cruciate-ligament intact knee. One approach is to resurface only the diseased compartments with discrete unicompartmental components, retaining the undamaged compartment(s). However, placing multiple small implants into the knee presents a greater surgical challenge than total knee arthroplasty, so it is not certain that the natural knee mechanics can be maintained or restored. The goal of this study was to determine whether near-normal knee kinematics can be obtained with a robot-assisted multi-compartmental knee arthroplasty.

Methods

Thirteen patients with 15 multi-compartmental knee arthroplasties using haptic robotic-assisted bone preparation were involved in this study. Nine subjects received a medial unicompartmental knee arthroplasty (UKA), three subjects received a medial UKA and patellofemoral (PF) arthroplasty, and three subjects received medial and lateral bi-unicondylar arthroplasty. Knee motions were recorded using video-fluoroscopy an average of 13 months (6–29 months) after surgery during stair and kneeling activities. The three-dimensional position and orientation of the implant components were determined using model-image registration techniques.

Results

Knee kinematics during maximum flexion kneeling showed femoral external rotation and posterior lateral condylar translation. All knees showed femoral external rotation and posterior condylar translation with flexion during the step activity. Knees with medial UKA and PF arthroplasty showed the most femoral external rotation and posterior translation, and knees with bicondylar UKA showed the least.

Conclusions

Knees with accurately placed uni- or bi-compartmental arthroplasty exhibited stable knee kinematics consistent with intact and functioning cruciate ligaments. The patterns of tibiofemoral motion were more similar to natural knees than commonly has been observed in knees with total knee arthroplasty. Larger series are required to confirm these as general observations, but the present results demonstrate the potential to restore or maintain closer-to-normal knee kinematics by retaining intact structures and compartments.

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Acknowledgments

This work was supported by research grants from and employees of MAKO Surgical Corp. The authors acknowledge significant contributions in the conception, planning, and execution of this study from Nicholas J. Dunbar, Alex Iorgulescu, and Kevin Leffers, MD.

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Authors and Affiliations

  1. Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA

    Toshifumi Watanabe & Scott A. Banks

  2. Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA

    Scott A. Banks

  3. MAKO Surgical Corp, Fort Lauderdale, FL, USA

    Ali Z. Abbasi, Michael A. Conditt, Jennifer Christopher & Jason K. Otto

  4. Memorial Bone and Joint Clinic, Houston, TX, USA

    Stefan Kreuzer

  5. Department of Cartilage Regeneration, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Toshifumi Watanabe

Authors
  1. Toshifumi Watanabe
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  2. Ali Z. Abbasi
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  3. Michael A. Conditt
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  4. Jennifer Christopher
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  5. Stefan Kreuzer
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  6. Jason K. Otto
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  7. Scott A. Banks
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Correspondence to Toshifumi Watanabe.

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Watanabe, T., Abbasi, A.Z., Conditt, M.A. et al. In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty. J Orthop Sci 19, 552–557 (2014). https://doi.org/10.1007/s00776-014-0578-3

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  • DOI: https://doi.org/10.1007/s00776-014-0578-3

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