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Achieving functional alignment in total knee arthroplasty: early experience using a second-generation imageless semi-autonomous handheld robotic sculpting system

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Abstract

Purpose

In order to minimize errors during achieving the targeted alignment of the total knee arthroplasty (TKA) components, robotic-assisted surgery has been introduced with the aim to help surgeons to improve implant survival, clinical outcomes, and patient satisfaction. The primary goal of this paper is to highlight surgical tips and tricks on how to achieve functional alignment (FA) through intra-operative boney mapping, numeric gap, and alignment data, using the next generation of imageless robotic surgical systems.

Method

This retrospective case-series contains planned and achieved data on the FA and joint gap data obtained from 526 patients captured and assessed with use of a semi-autonomous imageless handheld robotic sculpting systems. All patients were operated upon by two experienced TKA surgeons.

Results

The mean difference between planned and achieved alignment was 1.46° (≥ 7° varus group), 1.02° (< 7° varus group), 1.16° (< 7° valgus group), and 1.43° (≥ 7° valgus group). The mean observed planned and achieved extension and flexion gaps were below 1.47 mm for medial extension gaps, 1.12 mm for the lateral extension gaps, 1.4 mm for the medial flexion gaps, and 1.16 mm for the lateral flexion gaps.

Conclusion

Analysis of these first cases highlights the capability of the next generation of imageless robotic-assisted total knee replacement using a semi-autonomous handheld robotic sculpting to maintain accuracy of the desired alignment. The system allows the surgeon to choose freely their own alignment philosophy while maintaining efficiency.

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Author information

Authors and Affiliations

  1. St. Trudo Hospital, Sint-Truiden, Belgium

    Peter Bollars

  2. Orthocure Medical Center, Dubai, UAE

    Prashant Meshram, Saeed Al Thani & Ali Albelooshi

  3. Mediclinic City Hospital, Dubai, UAE

    Prashant Meshram, Saeed Al Thani & Ali Albelooshi

  4. Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Centre, Sittard-Geleen, Netherlands

    Martijn G. M. Schotanus

  5. School of Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands

    Martijn G. M. Schotanus

  6. Clemanceau Medical Center, Dubai, UAE

    Ali Albelooshi

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  5. Ali Albelooshi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Prashant Meshram and Saeed Al Thani. The first draft of the manuscript was written by Peter Bollars and Ali Albelooshi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ali Albelooshi.

Ethics declarations

Ethics approval

This is a retrospective study that only contains data obtained from the robot. No direct or indirect data related from human participants was used. Research Ethics Committee approval is not required.

Consent to participate

Informed consent was not obtained from individual participants since no data from participants is included in the study. Only data obtained from a robot was used.

Consent to publish

Not applicable.

Conflict of interests

Financial interests: Author PM, SA and MGM declare they have no financial interests. Authors PB and AB have received speaker honorarium, research funding, and travel support from Smith & Nephew.

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Bollars, P., Meshram, P., Al Thani, S. et al. Achieving functional alignment in total knee arthroplasty: early experience using a second-generation imageless semi-autonomous handheld robotic sculpting system. International Orthopaedics (SICOT) 47, 585–593 (2023). https://doi.org/10.1007/s00264-022-05649-x

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