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Joint line is restored in robotic-arm-assisted total knee arthroplasty performed with a tibia-based functional alignment

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Functional alignment (FA) in total knee arthroplasty (TKA) has been introduced to restore the native joint line obliquity, respect the joint line height and minimize the need of soft tissue releases. The purpose of this study was to assess the intraoperative joint line alignment and compare it with the preoperative epiphyseal orientation of the femur and tibia in patients undergoing robotic-arm-assisted (RA)-TKA using FA.

Materials and Methods

This retrospective study included a consecutive series of patients undergoing RA-TKA between February 2019 and February 2021. The joint line orientation of the femur and tibia in the three-dimensions was calculated and classified on preoperative CT-scans and compared with the intraoperative implant alignment. The tibial cut was performed according to the tibial preoperative anatomy. The femoral cuts were fine-tuned based on tensioned soft tissues, aiming for balanced medial and lateral gaps in flexion and extension.

Results

A total of 115 RA-TKAs were assessed. On average, the tibial component was placed at 1.8° varus (SD 1.3), while the femur was placed at 0.8° valgus (SD 2.2) and 0.6° external rotation (SD 2.6) relative to the surgical transepicondylar axis. Moderate to strong, statistically significant relationships were described between preoperative tibial coronal alignment and tibial cut orientation (r = 0.7, p < 0.0001), preoperative femoral orientation in the coronal and axial planes and intraoperative femoral cuts alignment (r = 0.7, p < 0.0001 and r = 0.5, p < 0.0001, respectively). One case (0.9%) of slight tibial component varus subsidence was reported 45-days post-operatively, but implant revision was not necessary.

Conclusions

The proposed robotic-assisted functional technique for TKA alignment, with a restricted tibial component coronal alignment, based on the preoperative phenotype and femoral component positioning as dictated by the soft tissues, provided joint line respecting resections. Further studies are needed to assess long-term implant survivorship, patient satisfaction and alignment-related failures.

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Acknowledgements

The authors would like to thank Laura Scholl, MSc for English language editing.

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

  1. Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio-Emilia, Modena, Italy

    Francesco Zambianchi, Gabriele Bazzan, Andrea Marcovigi, Andrea Illuminati, Andrea Ensini & Fabio Catani

  2. Ab Medica S.P.A, Cerro Maggiore, MI, Italy

    Marco Pavesi

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  1. Francesco Zambianchi
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  2. Gabriele Bazzan
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  3. Andrea Marcovigi
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  6. Andrea Ensini
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  7. Fabio Catani
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Contributions

FZ—developed the study protocol, performed data interpretation and wrote the manuscript. GB—collected primary data. AM—performed data analysis and interpretation. MP—collected primary data. AI—performed data analysis. AE—revised the manuscript critically. FC—generated the study hypothesis, performed data interpretation and critically appraised the manuscript.

Corresponding author

Correspondence to Francesco Zambianchi.

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Conflict of interest

The authors Francesco Zambianchi, Gabriele Bazzan, Andrea Marcovigi, Andrea Illuminati and Andrea Ensini or any member of their immediate family, have no funding or 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. The author Marco Pavesi is a paid employee of Ab Medica S.p.A. The author Fabio Catani reports consultancy and speaking fees, royalties, and fees for participation in review activities from Stryker and consultancy fees from Adler.

Ethics approval

Given the retrospective nature of the study, which was conducted on already available data and without involving subjects, Ethics Approval was not necessary.

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Zambianchi, F., Bazzan, G., Marcovigi, A. et al. Joint line is restored in robotic-arm-assisted total knee arthroplasty performed with a tibia-based functional alignment. Arch Orthop Trauma Surg 141, 2175–2184 (2021). https://doi.org/10.1007/s00402-021-04039-z

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  • DOI: https://doi.org/10.1007/s00402-021-04039-z

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