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Increased accuracy in component positioning using an image-less robotic arm system in primary total knee arthroplasty: a retrospective study

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

Abstract

Background

Robotic-assisted total knee arthroplasty (RTKA) and navigated total knee arthroplasty (NTKA) have shown improved knee alignment and reduced radiographic outliers. Recent studies have proven that conventional mechanical alignment may not be the optimal goal for every patient. The aim of this study was to compare the accuracy of the planned implant positioning of a novel image-less robotic technique with an established navigated technique (NTKA).

Method

The study is a retrospective analysis of prospectively collected data that compared the implant positioning and lower-limb alignment of 86 image-less RTKA with 86 image-less NTKA. Radiographic analysis was performed to evaluate the lower-limb overall alignment, femoral and tibial components positioning in the coronal and sagittal planes. Outliers were evaluated with a cutoff of ± 3°.

Results

No difference was noted between the two groups for radiographic outliers within ± 3° from neutral (p = 0.098). The mean hip–knee–ankle angle deviation from target was 1.3° in the RTKA group compared to 1.9° in the NTKA (p < 0.001). Femoral sagittal deviation (femoral component flexion) was smaller in the RTKA group (0.9° vs 1.9°; p < 0.001). Similarly, tibial coronal deviation (0.8° vs 1.5°; p < 0.001) and tibial sagittal deviation (tibial slope) were smaller in the RTKA group compared to the NTKA group (0.9° vs 1.7°; p < 0.001).

Conclusions

The RTKA group reported a substantial and significant reduced error from the planned target angles for both tibial and femoral components. No difference in terms of radiographic outliers was noted between navigation and robotic assistance.

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Authors and Affiliations

  1. Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy

    Fabio Mancino, Stefano Marco Paolo Rossi, Rudy Sangaletti, Matteo Caredda & Francesco Benazzo

  2. Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, WA, Australia

    Fabio Mancino

  3. Università Cattolica del Sacro Cuore, Rome, Italy

    Matteo Caredda

  4. Università degli Studi di Pavia, Pavia, Italy

    Rudy Sangaletti

  5. U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy

    Flavio Terragnoli

  6. IUSS Istituto Universitario Di Studi Superiori, Pavia, Italy

    Francesco Benazzo

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  1. Fabio Mancino
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Contributions

SMPR and FB designed the study. FB, SMPR and FT performed the surgeries. FM, RS and MC collected the data. FM and SMPR performed radiographic analysis. FM drafted the manuscript. SMPR critically revised it. FB gave the final approval before submission. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Stefano Marco Paolo Rossi.

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Conflict of interest

Prof. Francesco Benazzo declares a teaching contract with the manufacturer (Zimmer Biomet); Dr. Fabio Mancino received a research grant from the manufacturer (Zimmer Biomet); the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript; all other authors declare no conflict of interest related to the present study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required. All patients signed an informed consent for the surgical procedure.

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Mancino, F., Rossi, S.M.P., Sangaletti, R. et al. Increased accuracy in component positioning using an image-less robotic arm system in primary total knee arthroplasty: a retrospective study. Arch Orthop Trauma Surg 144, 393–404 (2024). https://doi.org/10.1007/s00402-023-05062-y

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