Robotic-assisted knee arthroplasty has been clinically available for the past 2 decades, but is still in the early stages of adoption for use in total knee arthroplasty (TKA). The purpose of this technology is to improve the precision, accuracy, and reproducibility of TKA. Robotic-assisted systems may be passive, semiactive, or active. Although robotic-assisted systems have been used extensively in unicondylar knee arthroplasty, there are relatively few studies of using this technology in TKA. These early studies have shown that robot-assisted technology may lead to improvements in both mechanical axis and component alignment. No studies have demonstrated that these radiographic improvements have translated into any clinical benefit, however. The purpose of this review is to introduce robotic-assisted systems for use in knee arthroplasty, describe the potential advantages and limitations associated with this technology, and review several of the systems that are currently available.
Studies have showed improved accuracy of lower leg alignment, precise component position, and soft-tissue balance with robotic-assisted unicompartmental knee arthroplasty (UKA). No studies, however, have assessed the effect on mid-term survivorship. Therefore, the purpose of this prospective multicenter study was to determine mid-tem survivorship, modes of failure, and satisfaction of robotic-assisted medial UKA.
473 consecutive patients (528 knees) underwent robotic-arm assisted medial UKA surgery at four separate institutions between March 2009 and December 2011. All patients received a fixed-bearing metal-backed onlay tibial component. Each patient was contacted at minimum five-year follow-up and asked a series of questions to determine survival and satisfaction. Kaplan-Meier method was used to determine survivorship.
Data was collected for 384 patients (432 knees) with mean follow-up of 5.7 years (5.0 – 7.7). The follow-up rate was 81.2%. In total, 13 revisions were performed, of which 11 knees were converted to TKA and in two cases one UKA component was revised, resulting in 97% survivorship. The mean time to revision was 2.27 years. The most common failure mode was aseptic loosening (7/13). Fourteen reoperations were reported. Of all unrevised patients, 91% was either very satisfied or satisfied with their knee function.
Robotic-arm assisted medial UKA showed high survivorship and satisfaction at mid-term follow-up in this prospective multicenter study. However, in spite of the robotic technique, early fixation failure remains the primary cause for revision with cemented implants. Comparative studies are necessary to confirm these findings and compare to conventional implanted UKA and TKA.
Computer-assisted surgical (CAS) navigation has been developed with the aim of improving the accuracy and precision of total knee arthroplasty (TKA) component positioning and therefore overall limb alignment. The historical goal of knee arthroplasty has been to restore the mechanical alignment of the lower limb by aligning the femoral and tibial components perpendicular to the mechanical axis of the femur and tibia. Despite over four decades of TKA component development and nearly two decades of interest in CAS, the fundamental question remains; does the alignment goal and/or the method of achieving that goal affect the outcome of the TKA in terms of patient reported outcome measures and/or overall survivorship? The quest for reliable and reproducible achievement of the intra-operative alignment goal has been the primary motivator for the introduction, development and refinement of CAS navigation. Numerous proprietary systems now exist and rapid technological advancements in computer processing power are stimulating further development of robotic surgical systems. Three categories of CAS can be defined; image-based large console navigation; imageless large-console navigation and more recently, accelerometer based hand-held navigation systems have been developed.
A review of the current literature demonstrates that there are enough well-designed studies to conclude that both large-console CAS and handheld navigation systems improve the accuracy and precision of component alignment in TKA. However, missing from the evidence base, other than the subgroup analysis provided by the AOANJRR, are any conclusive demonstrations of a clinical superiority in terms of improved patient reported outcome measures and/or decreased cumulative revision rates in the long term. Few authors would argue that accuracy of alignment is a goal to ignore, therefore in the absence of clinical evidence, many of the arguments against the use of large console CAS navigation centre on the prohibitive cost of the systems. The utilization of low-cost, handheld CAS navigation systems may therefore bridge this important gap and over time, further clinical evidence may emerge