{"title":"Individualized Functional Knee Alignment in Total Knee Arthroplasty: A Robotic-assisted Technique","authors":"G. Clark, C. Esposito, D. Wood","doi":"10.1097/BTO.0000000000000567","DOIUrl":null,"url":null,"abstract":"Introduction: The use of robotic technology is becoming a well-recognized alternative to conventional total knee arthroplasty (TKA). The quantitative soft tissue information generated in robotic surgery can be used to balance the knee and achieve functional alignment (FA) of the components. This paper describes a novel FA technique using an individualized preoperative plan that is then adjusted to achieve soft tissue balance. Materials and Methods: We report on surgical technique, indications, considerations, and complications after our experience of performing 650 functionally aligned TKAs. We collected 2-year patient reported outcomes on 165 TKAs in this series (165 of 193 TKAs have reached 2 years follow-up in the series of 650 TKAs; 85% follow-up rate). Results: We found significant postoperative improvements with few infections and no revisions for mechanical reasons 2 years after surgery with this technique. Patients had improved knee range-of-motion (105 degrees° flexion preoperatively vs. 125 degrees flexion postoperatively; P<0.001), higher Forgotten Joint Scores (17 preoperatively vs. 77 postoperatively; P<0.001), improved Oxford Knee Scores (22 preoperatively vs. 43 postoperatively; P<0.001), higher KOOS Jr scores (48 preoperatively vs. 88 postoperatively; P<0.001) and lower visual analogue score pain scores (70 preoperatively vs. 12 postoperatively; P<0.001) 2 years postoperatively. Discussion: The described surgical technique is a promising method for conducting a robotic TKA. Benefits of FA include improved efficiency with preresection balancing, reduced soft tissue releases compared with a mechanical alignment technique, and accurate bony cuts with robotic assistance. Further studies are required to compare this technique with established methods to determine any differences in outcomes.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"42 1","pages":"185 - 191"},"PeriodicalIF":0.2000,"publicationDate":"2021-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"12","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/BTO.0000000000000567","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 12
Abstract
Introduction: The use of robotic technology is becoming a well-recognized alternative to conventional total knee arthroplasty (TKA). The quantitative soft tissue information generated in robotic surgery can be used to balance the knee and achieve functional alignment (FA) of the components. This paper describes a novel FA technique using an individualized preoperative plan that is then adjusted to achieve soft tissue balance. Materials and Methods: We report on surgical technique, indications, considerations, and complications after our experience of performing 650 functionally aligned TKAs. We collected 2-year patient reported outcomes on 165 TKAs in this series (165 of 193 TKAs have reached 2 years follow-up in the series of 650 TKAs; 85% follow-up rate). Results: We found significant postoperative improvements with few infections and no revisions for mechanical reasons 2 years after surgery with this technique. Patients had improved knee range-of-motion (105 degrees° flexion preoperatively vs. 125 degrees flexion postoperatively; P<0.001), higher Forgotten Joint Scores (17 preoperatively vs. 77 postoperatively; P<0.001), improved Oxford Knee Scores (22 preoperatively vs. 43 postoperatively; P<0.001), higher KOOS Jr scores (48 preoperatively vs. 88 postoperatively; P<0.001) and lower visual analogue score pain scores (70 preoperatively vs. 12 postoperatively; P<0.001) 2 years postoperatively. Discussion: The described surgical technique is a promising method for conducting a robotic TKA. Benefits of FA include improved efficiency with preresection balancing, reduced soft tissue releases compared with a mechanical alignment technique, and accurate bony cuts with robotic assistance. Further studies are required to compare this technique with established methods to determine any differences in outcomes.
机器人技术的使用正在成为传统全膝关节置换术(TKA)的公认替代方案。机器人手术中产生的定量软组织信息可用于平衡膝关节并实现部件的功能对齐(FA)。本文描述了一种新的FA技术,使用个性化的术前计划,然后调整以达到软组织平衡。材料和方法:我们报告650例功能对齐tka手术后的手术技术、适应证、注意事项和并发症。我们收集了该系列中165例tka的2年患者报告结果(193例tka中有165例在650例tka中随访2年;85%随访率)。结果:我们发现术后明显改善,感染少,术后2年无机械原因翻修。患者的膝关节活动度得到改善(术前105度,术后125度;P<0.001),遗忘关节评分较高(术前17分,术后77分;P<0.001),改善牛津膝关节评分(术前22分,术后43分;P<0.001), KOOS Jr评分较高(术前48分,术后88分;P<0.001)和较低的视觉模拟评分疼痛评分(术前70分,术后12分;P<0.001)。讨论:所描述的外科技术是进行机器人TKA的一种很有前途的方法。FA的好处包括:与机械对齐技术相比,术前平衡提高了效率,减少了软组织的释放,以及在机器人辅助下精确的骨切割。需要进一步的研究将该技术与现有方法进行比较,以确定结果的差异。
期刊介绍:
The purpose of Techniques in Orthopaedics is to provide information on the latest orthopaedic procedure as they are devised and used by top orthopaedic surgeons. The approach is technique-oriented, covering operations, manipulations, and instruments being developed and applied in such as arthroscopy, arthroplasty, and trauma. Each issue is guest-edited by an expert in the field and devoted to a single topic.