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Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance

BACKGROUND: Achieving balanced gaps is a key surgical goal in total knee arthroplasty, yet most methods rely on subjective surgeon feel and experience to assess and achieve knee balance intraoperatively. Our objective was to evaluate the ability to quantitatively plan and achieve a balanced knee thr...

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Autores principales: Shalhoub, Sami, Lawrence, Jeffrey M., Keggi, John M., Randall, Amber L., DeClaire, Jeffrey H., Plaskos, Christopher
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728592/
https://www.ncbi.nlm.nih.gov/pubmed/31516978
http://dx.doi.org/10.1016/j.artd.2019.07.003
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author Shalhoub, Sami
Lawrence, Jeffrey M.
Keggi, John M.
Randall, Amber L.
DeClaire, Jeffrey H.
Plaskos, Christopher
author_facet Shalhoub, Sami
Lawrence, Jeffrey M.
Keggi, John M.
Randall, Amber L.
DeClaire, Jeffrey H.
Plaskos, Christopher
author_sort Shalhoub, Sami
collection PubMed
description BACKGROUND: Achieving balanced gaps is a key surgical goal in total knee arthroplasty, yet most methods rely on subjective surgeon feel and experience to assess and achieve knee balance intraoperatively. Our objective was to evaluate the ability to quantitatively plan and achieve a balanced knee throughout the range of motion using robotic-assisted instrumentation in a tibia-first, gap-balancing technique. METHODS: A robotic-assisted, gap-balancing technique was used in 121 consecutive knees. After resection of the proximal tibia, a computer-controlled tensioning device was inserted into the knee joint and the pre-femoral-resection knee gaps were acquired dynamically throughout flexion under controlled load. Predicted gap profiles were used to plan the femoral implant by adjusting the implant alignment and position within certain boundaries to achieve a balanced knee throughout the range of flexion. Femoral cuts were then made according to this plan using a miniature robotic-assisted cutting guide. The tensioning device used to measure the pre-femoral-resection gaps was then reinserted into the joint to quantify the final gap balance under known tension. The final gap profiles were then compared with the predictive gap plans. RESULTS: The overall root mean square error between the predicted and achieved gaps was 1.3 mm and 1.5 mm for the medial and lateral sides, respectively. Use of robotic assistance resulted in over 90% of knees having mediolateral balance within 2 mm across the flexion range. Gaps at 0° flexion were 2 mm smaller than the gaps at 90°. This difference decreased to less than 1 mm when comparing the tibiofemoral gaps at 10°, 45°, and 90°. CONCLUSIONS: Imageless, robotic-assisted total knee arthroplasty accurately predicts postoperative gaps before femoral resections. This allows surgeons to virtually plan femoral implant alignment and optimize gap balance throughout the range of motion. The accurate prediction of gaps throughout the arc of motion combined with precise, robotically assisted femoral resection produces accurate postoperative ligament balance consistently.
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spelling pubmed-67285922019-09-12 Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance Shalhoub, Sami Lawrence, Jeffrey M. Keggi, John M. Randall, Amber L. DeClaire, Jeffrey H. Plaskos, Christopher Arthroplast Today Original Research BACKGROUND: Achieving balanced gaps is a key surgical goal in total knee arthroplasty, yet most methods rely on subjective surgeon feel and experience to assess and achieve knee balance intraoperatively. Our objective was to evaluate the ability to quantitatively plan and achieve a balanced knee throughout the range of motion using robotic-assisted instrumentation in a tibia-first, gap-balancing technique. METHODS: A robotic-assisted, gap-balancing technique was used in 121 consecutive knees. After resection of the proximal tibia, a computer-controlled tensioning device was inserted into the knee joint and the pre-femoral-resection knee gaps were acquired dynamically throughout flexion under controlled load. Predicted gap profiles were used to plan the femoral implant by adjusting the implant alignment and position within certain boundaries to achieve a balanced knee throughout the range of flexion. Femoral cuts were then made according to this plan using a miniature robotic-assisted cutting guide. The tensioning device used to measure the pre-femoral-resection gaps was then reinserted into the joint to quantify the final gap balance under known tension. The final gap profiles were then compared with the predictive gap plans. RESULTS: The overall root mean square error between the predicted and achieved gaps was 1.3 mm and 1.5 mm for the medial and lateral sides, respectively. Use of robotic assistance resulted in over 90% of knees having mediolateral balance within 2 mm across the flexion range. Gaps at 0° flexion were 2 mm smaller than the gaps at 90°. This difference decreased to less than 1 mm when comparing the tibiofemoral gaps at 10°, 45°, and 90°. CONCLUSIONS: Imageless, robotic-assisted total knee arthroplasty accurately predicts postoperative gaps before femoral resections. This allows surgeons to virtually plan femoral implant alignment and optimize gap balance throughout the range of motion. The accurate prediction of gaps throughout the arc of motion combined with precise, robotically assisted femoral resection produces accurate postoperative ligament balance consistently. Elsevier 2019-08-13 /pmc/articles/PMC6728592/ /pubmed/31516978 http://dx.doi.org/10.1016/j.artd.2019.07.003 Text en © 2019 Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Shalhoub, Sami
Lawrence, Jeffrey M.
Keggi, John M.
Randall, Amber L.
DeClaire, Jeffrey H.
Plaskos, Christopher
Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
title Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
title_full Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
title_fullStr Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
title_full_unstemmed Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
title_short Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
title_sort imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728592/
https://www.ncbi.nlm.nih.gov/pubmed/31516978
http://dx.doi.org/10.1016/j.artd.2019.07.003
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