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Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes
Purpose Image-free handheld robotic-assisted total knee arthroplasty (RATKA) has shown to achieve desired limb alignment compared to conventional jig-based instrumented total knee arthroplasty (CTKA). The aim of this prospective randomized controlled trial (RCT) was to evaluate the accuracy of a sem...
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| Published in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2023-12, Vol.31 (12), p.5446-5452 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Bollars, Peter Janssen, Daniel De Weerdt, Wim Albelooshi, Ali Meshram, Prashant Nguyen, Thang D. Lacour, Michael T. Schotanus, Martijn G. M. |
| description | Purpose
Image-free handheld robotic-assisted total knee arthroplasty (RATKA) has shown to achieve desired limb alignment compared to conventional jig-based instrumented total knee arthroplasty (CTKA). The aim of this prospective randomized controlled trial (RCT) was to evaluate the accuracy of a semi-autonomous imageless handheld RATKA compared to CTKA in order to achieve the perioperative planned target alignment of the knee postoperatively.
Methods
Fifty-two patients with knee osteoarthritis were randomized in 1:1 ratio to undergo unilateral CTKA or an imageless handheld RATKA. A full-length lower limb CT-scan was obtained pre- and 6-week postoperative. The primary outcomes were radiologic measurements of achieved target hip–knee–ankle axis (HKA-axis) and implant component position including varus and external rotation and flexion of the femur component, and posterior tibial slope. The proportion of outliers in above radiographic outcomes, defined as > 3° deviation in postoperative CT measurements as compared to perioperative planned target, were also noted. Knee phenotypes were compared with use of the Coronal Plane Alignment of the Knee (CPAK) classification.
Results
Baseline conditions were comparable between both groups. The overall proportion and percentage of outliers (
n
= 38, 24.4% vs
n
= 9, 5.8%) was statistically significant (
p
|
| doi_str_mv | 10.1007/s00167-023-07590-x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2873251580</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2901289326</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4265-512111ee7e910f2ef702f07dddf922b527a0b83b3e1cc00f0da0cfacc51b872c3</originalsourceid><addsrcrecordid>eNqNUk1v1DAQDYiPLoU_wAFZ4sIlMLY3cdJbWVGoqMSBco4cZ7LrksSp7Wwbfj2TbgGJA-KSjJ333ryZvCR5yeEtB1DvAgDPVQpCpqCyEtLbh8mKr6VMlVyrR8kKyrVIBWT5UfIshCsAKtfl0-RIKlXmEtTqwZPzfvRujw3Txkxem5m5ltl-7PQQGT0N9kjVjY07pgf6orfYYQhsp4dmh13DvKtdtIaFOUTsmXH9qD0JRkf1sCe2dYPumB1C9NOippcbOrORKjoHNg0N-q2zw5ZokcDfB0Smfdx5RyZCnE-YZuQ0jGii3SPz1N719gc1oi7Ru65benpL5CksQpvLtNZhmSwEMnw3Bs3mdWNd57bWENJNkfxieJ48bnUX8MX9-zj5dvbhcvMpvfjy8XxzepGatcizNOOCc46osOTQCmwViBZU0zRtKUSdCaWhLmQtkRsD0EKjwbS02YzXhRJGHidvDro0yvWEIVa9DQY72ja6KVSiUFJkPCuAoK__gl65ydMiCVUCF0UpRU4ocUAZ2k3w2Fajp3_k54pDtaSkOqSkopRUdympbon06l56qntsflN-xYIAJwfAje1w_g_J6vPX0_dnUORlRmR5IAfiDVv0f4z_w9NPLTHisw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2901289326</pqid></control><display><type>article</type><title>Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes</title><source>EBSCOhost SPORTDiscus with Full Text</source><source>Wiley-Blackwell Read & Publish Collection</source><source>Springer Link</source><creator>Bollars, Peter ; Janssen, Daniel ; De Weerdt, Wim ; Albelooshi, Ali ; Meshram, Prashant ; Nguyen, Thang D. ; Lacour, Michael T. ; Schotanus, Martijn G. M.</creator><creatorcontrib>Bollars, Peter ; Janssen, Daniel ; De Weerdt, Wim ; Albelooshi, Ali ; Meshram, Prashant ; Nguyen, Thang D. ; Lacour, Michael T. ; Schotanus, Martijn G. M.</creatorcontrib><description>Purpose
Image-free handheld robotic-assisted total knee arthroplasty (RATKA) has shown to achieve desired limb alignment compared to conventional jig-based instrumented total knee arthroplasty (CTKA). The aim of this prospective randomized controlled trial (RCT) was to evaluate the accuracy of a semi-autonomous imageless handheld RATKA compared to CTKA in order to achieve the perioperative planned target alignment of the knee postoperatively.
Methods
Fifty-two patients with knee osteoarthritis were randomized in 1:1 ratio to undergo unilateral CTKA or an imageless handheld RATKA. A full-length lower limb CT-scan was obtained pre- and 6-week postoperative. The primary outcomes were radiologic measurements of achieved target hip–knee–ankle axis (HKA-axis) and implant component position including varus and external rotation and flexion of the femur component, and posterior tibial slope. The proportion of outliers in above radiographic outcomes, defined as > 3° deviation in postoperative CT measurements as compared to perioperative planned target, were also noted. Knee phenotypes were compared with use of the Coronal Plane Alignment of the Knee (CPAK) classification.
Results
Baseline conditions were comparable between both groups. The overall proportion and percentage of outliers (
n
= 38, 24.4% vs
n
= 9, 5.8%) was statistically significant (
p
< 0.001) in favor of RATKA. The achieved varus–valgus of the femoral component (varus 1.3° ± 1.7° vs valgus − 0.1° ± 1.9°,
p
< 0.05) with statistically significant less outliers (0% vs 88.5%,
p
< 0.01), the achieved HKA-axis (varus 0.4° ± 2.1° vs valgus − 1.2° ± 2.1°,
p
< 0.05) and the posterior tibial slope (1.4° ± 1.1° vs 3.2° ± 1.8°,
p
< 0.05) were more accurate with RATKA. The most common postoperative CPAK categories were type II (50% CTKA vs 61.5% RATKA), type I (3.8% CTKA vs 23.1% RATKA) and type V (26.9% CTKA vs 15.4% RATKA). CPAK classification III was only found in CTKA (19.2%). Type VI, VII, VIII, and IX were rare in both populations.
Conclusions
The present trial demonstrates that an imageless handheld RATKA system can be used to accurately perioperatively plan the desired individual component implant positions with less alignment outliers whilst aiming for a constitutional alignment.
Level of evidence
I.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-023-07590-x</identifier><identifier>PMID: 37796307</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>3D‐CT ; Alignment ; Ankle ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee ; Biomedical materials ; Classification ; Clinical trials ; Computed tomography ; Control equipment ; CPAK classification ; CT‐shape match ; Femoral components ; Femur ; Humans ; Imageless ; Image‐free ; Implant placement accuracy ; Instrumentation ; Joint replacement surgery ; Knee ; Knee Joint - diagnostic imaging ; Knee Joint - surgery ; Knee phenotypes ; Knee Prosthesis ; Medicine ; Medicine & Public Health ; Orthopaedic implants ; Orthopedics ; Osteoarthritis ; Osteoarthritis, Knee - diagnostic imaging ; Osteoarthritis, Knee - surgery ; Outliers (statistics) ; Phenotypes ; RATKA ; Robotic assisted ; Robotic surgery ; Robotic Surgical Procedures ; Robotics ; Sports Medicine ; Statistical analysis ; TKA ; Tomography, X-Ray Computed ; Total knee arthroplasty ; Transplants & implants</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-12, Vol.31 (12), p.5446-5452</ispartof><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)</rights><rights>2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4265-512111ee7e910f2ef702f07dddf922b527a0b83b3e1cc00f0da0cfacc51b872c3</citedby><cites>FETCH-LOGICAL-c4265-512111ee7e910f2ef702f07dddf922b527a0b83b3e1cc00f0da0cfacc51b872c3</cites><orcidid>0000-0002-8611-2876</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37796307$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bollars, Peter</creatorcontrib><creatorcontrib>Janssen, Daniel</creatorcontrib><creatorcontrib>De Weerdt, Wim</creatorcontrib><creatorcontrib>Albelooshi, Ali</creatorcontrib><creatorcontrib>Meshram, Prashant</creatorcontrib><creatorcontrib>Nguyen, Thang D.</creatorcontrib><creatorcontrib>Lacour, Michael T.</creatorcontrib><creatorcontrib>Schotanus, Martijn G. M.</creatorcontrib><title>Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Image-free handheld robotic-assisted total knee arthroplasty (RATKA) has shown to achieve desired limb alignment compared to conventional jig-based instrumented total knee arthroplasty (CTKA). The aim of this prospective randomized controlled trial (RCT) was to evaluate the accuracy of a semi-autonomous imageless handheld RATKA compared to CTKA in order to achieve the perioperative planned target alignment of the knee postoperatively.
Methods
Fifty-two patients with knee osteoarthritis were randomized in 1:1 ratio to undergo unilateral CTKA or an imageless handheld RATKA. A full-length lower limb CT-scan was obtained pre- and 6-week postoperative. The primary outcomes were radiologic measurements of achieved target hip–knee–ankle axis (HKA-axis) and implant component position including varus and external rotation and flexion of the femur component, and posterior tibial slope. The proportion of outliers in above radiographic outcomes, defined as > 3° deviation in postoperative CT measurements as compared to perioperative planned target, were also noted. Knee phenotypes were compared with use of the Coronal Plane Alignment of the Knee (CPAK) classification.
Results
Baseline conditions were comparable between both groups. The overall proportion and percentage of outliers (
n
= 38, 24.4% vs
n
= 9, 5.8%) was statistically significant (
p
< 0.001) in favor of RATKA. The achieved varus–valgus of the femoral component (varus 1.3° ± 1.7° vs valgus − 0.1° ± 1.9°,
p
< 0.05) with statistically significant less outliers (0% vs 88.5%,
p
< 0.01), the achieved HKA-axis (varus 0.4° ± 2.1° vs valgus − 1.2° ± 2.1°,
p
< 0.05) and the posterior tibial slope (1.4° ± 1.1° vs 3.2° ± 1.8°,
p
< 0.05) were more accurate with RATKA. The most common postoperative CPAK categories were type II (50% CTKA vs 61.5% RATKA), type I (3.8% CTKA vs 23.1% RATKA) and type V (26.9% CTKA vs 15.4% RATKA). CPAK classification III was only found in CTKA (19.2%). Type VI, VII, VIII, and IX were rare in both populations.
Conclusions
The present trial demonstrates that an imageless handheld RATKA system can be used to accurately perioperatively plan the desired individual component implant positions with less alignment outliers whilst aiming for a constitutional alignment.
Level of evidence
I.</description><subject>3D‐CT</subject><subject>Alignment</subject><subject>Ankle</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>Biomedical materials</subject><subject>Classification</subject><subject>Clinical trials</subject><subject>Computed tomography</subject><subject>Control equipment</subject><subject>CPAK classification</subject><subject>CT‐shape match</subject><subject>Femoral components</subject><subject>Femur</subject><subject>Humans</subject><subject>Imageless</subject><subject>Image‐free</subject><subject>Implant placement accuracy</subject><subject>Instrumentation</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Knee Joint - diagnostic imaging</subject><subject>Knee Joint - surgery</subject><subject>Knee phenotypes</subject><subject>Knee Prosthesis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopaedic implants</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis, Knee - diagnostic imaging</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Outliers (statistics)</subject><subject>Phenotypes</subject><subject>RATKA</subject><subject>Robotic assisted</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures</subject><subject>Robotics</subject><subject>Sports Medicine</subject><subject>Statistical analysis</subject><subject>TKA</subject><subject>Tomography, X-Ray Computed</subject><subject>Total knee arthroplasty</subject><subject>Transplants & implants</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqNUk1v1DAQDYiPLoU_wAFZ4sIlMLY3cdJbWVGoqMSBco4cZ7LrksSp7Wwbfj2TbgGJA-KSjJ333ryZvCR5yeEtB1DvAgDPVQpCpqCyEtLbh8mKr6VMlVyrR8kKyrVIBWT5UfIshCsAKtfl0-RIKlXmEtTqwZPzfvRujw3Txkxem5m5ltl-7PQQGT0N9kjVjY07pgf6orfYYQhsp4dmh13DvKtdtIaFOUTsmXH9qD0JRkf1sCe2dYPumB1C9NOippcbOrORKjoHNg0N-q2zw5ZokcDfB0Smfdx5RyZCnE-YZuQ0jGii3SPz1N719gc1oi7Ru65benpL5CksQpvLtNZhmSwEMnw3Bs3mdWNd57bWENJNkfxieJ48bnUX8MX9-zj5dvbhcvMpvfjy8XxzepGatcizNOOCc46osOTQCmwViBZU0zRtKUSdCaWhLmQtkRsD0EKjwbS02YzXhRJGHidvDro0yvWEIVa9DQY72ja6KVSiUFJkPCuAoK__gl65ydMiCVUCF0UpRU4ocUAZ2k3w2Fajp3_k54pDtaSkOqSkopRUdympbon06l56qntsflN-xYIAJwfAje1w_g_J6vPX0_dnUORlRmR5IAfiDVv0f4z_w9NPLTHisw</recordid><startdate>202312</startdate><enddate>202312</enddate><creator>Bollars, Peter</creator><creator>Janssen, Daniel</creator><creator>De Weerdt, Wim</creator><creator>Albelooshi, Ali</creator><creator>Meshram, Prashant</creator><creator>Nguyen, Thang D.</creator><creator>Lacour, Michael T.</creator><creator>Schotanus, Martijn G. M.</creator><general>Springer Berlin Heidelberg</general><general>Springer‐Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8611-2876</orcidid></search><sort><creationdate>202312</creationdate><title>Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes</title><author>Bollars, Peter ; Janssen, Daniel ; De Weerdt, Wim ; Albelooshi, Ali ; Meshram, Prashant ; Nguyen, Thang D. ; Lacour, Michael T. ; Schotanus, Martijn G. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4265-512111ee7e910f2ef702f07dddf922b527a0b83b3e1cc00f0da0cfacc51b872c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>3D‐CT</topic><topic>Alignment</topic><topic>Ankle</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>Biomedical materials</topic><topic>Classification</topic><topic>Clinical trials</topic><topic>Computed tomography</topic><topic>Control equipment</topic><topic>CPAK classification</topic><topic>CT‐shape match</topic><topic>Femoral components</topic><topic>Femur</topic><topic>Humans</topic><topic>Imageless</topic><topic>Image‐free</topic><topic>Implant placement accuracy</topic><topic>Instrumentation</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Knee Joint - diagnostic imaging</topic><topic>Knee Joint - surgery</topic><topic>Knee phenotypes</topic><topic>Knee Prosthesis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopaedic implants</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis, Knee - diagnostic imaging</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Outliers (statistics)</topic><topic>Phenotypes</topic><topic>RATKA</topic><topic>Robotic assisted</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures</topic><topic>Robotics</topic><topic>Sports Medicine</topic><topic>Statistical analysis</topic><topic>TKA</topic><topic>Tomography, X-Ray Computed</topic><topic>Total knee arthroplasty</topic><topic>Transplants & implants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bollars, Peter</creatorcontrib><creatorcontrib>Janssen, Daniel</creatorcontrib><creatorcontrib>De Weerdt, Wim</creatorcontrib><creatorcontrib>Albelooshi, Ali</creatorcontrib><creatorcontrib>Meshram, Prashant</creatorcontrib><creatorcontrib>Nguyen, Thang D.</creatorcontrib><creatorcontrib>Lacour, Michael T.</creatorcontrib><creatorcontrib>Schotanus, Martijn G. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Physical Education Index</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bollars, Peter</au><au>Janssen, Daniel</au><au>De Weerdt, Wim</au><au>Albelooshi, Ali</au><au>Meshram, Prashant</au><au>Nguyen, Thang D.</au><au>Lacour, Michael T.</au><au>Schotanus, Martijn G. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2023-12</date><risdate>2023</risdate><volume>31</volume><issue>12</issue><spage>5446</spage><epage>5452</epage><pages>5446-5452</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Image-free handheld robotic-assisted total knee arthroplasty (RATKA) has shown to achieve desired limb alignment compared to conventional jig-based instrumented total knee arthroplasty (CTKA). The aim of this prospective randomized controlled trial (RCT) was to evaluate the accuracy of a semi-autonomous imageless handheld RATKA compared to CTKA in order to achieve the perioperative planned target alignment of the knee postoperatively.
Methods
Fifty-two patients with knee osteoarthritis were randomized in 1:1 ratio to undergo unilateral CTKA or an imageless handheld RATKA. A full-length lower limb CT-scan was obtained pre- and 6-week postoperative. The primary outcomes were radiologic measurements of achieved target hip–knee–ankle axis (HKA-axis) and implant component position including varus and external rotation and flexion of the femur component, and posterior tibial slope. The proportion of outliers in above radiographic outcomes, defined as > 3° deviation in postoperative CT measurements as compared to perioperative planned target, were also noted. Knee phenotypes were compared with use of the Coronal Plane Alignment of the Knee (CPAK) classification.
Results
Baseline conditions were comparable between both groups. The overall proportion and percentage of outliers (
n
= 38, 24.4% vs
n
= 9, 5.8%) was statistically significant (
p
< 0.001) in favor of RATKA. The achieved varus–valgus of the femoral component (varus 1.3° ± 1.7° vs valgus − 0.1° ± 1.9°,
p
< 0.05) with statistically significant less outliers (0% vs 88.5%,
p
< 0.01), the achieved HKA-axis (varus 0.4° ± 2.1° vs valgus − 1.2° ± 2.1°,
p
< 0.05) and the posterior tibial slope (1.4° ± 1.1° vs 3.2° ± 1.8°,
p
< 0.05) were more accurate with RATKA. The most common postoperative CPAK categories were type II (50% CTKA vs 61.5% RATKA), type I (3.8% CTKA vs 23.1% RATKA) and type V (26.9% CTKA vs 15.4% RATKA). CPAK classification III was only found in CTKA (19.2%). Type VI, VII, VIII, and IX were rare in both populations.
Conclusions
The present trial demonstrates that an imageless handheld RATKA system can be used to accurately perioperatively plan the desired individual component implant positions with less alignment outliers whilst aiming for a constitutional alignment.
Level of evidence
I.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37796307</pmid><doi>10.1007/s00167-023-07590-x</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-8611-2876</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023-12, Vol.31 (12), p.5446-5452 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2873251580 |
| source | EBSCOhost SPORTDiscus with Full Text; Wiley-Blackwell Read & Publish Collection; Springer Link |
| subjects | 3D‐CT Alignment Ankle Arthroplasty (knee) Arthroplasty, Replacement, Knee Biomedical materials Classification Clinical trials Computed tomography Control equipment CPAK classification CT‐shape match Femoral components Femur Humans Imageless Image‐free Implant placement accuracy Instrumentation Joint replacement surgery Knee Knee Joint - diagnostic imaging Knee Joint - surgery Knee phenotypes Knee Prosthesis Medicine Medicine & Public Health Orthopaedic implants Orthopedics Osteoarthritis Osteoarthritis, Knee - diagnostic imaging Osteoarthritis, Knee - surgery Outliers (statistics) Phenotypes RATKA Robotic assisted Robotic surgery Robotic Surgical Procedures Robotics Sports Medicine Statistical analysis TKA Tomography, X-Ray Computed Total knee arthroplasty Transplants & implants |
| title | Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T14%3A13%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Improved%20accuracy%20of%20implant%20placement%20with%20an%20imageless%20handheld%20robotic%20system%20compared%20to%20conventional%20instrumentation%20in%20patients%20undergoing%20total%20knee%20arthroplasty:%20a%20prospective%20randomized%20controlled%20trial%20using%20CT-based%20assessment%20of%20radiological%20outcomes&rft.jtitle=Knee%20surgery,%20sports%20traumatology,%20arthroscopy%20:%20official%20journal%20of%20the%20ESSKA&rft.au=Bollars,%20Peter&rft.date=2023-12&rft.volume=31&rft.issue=12&rft.spage=5446&rft.epage=5452&rft.pages=5446-5452&rft.issn=0942-2056&rft.eissn=1433-7347&rft_id=info:doi/10.1007/s00167-023-07590-x&rft_dat=%3Cproquest_cross%3E2901289326%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c4265-512111ee7e910f2ef702f07dddf922b527a0b83b3e1cc00f0da0cfacc51b872c3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2901289326&rft_id=info:pmid/37796307&rfr_iscdi=true |