Search Results (46)

Background: The ROSA Knee System (Zimmer Biomet, Warsaw, IN, USA) is a robotic system aiming to increase bone resections and component alignment accuracy during TKA. While much is known about its performance in the coronal plane, its accuracy in the sagittal plane remains debated. The present investigation evaluated the system’s accuracy in achieving planned mechanical axis alignment and specific knee angles in both planes. Methods: A retrospective analysis was performed on 55 consecutive patients who underwent robotic-assisted TKA using the ROSA Knee System. Data on the medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), hip–knee–ankle angle (HKA), tibial slope (TS), and distal femoral flexion (DFF) were collected pre- and post-operatively using the ROSA software. Planned and achieved angles were compared, with deviations greater than 2° and 3° defined as outliers. Results: The mean differences between planned and achieved angles for LDFA and MPTA were 0.5° ± 1.00° and 0.3° ± 1.3°, respectively, with less than 10% outliers. The hip–knee angle recorded only a minimal deviation from planned values. In contrast, the TS angle showed a statistically significant difference between planned and achieved values, while no significant difference was found for the DFF angle. The surgeon’s experience did not impact alignment accuracy. Conclusions: The ROSA Knee System demonstrates high accuracy in achieving planned alignment in the coronal plane during robotic-assisted TKA, with minimal outliers and reliable predictions for both femoral and tibial angles. However, the ROSA Knee System showed less accuracy in the sagittal plane, particularly for the tibial slope, which did not adversely affect the implant’s stability. Full article

Background/Objectives: Total knee arthroplasty (TKA) is an effective surgical intervention for end stage knee osteoarthritis in elderly patients, with emerging robotically assisted techniques aiming to enhance surgical precision and patient outcomes. This study aimed to compare medium-term balance and functional outcomes between robotically assisted and conventional manual TKA in community-dwelling elderly patients. Methods: This cross-sectional study included 50 elderly patients undergoing TKA, who were divided into robotically assisted (n = 25) and conventional manual (n = 25) groups. Demographic and clinical data, balance performance, and functional outcomes were compared at nearly 1.5 years postoperatively. Outcome measures included balance performance assessed by the Berg Balance Scale (BBS), pain via the Visual Analog Scale (VAS), knee function as measured by the Lysholm Knee Scoring Scale, quality of life using the Short Form-12 (SF-12), joint awareness as evaluated by the Forgotten Joint Score-12 (FJS-12), and surgical satisfaction. Results: The groups had similar demographic and clinical data regarding age, gender, follow-up duration, surgical time, and anesthesia type (p > 0.05). The robotically assisted group demonstrated better balance performance on the BBS (p = 0.043) and had a statistically shorter length of hospital stay (1.22 vs. 1.42 days; p = 0.005). However, no statistically significant differences were observed in VAS activity pain (p = 0.053), Lysholm Knee Scoring Scale (p = 0.117), SF-12 physical and mental scores (p = 0.174 and p = 0.879), FJS-12 (p = 0.760), and surgical satisfaction (p = 0.218). Conclusions: Robotically assisted TKA is associated with advantageous postoperative recovery, particularly in terms of balance performance, showing no clinical difference in other functional outcomes compared to the conventional manual technique. From a physical therapy perspective, these findings emphasize the importance of developing tailored and effective rehabilitation strategies in the medium term for functional recovery in the elderly population. Full article

(1) Introduction: Precise femoral component rotation is critical for achieving symmetric flexion-gap balance and physiologic patellofemoral tracking in mechanically aligned total knee arthroplasty (TKA). Surgeons often infer an appropriate rotational target from the patient’s coronal limb alignment, yet the strength of this relationship remains uncertain. (2) Methods: We identified 695 consecutive patients undergoing primary TKA with a preoperative planning CT scan. The surgical transepicondylar axis (sTEA) and posterior condylar axis (PCAxis) were identified and the angle between them was measured. The angle between the mechanical axis of the femur and tibia was used to measure the coronal alignment of the limb. (3) Results: The mean sTEA was 3.0° externally rotated to the PCAxis (range 3.1° internal to 9.2° external). The mean coronal alignment was 4.3° varus (range −12.5° valgus to 24.5° varus). There were 465 patients with >2° varus and 101 patients with >2° valgus. The mean sTEA was 2.9 ± 1.9° externally rotated relative to the PCAxis in the valgus group and 2.8 ± 2.0° in the varus group, with no statistically significant difference (p = 0.7). (4) Conclusions: There is significant variation in the femoral rotation axes between patients, but no significant relationship between overall limb coronal alignment and the magnitude of femoral rotation axes variation. This reinforces the need for independent assessment of rotational landmarks when performing mechanically aligned TKA. Full article

Background: Robotic-assisted technology has become an increasingly utilized adjunct within the realm of primary total knee arthroplasty (TKA). Previous studies have shown that robotic-assisted total knee arthroplasty (raTKA) offers potential advantages of enhanced bony preparation and optimal implant alignment with equivalent long-term patient outcomes and component longevity in comparison to conventional TKA (cTKA). Furthermore, recent studies have identified the additional benefit of decreased surgeon physiologic stress with the use of raTKA. The purpose of this study was to compare differences in surgeon posture between primary raTKA and cTKA. Materials and Methods: We prospectively evaluated 103 consecutive primary TKA cases (48 raTKAs, 55 cTKAs) performed by three high-volume, fellowship-trained arthroplasty surgeons. Throughout each case, surgeons wore a posture-tracking device to evaluate time spent slouching. The threshold for slouching was set to 30 degrees of flexion from a neutral spinal axis. Demographic and operative factors were collected. Two-tailed tests and multivariate analysis were used to assess for differences between groups. Results: After controlling for individual surgeon differences in posture, we found a decrease in the percentage and duration of time spent slouching in raTKA cases compared to cTKA cases (42.4 vs. 72.5%, p < 0.001, 35.4 vs. 54.7 min, p = 0.037). On average, the use of the robot decreased surgeon slouching time by 19.3 min (26.6%, p < 0.001). Patient factors such as increased age and ASA 2 were also associated with favorable effects on posture (p < 0.001). Conclusions: Surgeons performing primary raTKA cases spend significantly less case time and case percentage in a slouched posture compared to conventional primary TKA cases. This suggests the potential for ergonomic benefit of robotic-assisted technology in primary TKA. Further research is needed to determine the long-term effects of posture on surgeon pain and career longevity. Full article

Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though RA-TKA had a higher risk of conversion to open surgery (10% vs. 2%). Meta-regression identified robotic system and surgeon experience as key predictors of outcome variability. Conclusions: RA-TKA offers advantages in implant alignment and postoperative pain reduction. However, benefits are inconsistent across settings, and some robotic systems may not provide improvements over C-TKA. Full article

Orthopedics is undergoing a transformative shift driven by personalized medical technologies that enhance precision, efficiency, and patient outcomes. Virtual surgical planning, robotic assistance, and real-time 3D navigation have revolutionized procedures like total knee arthroplasty and hip replacement, offering unparalleled accuracy and reducing recovery times. Integrating artificial intelligence, advanced imaging, and 3D-printed patient-specific implants further elevates surgical precision, minimizes intraoperative complications, and supports individualized care. In sports orthopedics, wearable sensors and motion analysis technologies are revolutionizing diagnostics, injury prevention, and rehabilitation, enabling real-time decision-making and improved patient safety. Health-tracking devices are advancing recovery and supporting preventative care, transforming athletic performance management. Concurrently, breakthroughs in biologics, biomaterials, and bioprinting are reshaping treatments for cartilage defects, ligament injuries, osteoporosis, and meniscal damage. These innovations are poised to establish new benchmarks for regenerative medicine in orthopedics. By combining cutting-edge technologies with interdisciplinary collaboration, the field is redefining surgical standards, optimizing patient care, and paving the way for a highly personalized and efficient future. Full article

Background: Robot-assisted total knee arthroplasty (TKA) has gained attention for its ability to improve surgical precision, optimize component alignment, and potentially enhance functional outcomes. Despite these advantages, early postoperative deficits, particularly in quadricep activation and the range of motion (ROM), remain common and can delay recovery. The objective of this study was to investigate early postoperative differences in quadricep muscle activation and the ROM between the operated and non-operated sides following robot-assisted TKA. Methods: A total of 101 participants (50 females, 51 males) were included in the study. Surface electromyography (sEMG) was recorded from the vastus lateralis and vastus medialis during an active knee extension test and a 4-m walking test. The ROM was assessed during gait. A linear mixed model was employed with operated side and sex as factors. Results: Significant differences were observed in quadricep muscle activation and the ROM between the operated and non-operated sides. During the knee extension test, males exhibited significantly higher vastus lateralis activity on the non-operated side (mean difference = 174 µV, 95% confidence interval (CI) [90, 258], p < 0.001) and females showed a similar pattern (mean difference = 238 µV, 95% CI [152, 324], p < 0.001). Additionally, vastus medialis activation was significantly higher on the non-operated side for both males (mean difference = 102 µV, 95% CI [34, 169], p = 0.003) and females (mean difference = 137 µV, 95% CI [47, 226], p = 0.003). During the 4-m walking test, females displayed a significantly reduced sagittal-plane ROM on the operated side (mean difference = 7.691°, p = 0.041) whereas no significant ROM differences were found in males (p > 0.903). Conclusions: Robot-assisted TKA patients exhibit significant early postoperative asymmetries in quadricep activation and the gait ROM, particularly among females. Full article

Many new technologies focused mainly on improving surgical accuracy were first developed in total knee arthroplasty and have not yet shown significant value. These non-significant clinical improvements could potentially be explained by an inadequate target. In this current concept paper, the authors will describe how artificial intelligence (AI), robotic-assisted surgery, and custom implants allow the definition of new targets and the standardization of the TKA process. As paradoxical as it may be, new technologies in TKA will allow for better standardization in the overall way in which this procedure is carried out. Achieving this goal can be accomplished by incorporating AI-driven tools into the medical field. These tools are intended to enhance decision making, refine surgical planning, and increase the precision and consistency of surgical procedures. Moreover, custom implants with personalized alignment, beyond restoring native anatomy, will define new targets and standardize the whole TKA process. Full article

Background: Robotic-assisted total knee arthroplasty (rTKA) has been introduced to improve surgical precision and alignment in knee replacement procedures. However, its impact on clinical outcomes, pain relief, and cost-effectiveness remains debated. This umbrella review synthesizes evidence from systematic reviews and meta-analyses comparing rTKA to conventional TKA. Methods: An umbrella review was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Database of Systematic Reviews. Systematic reviews and meta-analyses comparing rTKA with conventional TKA were included. Methodological quality was assessed using AMSTAR 2 and ROBIS tools. Primary outcomes included hospital stay, radiographic alignment, postoperative pain, functional outcomes, and patient satisfaction. Results: Ten systematic reviews were included. rTKA demonstrated superior alignment accuracy and a reduction in alignment outliers. Some studies reported shorter hospital stays and lower early postoperative pain scores for rTKA. However, these benefits did not consistently translate into improved long-term functional outcomes, patient satisfaction, or reduced revision rates. Cost-effectiveness analyses indicated that rTKA remains an expensive option, with benefits largely dependent on surgical volume and healthcare system resources. Conclusions: While rTKA improves surgical precision and may offer short-term advantages, its long-term superiority over conventional TKA remains unproven. Higher costs and longer operative times limit its widespread adoption. Further high-quality, long-term studies are needed to determine its clinical and economic value. Full article

Background: This study compared the early rehabilitation progress of patients undergoing robotic-assisted medial unicompartmental knee arthroplasty (mUKA) and robotic-assisted kinematically aligned total knee arthroplasty (rKA-TKA), focusing on daily activity by step-count measurements. Methods: A retrospective analysis of prospectively collected data from 88 patients (53 rKA-TKA and 35 mUKA) was conducted. Patients wore Garmin Vivofit^® 4 activity trackers pre and postoperatively. Daily step counts were analyzed, and clinical outcomes were assessed using various scores, including the Knee Society Score (KSS) and Forgotten Joint Score (FJS). Results: Preoperative median daily step counts were comparable between groups (rKA-TKA: 3988 and mUKA: 4315; p = 0.128). At 6 and 7 weeks post-surgery, the mUKA group showed significantly higher median step counts (3741 and 4730) compared to the rKA-TKA group (2370 and 2910), with p-values of 0.015 and 0.048, respectively. The mUKA group reached 86.7% of their preoperative step count at week 6 and 100% at week 7, while the rKA-TKA group achieved 59.4% and 73%, respectively. Both groups surpassed their preoperative activity levels by week 9. Clinical outcomes at 2 months and 1 year post-surgery showed no significant differences between groups. Conclusions: While both the mUKA and rKA-TKA patients achieved their preoperative daily activity levels within nine weeks post-surgery, the mUKA patients reached this milestone approximately two weeks earlier. This study demonstrates a clinical benefit of mUKA in terms of faster postoperative remobilization, even when compared to kinematically aligned robotic-assisted TKA. Full article

Background: The objective of this study was to compare the outcomes between patients undergoing mechanically aligned conventional total knee arthroplasty (MA-CTKA) and functionally aligned robotic-arm-assisted TKA (FA-RTKA). Methods: We reviewed a prospectively collected database of consecutive patients who underwent primary total knee arthroplasty (TKA) for knee osteoarthritis between June 2022 and May 2023. Patients were divided into two groups—MA-CTKA (n = 50) and FA-RTKA (n = 50)—based on the introduction of a robotic-arm-assisted system during the study period. The hip–knee–ankle (HKA) angle, joint line orientation angle (JLOA) relative to the floor, and weight-bearing line (WBL) ratio were evaluated using full-length standing hip-to-calcaneus radiographs to compare the conventional mechanical axis (MA) and the ground mechanical axis (GA) passing through the knee joint between the groups. Clinical outcomes were also compared between the two groups. Results: There were no significant differences in the postoperative HKA angle between the groups, due to discrepancies in the targeted alignment strategies (FA-RTKA: 2.0° vs. MA-CTKA: 0.5°; p = 0.001). The postoperative JLOA in the FA-RTKA group was more parallel to the floor, whereas the MA-CTKA group showed a downward angulation toward the lateral side (0.6° vs. −2.7°; p < 0.001). In the FA-RTKA group, the GA passed through a neutral position when accounting for the calcaneus, while the MA-CTKA group showed a more lateral GA position (48.8% vs. 53.8%; p = 0.001). No significant differences in clinical outcomes were shown between the FA-RTKA and MA-CTKA groups, with the FA-RTKA group demonstrating higher Forgotten Joint Scores and a greater range of motion (all p < 0.05). Conclusions: Functionally aligned TKA demonstrated improved joint line parallelism to the floor and more neutral weight-bearing alignment in the GA compared to mechanically aligned TKA. These findings indicate a more balanced load distribution across the knee, which may contribute to the superior clinical outcomes observed in the functionally aligned group. Full article

The rapid adoption of robotic-assisted total knee arthroplasty (RATKA) has resulted in pre-operative CT scans becoming more readily available. After the segmentation and identification of landmarks by trained segmentation specialists, the Mako SmartRobotics^TM software generates measurements of interest for the calculation of the arithmetic hip-knee-ankle axis (aHKA), joint line obliquity (JLO), and the Coronal Plane Alignment of the Knee (CPAK) phenotype. The aim of this study is to ascertain how closely correlated these two sets of readings are and whether the CPAK distribution is altered when comparing both modalities. A retrospective radiological study was undertaken on 500 knees (367 patients: 133 bilateral, 234 unilateral) comparing the CT-based software-generated measurements of patients undergoing RATKA using the Stryker Mako system against manual measurements derived from long limb radiographs (LLRs). There were statistically significant differences between the average measurements of the LDFA (0.27 ± 2.95, p = 0.045), MPTA (1.15 ± 2.20, p < 0.001), aHKA (1.41 ± 3.85, p < 0.001) and JLO (0.89 ± 3.50, p < 0.001), with CT measurements having higher mean readings for LDFA, lower readings for MPTA, more varus aHKA and increased apex distal JLO. Despite this, correlation was moderately good: LDFA (r = 0.409, p < 0.001), MPTA (r = 0.683, p < 0.001), aHKA (r = 0.595, p < 0.001) and JLO (r = 0.456, p < 0.001). The CPAK distribution was also significantly different. LLRs underestimate the degree of constitutional varus and JLO compared to CT-based software-generated measurements, with a resultant increase in CPAK Types I and IV when using CT measurements. Despite moderately good correlation between both imaging modalities, there remains a statistically significant difference between them. Full article

Background: The aim of this study was to evaluate the balance in extension and flexion achievable after total knee arthroplasty (TKA) using a modified kinematic alignment (KA) plan and the subsequent balance achievable after adjusting the component based on the functional alignment (FA) principle. Methods: This retrospective cohort study included 100 consecutive patients who underwent primary TKA for knee osteoarthritis through an image-based robotic system in a single center between October 2021 and February 2022. Whether modified KA or FA could achieve a balanced knee was evaluated by assessing the ligament balance in the medial and lateral compartments using a robotic system at extension and 90° flexion. Balance was defined as a difference of ≤2 mm between the compartments. Component positioning was adjusted within limits based on the functional positioning principles to achieve balance. Implant positioning and balance in extension and 90° flexion were compared between the modified KA plan (n = 100) and after FA adjustments (n = 100). Results: FA achieved significantly better balance in extension (FA, 99.0% vs. modified KA, 86.0%; p = 0.001) and flexion (98.0% vs. 43.0%; p < 0.001) than the modified KA plan. The mean difference in gap balance in extension (FA, 0.1 mm vs. modified KA, 0.6 mm; p = 0.001) and flexion (0.1 mm vs. 2.3 mm; p < 0.001) was also significant between the two techniques. The femoral component was positioned more externally rotated relative to the transepicondylar axis (FA, 2.5° vs. modified KA, 0.0°; p < 0.001) to obtain balanced targets. There were significant improvements in the patient-reported outcome measures between preoperative and postoperative assessments two years after TKA (all p < 0.05). Conclusions: FA consistently achieved superior balance in both extension and flexion following TKA compared with modified KA without altering the soft tissue envelope, leading to significant improvements in clinical outcomes at the two-year follow-up. Full article

The optimal procedure for isolated end-stage medial compartment knee osteoarthritis (OA) remains uncertain, with debate persisting between unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The aim of this narrative review is to evaluate current outcome measures in knee arthroplasty (KA) and explore how evolving patient populations and technological advancements may necessitate the use of different patient-reported outcome measures (PROMs) for evaluating UKA. While UKA offers potential advantages over TKA in early pain relief and functional outcomes, most randomised control trials using traditional PROMs have failed to show definitive superiority. The recent introduction of robotic assistance may have further enhanced the benefits of UKA. However, it remains uncertain whether the advantages outweigh the higher revision rates associated with UKA. Although traditional PROMs, such as the Oxford Knee Score or Knee Injury and Osteoarthritis Outcome Score, were designed for the KA population of 30 years ago, they continue to be employed today. The current KA population, particularly those undergoing UKA, are typically younger, physically fitter, and have higher functional demands than those for whom traditional PROMs were originally designed. As a result, these PROMs are now limited by ceiling effects. High-performance PROMs, such as the Forgotten Joint Score-12 or the metabolic equivalent of task score, have recently been utilised for high-demand patients and do not have postoperative ceiling effects. Return to work and sport are also important outcomes that are often overlooked for younger, high-demand patients. Future studies should aim to define the differences between UKA and TKA populations, identify patient factors that predict UKA success, and validate high-performance PROMs for UKA. This will provide deeper insights into the functional benefits of UKA and TKA, enabling patients and surgeons to make more informed decisions regarding implant selection. Full article

Background/Objectives: This study evaluated the learning curve for robotic-assisted total knee arthroplasty (RA TKA) performed by three experienced surgeons, focusing on procedure duration, surgeon satisfaction, and confidence. Methods: A prospective study was conducted with three senior arthroplasty surgeons, each performing 15 RA TKA procedures using the Triathlon Knee System with the Robotic Arm Interactive Orthopedic (RIO) System. Data on preparation, cut-to-suture, and breakdown times were collected. Surgeon anxiety levels were measured preoperatively using the STAI-6 scale, while postoperative satisfaction and confidence were assessed via a questionnaire. Statistical analysis was conducted using GraphPad Prism. Results: Of 50 scheduled surgeries, 45 were completed. The average cut-to-suture time was 1 h 38 min, with significant time reductions in robotic-specific steps as experience increased. Comparing the first five surgeries to the last five, the time for navigation hardware mounting, landmarks registration, femur and tibia registration, and bone preparation decreased by up to 30% (p < 0.001 to p = 0.025). General instrument preparation time decreased by 20% (p = 0.004). Surgeon anxiety levels dropped, indicating increased comfort with the system, while postoperative surveys showed increased satisfaction and confidence. Conclusions: The study demonstrated a substantial learning curve for RA TKA, with improved efficiency and surgeon confidence by the fifteenth procedure. These findings highlight the potential for streamlined workflows and guide training for new adopters of robotic knee arthroplasty. Full article