Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

Abstract

Patello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

Keywords

patellofemoral arthroplasty - robotic - Mako

Publication History

Received: 06 April 2020

Accepted: 09 August 2020

Article published online:
30 October 2020

• References

• 1 Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM. The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 2002; (402) 206-212
• 2 . National Joint Registry 14th Annual Report. Accessed September 16, 2020 at: https://www.hqip.org.uk/wp-content/uploads/pelerous_media_manager/public/253/NJR/NJR%2014th%20Annual%20Report%202017.pdf.
• 3 Leadbetter WB, Ragland PS, Mont MA. The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Relat Res 2005; x (436) 91-99
• 4 Delanois RE, McGrath MS, Ulrich SD. et al. Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am 2008; 39 (03) 381-388 , vii
• 5 Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. A report of two hundred and twenty cases. J Bone Joint Surg Am 1979; 61 (02) 173-180
• 6 Freeman MA, Todd RC, Bamert P, Day WH. ICLH arthroplasty of the knee: 1968--1977. J Bone Joint Surg Br 1978; 60-B [phone]
• 7 Chauhan SK, Clark GW, Lloyd S, Scott RG, Breidahl W, Sikorski JM. Computer-assisted total knee replacement. A controlled cadaver study using a multi-parameter quantitative CT assessment of alignment (the Perth CT Protocol). J Bone Joint Surg Br 2004; 86 (06) 818-823
• 8 Kim Y-H, Kim J-S, Choi Y, Kwon O-R. Computer-assisted surgical navigation does not improve the alignment and orientation of the components in total knee arthroplasty. J Bone Joint Surg Am 2009; 91 (01) 14-19
• 9 Moon Y-W, Ha C-W, Do K-H. et al. Comparison of robot-assisted and conventional total knee arthroplasty: a controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg 2012; 17 (02) 86-95
• 10 Kayani B, Konan S, Pietrzak JRT, Huq SS, Tahmassebi J, Haddad FS. The learning curve associated with robotic-arm assisted unicompartmental knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B [phone]
• 11 Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am 2016; 98 (08) 627-635
• 12 Song E-K, Seon J-K, Yim J-H, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 2013; 471 (01) 118-126
• 13 Turktas U, Piskin A, Poehling GG. Short-term outcomes of robotically assisted patello-femoral arthroplasty. Int Orthop 2016; 40 (05) 919-924
• 14 Batailler C, Neyret P. Trochlear dysplasia: imaging and treatment options. EFORT Open Rev 2018; 3 (05) 240-247
• 15 Osarumwense D, Syed F, Nzeako O, Akilapa S, Zubair O, Waite J. Patellofemoral joint arthroplasty: early results and functional outcome of the zimmer gender solutions patello-femoral joint system. Clin Orthop Surg 2017; 9 (03) 295-302
• 16 Leadbetter WB, Ragland PS, Mont MA. The appropriate use of patellofemoral arthroplasty: an analysis of reported indications, contraindications, and failures. Clin Orthop Relat Res 2005; (436) 91-99
• 17 Argenson J-NA, Flecher X, Parratte S, Aubaniac J-M. Patellofemoral arthroplasty: an update. Clin Orthop Relat Res 2005; 440 (440) 50-53
• 18 De Cloedt P, Legaye J, Lokietek W. [Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3-12 years] (in French). Acta Orthop Belg 1999; 65 (02) 170-175
• 19 Vermeulen H, De Doncker E, Watillon M. [The Mac Keever patellar prosthesis in femoro-patellar arthrosis] (in French). Acta Orthop Belg 1973; 39 (01) 79-90
• 20 Borus T, Brilhault J, Confalonieri N, Johnson D, Thienpont E. Patellofemoral joint replacement, an evolving concept. Knee 2014; 21 (Suppl. 01) S47-S50
• 21 de Winter WE, Feith R, van Loon CJ. The Richards type II patellofemoral arthroplasty: 26 cases followed for 1-20 years. Acta Orthop Scand 2001; 72 (05) 487-490
• 22 Blazina ME, Fox JM, Del Pizzo W, Broukhim B, Ivey FM. Patellofemoral replacement. Clin Orthop Relat Res 1979; (144) 98-102
• 23 Lonner JH. Patellofemoral arthroplasty: pros, cons, and design considerations. Clin Orthop Relat Res 2004; (428) 158-165
• 24 Lonner JH, Bloomfield MR. The clinical outcome of patellofemoral arthroplasty. Orthop Clin North Am 2013; 44 (03) 271-280 , vii
• 25 Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1132-1141
• 26 Kamara E, Berliner ZP, Hepinstall MS, Cooper HJ. Pin site complications associated with computer-assisted navigation in hip and knee arthroplasty. J Arthroplasty 2017; 32 (09) 2842-2846
• 27 van der List JP, Chawla H, Joskowicz L, Pearle AD. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3482-3495