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J Knee Surg 2022; 35(14): 1587-1594
DOI: 10.1055/s-0041-1729548
Original Article

The Accuracy of Computed Tomography-Based, Three-Dimensional Implant Planning in Robotic-Assisted Total Knee Arthroplasty

Kevin B. Marchand
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
2   CUNY School of Medicine, New York, New York
,
Hytham S. Salem
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
,
Kevin K. Mathew
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
,
Steven F. Harwin
3   Department of Orthopaedic Surgery, Mount Sinai West New York, Manhattan New York
,
Michael A. Mont
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
,
Robert C. Marchand
4   South County Orthopedics, Orthopedics Rhode Island, Wakefield, Rhode Island
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Abstract

Advanced imaging used in robotic-assisted total knee arthroplasty (TKA), such as computed tomography (CT)-based three-dimensional (3D) planning, may provide an accurate means of implant sizing preoperatively. The purpose of this study was to examine preoperative CT-based implant planning accuracy for robotic-assisted TKA in patients who have (1) varus deformities, (2) valgus deformities, (3) neutral alignment, and (4) retained hardware. A total of 393 patients underwent a robotic-assisted TKA by a single surgeon received preoperative CT scans. The surgeon reviewed the CT-based model preoperatively and recorded the expected size of the components. The final implants used in each case were recorded and compared with the surgeon's preoperative plan. In all groups of patients, the surgeon's CT-based implant plan was within one size of the implant utilized 100% of the time for both the tibiae and femora. Overall, the surgeon was exactly matched in 319 (81%) and 315 (80%) cases for the femoral and tibial components, respectively. For the femoral component, the mean age for patients in whom the original plan was exactly matched was younger than those whose implants were upsized and older than patients those implants were downsized (p = 0.024). Other patient demographics and preoperative knee alignment were not associated with predictive accuracy for femoral or tibial components. Our results demonstrate how preoperative CT-based, 3D planning for robotic-assisted TKA is accurate to within one size of the components in every case (100%), and exactly matched in 80%. The results of this study are important because they demonstrate how CT-based preoperative implant planning for TKA is reliable and accurate across all native knee alignments and other patient-specific factors. In addition, they build on a previous study by the same single surgeon, demonstrating that predictive ability can improve over time. This may be important as we move toward more outpatient surgery with less ability for prostheses inventory at ambulatory sites.

Keywords

osteoarthritis - knee - arthroplasty - computed tomography


Publication History

Received: 06 March 2020

Accepted: 12 March 2021

Article published online:
01 May 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic arm-assisted total knee arthroplasty. J Arthroplasty 2018; 33 (07) 2002-2006
    CrossrefPubMedGoogle Scholar
  • 2 Condrey C, Mont MA, Bhowmik-Stoker M. et al. Does the robotic arm and preoperative CT planning help with 3D intraoperative total knee arthroplasty planning?. J Knee Surg 2019; 32 (08) 742-749
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 2019; 4 (10) 611-617
    CrossrefPubMedGoogle Scholar
  • 4 Banerjee S, Cherian JJ, Elmallah RK, Pierce TP, Jauregui JJ, Mont MA. Robot-assisted total hip arthroplasty. Expert Rev Med Devices 2016; 13 (01) 47-56
    CrossrefPubMedGoogle Scholar
  • 5 Nodzo SR, Chang CC, Carroll KM. et al. Intraoperative placement of total hip arthroplasty components with robotic-arm assisted technology correlates with postoperative implant position: a CT-based study. Bone Joint J 2018; 100-B (10) 1303-1309
    CrossrefPubMedGoogle Scholar
  • 6 Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplasty 2016; 31 (10) 2353-2363
    CrossrefPubMedGoogle Scholar
  • 7 Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty 2017; 32 (09) 2663-2668
    CrossrefPubMedGoogle Scholar
  • 8 Gemescu IN, Weber M-A, Rehnitz C, Mittelmeier W, Carrino JA, Thierfelder KM. Assessment of loosening and rotational malalignment following knee endoprosthesis or other surgical components. Semin Musculoskelet Radiol 2018; 22 (04) 435-443
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Gonzalez MH, Mekhail AO. The failed total knee arthroplasty: evaluation and etiology. J Am Acad Orthop Surg 2004; 12 (06) 436-446
    CrossrefPubMedGoogle Scholar
  • 10 Hampp EL, Chughtai M, Scholl LY. et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019; 32 (03) 239-250
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Moon YW, Ha CW, Do KH. 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
    CrossrefPubMedGoogle Scholar
  • 12 Kim S-M, Park Y-S, Ha C-W, Lim S-J, Moon Y-W. Robot-assisted implantation improves the precision of component position in minimally invasive TKA. Orthopedics 2012; 35 (09) e1334-e1339
    CrossrefPubMedGoogle Scholar
  • 13 Liow MHL, Chin PL, Tay KJD, Chia SL, Lo NN, Yeo SJ. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch ROBODOC surgical system. Singapore Med J 2014; 55 (10) 529-534
    CrossrefPubMedGoogle Scholar
  • 14 Mannan A, Vun J, Lodge C, Eyre-Brook A, Jones S. Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: a systematic review and meta-analysis. Surgeon 2018; 16 (04) 237-244
    CrossrefPubMedGoogle Scholar
  • 15 Sires JD, Craik JD, Wilson CJ. Accuracy of bone resection in MAKO total knee robotic-assisted surgery. J Knee Surg 2019; 1 (212) 2-5
    PubMedGoogle Scholar
  • 16 Khlopas A, Chughtai M, Hampp EL. et al. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg Technol Int 2017; 30: 441-446
    PubMedGoogle Scholar
  • 17 Sultan AA, Piuzzi N, Khlopas A, Chughtai M, Sodhi N, Mont MA. Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection. Expert Rev Med Devices 2017; 14 (12) 925-927
    CrossrefPubMedGoogle Scholar
  • 18 Marchand RC, Sodhi N, Khlopas A. et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg 2018; 31 (01) 2-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Marchand RC, Khlopas A, Sodhi N. et al. Difficult cases in robotic arm-assisted total knee arthroplasty: a case series. J Knee Surg 2018; 31 (01) 27-37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Sodhi N, Khlopas A, Ehiorobo JO. et al. Robotic-assisted total knee arthroplasty in the presence of extra-articular deformity. Surg Technol Int 2019; 34: 497-502
    PubMedGoogle Scholar
  • 21 Siebert W, Mai S, Kober R, Heeckt PF. Technique and first clinical results of robot-assisted total knee replacement. Knee 2002; 9 (03) 173-180
    CrossrefPubMedGoogle Scholar
  • 22 Khlopas A, Sodhi N, Hozack WJ. et al. Patient-reported functional and satisfaction outcomes after robotic-arm-assisted total knee arthroplasty: early results of a prospective multicenter investigation. J Knee Surg 2020; 33 (07) 685-690
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B (07) 930-937
    CrossrefPubMedGoogle Scholar
  • 24 Grau L, Lingamfelter M, Ponzio D. et al. Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve. Arthroplast Today 2019; 5 (04) 465-470
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 26 Pietrzak JRT, Rowan FE, Kayani B, Donaldson MJ, Huq SS, Haddad FS. Preoperative CT-based three-dimensional templating in robot-assisted total knee arthroplasty more accurately predicts implant sizes than two-dimensional templating. J Knee Surg 2019; 32 (07) 642-648
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 McLawhorn AS, Carroll KM, Blevins JL, DeNegre ST, Mayman DJ, Jerabek SA. Template-directed instrumentation reduces cost and improves efficiency for total knee arthroplasty: an economic decision analysis and pilot study. J Arthroplasty 2015; 30 (10) 1699-1704
    CrossrefPubMedGoogle Scholar
  • 28 Hsu AR, Gross CE, Bhatia S, Levine BR. Template-directed instrumentation in total knee arthroplasty: cost savings analysis. Orthopedics 2012; 35 (11) e1596-e1600
    PubMedGoogle Scholar
  • 29 Hsu AR, Kim JD, Bhatia S, Levine BR. Effect of training level on accuracy of digital templating in primary total hip and knee arthroplasty. Orthopedics 2012; 35 (02) e179-e183
    PubMedGoogle Scholar
  • 30 The B, Diercks RL, van Ooijen PMA, van Horn JR. Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees. Acta Orthop 2005; 76 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 31 Howcroft DWJ, Fehily MJ, Peck C, Fox A, Dillon B, Johnson DS. The role of preoperative templating in total knee arthroplasty: comparison of three prostheses. Knee 2006; 13 (06) 427-429
    CrossrefPubMedGoogle Scholar
  • 32 Sodhi N, Khlopas A, Piuzzi NS. et al. The learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018; 31 (01) 17-21
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Deep K, Eachempati KK, Apsingi S. The dynamic nature of alignment and variations in normal knees. Bone Joint J 2015; 97-B (04) 498-502
    CrossrefPubMedGoogle Scholar
  • 34 Siegel GW, Patel NN, Milshteyn MA, Buzas D, Lombardo DJ, Morawa LG. Cost analysis and surgical site infection rates in total knee arthroplasty comparing traditional vs. single-use instrumentation. J Arthroplasty 2015; 30 (12) 2271-2274
    CrossrefPubMedGoogle Scholar
  • 35 Fabricant PD, Seeley MA, Rozell JC. et al. Cost savings from utilization of an ambulatory surgery center for orthopaedic day surgery. J Am Acad Orthop Surg 2016; 24 (12) 865-871
    CrossrefPubMedGoogle Scholar
  • 36 Elsharydah A, Michaelis MA, Rajan N. Lean management: inventory, waste management. In: Rajan N. ed. Manual of Practice Management for Ambulatory Surgery Centers. Switzerland: Springer International Publishing; 2020: 113-118
    Google Scholar
  • 37 Gandhi RR, Manzotti A, Confalonieri N, Cerveri P. Comparison of CT-based patient-specific templating and digital radiography templating in total knee arthroplasty. J Arthrosc Jt Surg 2016; 3 (01) 17-21
    CrossrefPubMedGoogle Scholar