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Postoperative limb alignment in total knee replacement. Conventional versus navigated versus robotic techniques.

María Durán-Serrano1, Miguel Lizcano-Palomares1, Antonio Francisco Laclériga-Giménez1

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The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS
|February 4, 2023
PubMed
Summary

Robotic surgery showed a higher improvement in limb alignment after total knee replacement (TKR) compared to conventional methods. However, overall post-operative alignment did not significantly differ across conventional, navigated, and robotic TKR techniques.

Keywords:
clinicalkneeknee arthroplastynavigationorthopaedicrobot

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Medical Technology

Background:

  • Accurate coronal mechanical axis alignment is crucial for successful total knee replacement (TKR).
  • Different surgical techniques, including conventional, navigated, and robotic-assisted surgery, aim to optimize this alignment.
  • Understanding the comparative efficacy of these methods is essential for clinical decision-making.

Purpose of the Study:

  • To compare the coronal mechanical axis achieved after total knee replacement (TKR) using conventional, navigated, and robotic surgical approaches.
  • To evaluate the differences in post-operative tibiofemoral angle and limb alignment among the three surgical groups.

Main Methods:

  • Retrospective analysis of 124 total knee replacement (TKR) cases.
  • Inclusion of three patient groups: conventional surgery (36 knees), navigated surgery (41 knees), and robotic surgery (47 knees).
  • Statistical comparison of pre-operative and post-operative tibiofemoral angles and identification of outliers (3-degree deviation).

Main Results:

  • No statistically significant differences in the post-operative tibiofemoral angle were observed between conventional, navigated, and robotic TKR groups (p = 0.396).
  • Repeated-measure analysis also showed no significant pre-operative to post-operative alignment changes across the groups (p = 0.387).
  • A significantly higher proportion of patients in the robotic group demonstrated improved mechanical alignment compared to the conventional group (p = 0.023), but not compared to the navigated group (p = 0.121).

Conclusions:

  • While overall post-operative alignment did not differ significantly among the techniques, robotic surgery showed a trend towards better alignment improvement.
  • Robotic-assisted TKR demonstrated a statistically significant improvement in the percentage of patients with better limb alignment compared to conventional surgery.
  • Further research may be warranted to explore the long-term clinical implications of these findings in TKR outcomes.