High Degree of Accuracy of a Novel Image-free Handheld Robot for Unicondylar Knee Arthroplasty in a Cadaveric Study

BackgroundSurgical robotics has been shown to improve the accuracy of bone preparation and soft tissue balance in unicondylar knee arthroplasty (UKA). However, although extensive data have emerged with regard to a CT scan-based haptically constrained robotic arm, little is known about the accuracy of a newer alternative, an imageless robotic system.Questions/purposesWe assessed the accuracy of a novel imageless semiautonomous freehand robotic sculpting system in performing bone resection and preparation in UKA using cadaveric specimens.MethodsIn this controlled study, we compared the planned and final implant placement in 25 cadaveric specimens undergoing UKA using the new tool. A quantitative analysis was performed to determine the translational, angular, and rotational differences between the planned and achieved positions of the implants.ResultsThe femoral implant rotational mean error was 1.04° to 1.88° and mean translational error was 0.72 to 1.29 mm across the three planes. The tibial implant rotational mean error was 1.48° to 1.98° and the mean translational error was 0.79 to 1.27 mm across the three planes.ConclusionsThe image-free robotic sculpting tool achieved accurate implementation of the surgical plan with small errors in implant placement. The next step will be to determine whether accurate implant placement translates into a clinical and functional benefit for the patient.

[1]  H. Sharifi,et al.  Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. , 2006, The Journal of bone and joint surgery. American volume.

[2]  Philip E Riches,et al.  Accuracy of a freehand sculpting tool for unicondylar knee replacement , 2014, The international journal of medical robotics + computer assisted surgery : MRCAS.

[3]  N. Pratt,et al.  The accuracy of reporting of periprosthetic joint infection to the Australian Orthopaedic Association National Joint Replacement Registry , 2004, Bone & Joint Open.

[4]  P Cartier,et al.  Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. , 1996, The Journal of arthroplasty.

[5]  P. Hernigou,et al.  Alignment Influences Wear in the Knee after Medial Unicompartmental Arthroplasty , 2004, Clinical orthopaedics and related research.

[6]  D W Murray,et al.  The Oxford medial unicompartmental arthroplasty: a ten-year survival study. , 1998, The Journal of bone and joint surgery. British volume.

[7]  Jonathan H. Lee,et al.  Unicompartmental knee arthroplasty relieves pain and improves function more than total knee arthroplasty. , 2012, The Journal of arthroplasty.

[8]  J. Galante,et al.  Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. , 2005, The Journal of bone and joint surgery. American volume.

[9]  C. Engh,et al.  Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty. , 2006, The Journal of arthroplasty.

[10]  Andrew D. Wiles,et al.  Accuracy assessment and interpretation for optical tracking systems , 2004, Medical Imaging: Image-Guided Procedures.

[11]  T. Gioe,et al.  Analysis of unicompartmental knee arthroplasty in a community-based implant registry. , 2003, Clinical orthopaedics and related research.

[12]  A. Lombardi,et al.  Is Recovery Faster for Mobile-bearing Unicompartmental than Total Knee Arthroplasty? , 2009, Clinical orthopaedics and related research.

[13]  Song Lee,et al.  Unicompartmental versus Total Knee Arthroplasty in the Same Patient , 2008 .

[14]  Gerard A Engh,et al.  Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. , 2006, The Journal of arthroplasty.

[15]  T. Thornhill,et al.  Unicompartmental total knee arthroplasty. , 1989, The Orthopedic clinics of North America.

[16]  Michael A Conditt,et al.  Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. , 2012, The Journal of arthroplasty.

[17]  D. Ammeen,et al.  The effect of alignment of the knee on the outcome of unicompartmental knee replacement. , 2002, The Journal of bone and joint surgery. British volume.

[18]  M. Miraldo,et al.  Unicondylar knee arthroplasty in the UK National Health Service: an analysis of candidacy, outcome and cost efficacy. , 2009, The Knee.

[19]  Daniel L Riddle,et al.  Yearly incidence of unicompartmental knee arthroplasty in the United States. , 2008, The Journal of arthroplasty.

[20]  J. Aubaniac,et al.  Modern Unicompartmental Knee Arthroplasty with Cement: A Three to Ten-Year Follow-up Study , 2002, The Journal of bone and joint surgery. American volume.

[21]  J. Jenny,et al.  Unicompartmental knee prosthesis implantation with a non-image-based navigation system: rationale, technique, case-control comparative study with a conventional instrumented implantation , 2002, Knee Surgery, Sports Traumatology, Arthroscopy.

[22]  J. Ranstam,et al.  The Swedish Knee Arthroplasty Register , 2014, Bone & joint research.

[23]  K Knutson,et al.  Revision of unicompartmental knee arthroplasty: outcome in 1,135 cases from the Swedish Knee Arthroplasty study. , 1998, Acta orthopaedica Scandinavica.

[24]  D. Heck,et al.  Unicompartmental knee arthroplasty. A multicenter investigation with long-term follow-up evaluation. , 1993, Clinical orthopaedics and related research.

[25]  J. Callaghan,et al.  Unicompartmental knee replacement. A minimum 15 year followup study. , 1999, Clinical orthopaedics and related research.

[26]  T. Gioe,et al.  Knee Arthroplasty in the Young Patient: Survival in a Community Registry , 2007, Clinical orthopaedics and related research.

[27]  H. Levine Medical Imaging , 2010, Annals of Biomedical Engineering.

[28]  P. Neyret,et al.  Cemented all polyethylene tibial insert unicompartimental knee arthroplasty: a long term follow-up study. , 2009, Orthopaedics & traumatology, surgery & research : OTSR.

[29]  M Jakopec,et al.  Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. , 2006, The Journal of bone and joint surgery. British volume.

[30]  M. Conditt,et al.  Robotic Arm-assisted UKA Improves Tibial Component Alignment: A Pilot Study , 2010, Clinical orthopaedics and related research.