• Arch Orthop Trauma Surg · Dec 2021

    Joint line is restored in robotic-arm-assisted total knee arthroplasty performed with a tibia-based functional alignment.

    • Francesco Zambianchi, Gabriele Bazzan, Andrea Marcovigi, Marco Pavesi, Andrea Illuminati, Andrea Ensini, and Fabio Catani.
    • Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena, University of Modena and Reggio-Emilia, Modena, Italy. francesco.zambianchi@gmail.com.
    • Arch Orthop Trauma Surg. 2021 Dec 1; 141 (12): 2175-2184.

    IntroductionFunctional alignment (FA) in total knee arthroplasty (TKA) has been introduced to restore the native joint line obliquity, respect the joint line height and minimize the need of soft tissue releases. The purpose of this study was to assess the intraoperative joint line alignment and compare it with the preoperative epiphyseal orientation of the femur and tibia in patients undergoing robotic-arm-assisted (RA)-TKA using FA.Materials And MethodsThis retrospective study included a consecutive series of patients undergoing RA-TKA between February 2019 and February 2021. The joint line orientation of the femur and tibia in the three-dimensions was calculated and classified on preoperative CT-scans and compared with the intraoperative implant alignment. The tibial cut was performed according to the tibial preoperative anatomy. The femoral cuts were fine-tuned based on tensioned soft tissues, aiming for balanced medial and lateral gaps in flexion and extension.ResultsA total of 115 RA-TKAs were assessed. On average, the tibial component was placed at 1.8° varus (SD 1.3), while the femur was placed at 0.8° valgus (SD 2.2) and 0.6° external rotation (SD 2.6) relative to the surgical transepicondylar axis. Moderate to strong, statistically significant relationships were described between preoperative tibial coronal alignment and tibial cut orientation (r = 0.7, p < 0.0001), preoperative femoral orientation in the coronal and axial planes and intraoperative femoral cuts alignment (r = 0.7, p < 0.0001 and r = 0.5, p < 0.0001, respectively). One case (0.9%) of slight tibial component varus subsidence was reported 45-days post-operatively, but implant revision was not necessary.ConclusionsThe proposed robotic-assisted functional technique for TKA alignment, with a restricted tibial component coronal alignment, based on the preoperative phenotype and femoral component positioning as dictated by the soft tissues, provided joint line respecting resections. Further studies are needed to assess long-term implant survivorship, patient satisfaction and alignment-related failures.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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