Archives of orthopaedic and trauma surgery
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The concept of custom total knee arthroplasty (TKA) is explored with specific attention to current limitations. Arguments in favor of custom TKA are the anatomic and functional variability we encounter in our patients. The biggest conceptual challenge is to marry the need for correction of deformity with the ambition to stay as close as possible to original anatomy. ⋯ Custom knee implants are the next step in matching the geometric features of the prosthesis to the anatomy of the individual patient, after several iterations that added asymmetry and sizes in the existing implants. Several companies have proven that it is feasible to produce these implants in a safe way. An overview of current literature reveals the lack of strong methodological studies that prove the value of this new technology. Custom knee implants face conceptual and practical difficulties, some of which might be overcome with technological advances, such as robotics and artificial intelligence.
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Arch Orthop Trauma Surg · Dec 2021
ReviewAssistive technologies in knee arthroplasty: fashion or evolution? Rate of publications and national registries prove the Scott Parabola wrong.
Most opponents of assistive technologies in orthopedic surgery consider them as a marketing ruse or fashion. Our hypothesis was that many innovations in modern knee arthroplasty are not following the Scott Parabola. This parabola represents the visual curve of a procedure or therapy showing great promise at the beginning, becoming the standard treatment after reports of encouraging results, only to fall into disuse due to adverse outcome reports. This study aimed to assess the interest in these assistive technologies by (1) their number of publications/year and (2) their actual surgical use reported in the National Joint Registries. ⋯ Most of the innovations in modern knee arthroplasty are not following the Scott Parabola. After a fast rise, these techniques do not disappear but continue to evolve. Their evolution is synergistic, and techniques appeared to be linked to each other's. Despite persisting concerns about the cost-efficiency of assisting technologies in knee arthroplasties, the interest and use do not decrease and seems to be directly linked to an exponential increase in interest for a better understanding of alignment targets and improved functional recovery.
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When active robotic technologies for Total Knee Arthroplasty (TKA) were introduced over 20 years ago, broad usage of robotic technology was not felt to be needed as early data suggested no clear improvement in clinical outcomes compared to conventional techniques of implantation. Only recently has there been renewed enthusiasm for use of robotic technologies for implantation. ⋯ This FDA study of an active robotic approach for TKA represented the first multicenter trial and first US experience with this technology. Results demonstrated an excellent safety profile and high degree of accuracy. Advantages of this approach relate to standardization of the technique, multiple device options in the implant library, an excellent safety and accuracy profile, and consistency of results. Active robotics for TKA represents a viable and safe technique for primary TKA.
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Arch Orthop Trauma Surg · Dec 2021
Joint line is restored in robotic-arm-assisted total knee arthroplasty performed with a tibia-based functional alignment.
Functional 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. ⋯ The 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.
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Arch Orthop Trauma Surg · Dec 2021
ReviewCustom total knee: understanding the indication and process.
Patient-specific total knee arthroplasty (TKA) is a copy of the bony knee morphology based on a pre-op computer tomography (CT). The images are segmented in 3D and software is utilized through a proprietary process to generate individual total knee implants to recreate the articulating surfaces. The distal condylar valgus angle of the prosthesis is matched anatomically to the distal femur and reversely matched on the tibia with a thicker lateral insert. ⋯ The system is available with one solid or two separated medial and lateral PE inserts. There is a cruciate retaining (CR) and posterior stabilized (PS) version available, including various insert thicknesses. The system allows the addition of two different cemented stem extensions if needed at the time of surgery.