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Functional alignment with robotic‑arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 19 December 2022

This article has been updated

Abstract

Purpose

Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion–extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA).

Methods

A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups.

Results

Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P < 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively).

Conclusions

Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments.

Level of evidence

III.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea

    Byung Sun Choi, Sung Eun Kim, Myungho Yang, Du Hyun Ro & Hyuk-Soo Han

  2. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea

    Hyuk-Soo Han

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Contributions

BSC: methodology; data curation; formal analysis; investigation; visualization; writing—original draft; writing–review & editing, SEK, MY: data curation; formal analysis; investigation; writing–review & editing, DHR: conceptualization; methodology; supervision; validation; writing–review & editing, and H-SH: conceptualization; methodology; project administration; resources; supervision; validation; writing–review & editing.

Corresponding author

Correspondence to Hyuk-Soo Han.

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All authors have no competing interests to declare.

Ethical approval

This study was approved by Seoul National University College of Medicine/Seoul National University Hospital Institutional Review Board. All investigations were conducted in conformity with ethical principles of research.

Informed consent

This study is a retrospective study, then we were exempted informed consent by the institutional review board.

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Choi, B.S., Kim, S.E., Yang, M. et al. Functional alignment with robotic‑arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 31, 1072–1080 (2023). https://doi.org/10.1007/s00167-022-07227-5

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