Robotic Assisted Total Knee Arthroplasty in Presence of Extra-Articular Deformity

摘要

Introduction: There is a lack of data concerning the use of the robotic device for patients with other potentially complex surgical factors. Therefore, the purpose of this series was to present cases in which the robotic-arm assisted TKA (RATKA) application was used in the setting of extra-articular deformities to educate the surgeon community on this potentially useful method to address these complex cases. Methods: Three cases of patients who underwent RATKA in the setting of pre-operative extra-articular deformities were identified. One had femoral and tibial fracture malunion, another had proximal tibial fracture nonunion, and another with a healed tibial plateau fracture. Patient clinical histories, intra-operative surgical techniques, and post-operative outcomes were obtained. Specific focus was placed on the surgical management of the patient’s pre-existing deformity. Results: The robotic software was able to appropriately consider the extra-articular deformity in the pre-operative and real-time updated intra-operative plans. Doing so, the surgeon achieved a balanced and aligned TKA. No intra-operative or post-operative complications occurred. Antero-posterior and lateral radiographs demonstrated well fixed and aligned femoral and tibial components with no signs of loosening or osteolysis. On physical exam, all patients had excellent range of motion with mean flexion of 122 degrees (range: 120 to 125 degrees of flexion) at final follow-up. Discussion: Utilizing pre-operative CT-scans with a 3D plan for robotic-arm assisted surgery allowed for appropriate assessment of the deformity pre-operatively and execution of a plan for a balanced and aligned total knee arthroplasty. We have demonstrated excellent results utilizing robotic-arm assisted TKA in these complex cases.