Portal de Periódicos da CAPES

New and evolving technologies for knee arthroplasty—computer navigation and robotics: state of the art

2018; Elsevier BV; Volume: 3; Issue: 1 Linguagem: Inglês

10.1136/jisakos-2017-000146

2059-7762

Francisco Figueroa, David Parker, Brett Fritsch, Sam Oussedik,

Orthopedic Infections and Treatments

Computer-assisted navigation was introduced as an adjunct to total knee arthroplasty (TKA) with the potential of improving positioning and alignment of TKA implants. Computer-assisted surgery (CAS) can be divided into: passive (navigated TKA) or semiactive and active (robotic TKA). Passive CAS has shown improved results regarding alignment in TKA compared with conventional instrumentation but it has several possible complications such as registration errors, pin site complications, increased surgical time and a potentially longer learning curve. Robotic TKA has been developed to eliminate the possible error in the preparation of bone surfaces by the surgeon. There is still little evidence on these systems but the early results are encouraging. Despite better results in accuracy with both CAS systems, clinical benefits are still subject of debate. Additional research is required to fully define the costs and benefits of robotics in regular medical practice. Computer-assisted navigation was introduced as an adjunct to total knee arthroplasty (TKA) with the potential of improving positioning and alignment of TKA implants. Computer-assisted surgery (CAS) can be divided into: passive (navigated TKA) or semiactive and active (robotic TKA). Passive CAS has shown improved results regarding alignment in TKA compared with conventional instrumentation but it has several possible complications such as registration errors, pin site complications, increased surgical time and a potentially longer learning curve. Robotic TKA has been developed to eliminate the possible error in the preparation of bone surfaces by the surgeon. There is still little evidence on these systems but the early results are encouraging. Despite better results in accuracy with both CAS systems, clinical benefits are still subject of debate. Additional research is required to fully define the costs and benefits of robotics in regular medical practice. Key articles on computer-assisted surgery (CAS) total knee arthroplasty (TKA)1.Delp et al 11Delp SL Stulberg SD Davies B et al.Computer assisted knee replacement.Clin Orthop Relat Res. 1998; 354: 49-5610.1097/00003086-199809000-00007Crossref PubMed Scopus (268) Google Scholar reported the first series of CAS TKA in 1998.2.Harvie et al 36Harvie P Sloan K Beaver RJ Three-dimensional component alignment and functional outcome in computer-navigated total knee arthroplasty: a prospective, randomized study comparing two navigation systems.J Arthroplasty. 2011; 26: 1285-129010.1016/j.arth.2010.12.022Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar published the results using a surface-mounted CAS system.3.Mayman16Mayman D Handheld navigation in total knee arthroplasty.Orthop Clin North Am. 2014; 45: 185-19010.1016/j.ocl.2013.12.002Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar made a comprehensive review on handheld CAS TKA.4.Gustke42Gustke KA Soft-tissue and alignment correction: the use of smart trials in total knee replacement.Bone Joint J. 2014; 96-B: 78-8310.1302/0301-620X.96B11.34339Crossref PubMed Scopus (21) Google Scholar reported the first results using a pressure-sensor in TKA.5.de Steiger et al 14de Steiger RN Liu YL Graves SE Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age.J Bone Joint Surg Am. 2015; 97: 635-64210.2106/JBJS.M.01496Crossref PubMed Scopus (183) Google Scholar demonstrated a clinical benefit in CAS TKA in patients younger than 65 years old.6.Siebert et al 51Siebert W Mai S Kober R et al.Technique and first clinical results of robot-assisted total knee replacement.Knee. 2002; 9: 173-18010.1016/S0968-0160(02)00015-7Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar reported the first series of robotic TKA in 2002.7.van der list et al 28van der List JP Chawla H Joskowicz L et al.Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3482-349510.1007/s00167-016-4305-9Crossref PubMed Scopus (115) Google Scholar did a systematic review on CAS navigated and robotic TKA.8.Jacofsky et al 48Jacofsky DJ Allen M Robotics in Arthroplasty: a comprehensive review.J Arthroplasty. 2016; 31: 2353-236310.1016/j.arth.2016.05.026Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar published a comprehensive review on history and evolution of robotics in arthroplasty.9.Gholson et al 45Gholson JJ Duchman KR Otero JE et al.Computer Navigated Total Knee Arthroplasty: Rates of Adoption and Early Complications.J Arthroplasty. 2017; 32: 2113-211910.1016/j.arth.2017.01.034Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar reported on current rates of adoption and complications on CAS TKA in USA.10.The Australian Orthopaedic Association National Joint Replacement Registry70Australian Orthopaedic Association National Joint Replacement RegistryAnnual Report. AOA, Adelaide2016Google Scholar is an obligated source of data in navigation surgery adoption rates and outcomes. 1.Delp et al 11Delp SL Stulberg SD Davies B et al.Computer assisted knee replacement.Clin Orthop Relat Res. 1998; 354: 49-5610.1097/00003086-199809000-00007Crossref PubMed Scopus (268) Google Scholar reported the first series of CAS TKA in 1998.2.Harvie et al 36Harvie P Sloan K Beaver RJ Three-dimensional component alignment and functional outcome in computer-navigated total knee arthroplasty: a prospective, randomized study comparing two navigation systems.J Arthroplasty. 2011; 26: 1285-129010.1016/j.arth.2010.12.022Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar published the results using a surface-mounted CAS system.3.Mayman16Mayman D Handheld navigation in total knee arthroplasty.Orthop Clin North Am. 2014; 45: 185-19010.1016/j.ocl.2013.12.002Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar made a comprehensive review on handheld CAS TKA.4.Gustke42Gustke KA Soft-tissue and alignment correction: the use of smart trials in total knee replacement.Bone Joint J. 2014; 96-B: 78-8310.1302/0301-620X.96B11.34339Crossref PubMed Scopus (21) Google Scholar reported the first results using a pressure-sensor in TKA.5.de Steiger et al 14de Steiger RN Liu YL Graves SE Computer navigation for total knee arthroplasty reduces revision rate for patients less than sixty-five years of age.J Bone Joint Surg Am. 2015; 97: 635-64210.2106/JBJS.M.01496Crossref PubMed Scopus (183) Google Scholar demonstrated a clinical benefit in CAS TKA in patients younger than 65 years old.6.Siebert et al 51Siebert W Mai S Kober R et al.Technique and first clinical results of robot-assisted total knee replacement.Knee. 2002; 9: 173-18010.1016/S0968-0160(02)00015-7Abstract Full Text Full Text PDF PubMed Scopus (173) Google Scholar reported the first series of robotic TKA in 2002.7.van der list et al 28van der List JP Chawla H Joskowicz L et al.Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3482-349510.1007/s00167-016-4305-9Crossref PubMed Scopus (115) Google Scholar did a systematic review on CAS navigated and robotic TKA.8.Jacofsky et al 48Jacofsky DJ Allen M Robotics in Arthroplasty: a comprehensive review.J Arthroplasty. 2016; 31: 2353-236310.1016/j.arth.2016.05.026Abstract Full Text Full Text PDF PubMed Scopus (184) Google Scholar published a comprehensive review on history and evolution of robotics in arthroplasty.9.Gholson et al 45Gholson JJ Duchman KR Otero JE et al.Computer Navigated Total Knee Arthroplasty: Rates of Adoption and Early Complications.J Arthroplasty. 2017; 32: 2113-211910.1016/j.arth.2017.01.034Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar reported on current rates of adoption and complications on CAS TKA in USA.10.The Australian Orthopaedic Association National Joint Replacement Registry70Australian Orthopaedic Association National Joint Replacement RegistryAnnual Report. AOA, Adelaide2016Google Scholar is an obligated source of data in navigation surgery adoption rates and outcomes.