In their series of 173 robotically assisted TKAs, Figueroa et al reported that the final implant femoral coronal, rotational and tibial coronal alignment were highly accurate compared with post-operative CT scans.48 However, overall coronal limb alignment HKA, femoral and tibial sagittal alignment were less accurate. Kayani et al noted that Mako-assisted TKAs were associated with reduced pain within the first three days, improved early functional recovery and earlier hospital discharge compared to conventional TKA.60 Furthermore, Naziri et al reported greater range of motion (ROM) and shorter length of stay in the Mako group compared to the conventional group.46 However, there were no differences in functional outcomes, final ROM and patient-reported outcome measures (PROMs) at three months. Femoral component planning can then be modified to optimize gap balancing throughout the range of motion. Additionally, the subsequent use of this robotic-assistance led to mediolateral gap balance within 2 mm throughout the flexion range of movement in 90% of patients.55 Unlike ROBODOC, this newer system incorporates a gap-tensioning in addition to a component-planning algorithm into its software.
Studies on the second generation of active systems are limited. The image-dependent software allows generation of a 3D patient-specific virtual model derived from two-dimensional (2D) radiographs, which is then mapped intra-operatively to the patient using a bony landmark registration process similar to other systems. One of the few comparative studies noted OMNIBot to be 0.5° closer to the mechanical axis compared to a computer-assisted navigation system. This system incorporates the OMNIBot robotic cutting guide for femoral bone cuts combined with a ligament-balancing tool called the BalanceBot. Originally introduced in Australia in 2018, the ROSA Knee robotic system (Zimmer Biomet, Warsaw, IN, USA) has recently gained Food and Drug Association (FDA) approval in the United States.26 Unlike other systems, ROSA provides the option of either image-dependent or imageless pathways. These systems are based on either computer-assisted or navigation technology, which provide positional guidance to the surgeon via an overhead monitor.14 With these systems, the potential for human error remains, due to a lack of safety constraints (haptic feedback) on preparation of bony surfaces and component positioning.
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First-generation robotic systems were introduced in the early 2000s. These were fully active systems such as ROBODOC (Curexo Technology Corporation, Fremont, CA, USA) and CASPAR (Ortho-Maquet/URS, Schwerin), both of which relied upon pre-operative CT imaging for surgical planning. Furthermore, the improvement in component alignment associated with the use of these systems has not demonstrated any additional benefit in improving long-term implant survivorship and clinical outcomes.15 Due to the aforementioned limitations of passive robotic systems, both semi-active and active systems are being increasingly used in TKA.16 Semi-active systems allow the surgeon to guide the robotic arm to perform both femoral and tibial bony preparation within the confines of haptic constraint pre-determined by surgical planning. The BalanceBot active spacer can then be used to calculate ligament tension throughout flexion/extension.
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The TSolution One system allows both femoral and tibial preparation for TKA using an autonomous milling system. Correction of tibial malunion and nonunion with six-axis analysis deformity correction using the Taylor Spatial Frame. Once planning is completed, the robotic arm guides a cutting block onto the femur or tibia based on the surgeon’s preference for bone preparation. Combined with the additional accuracy provided by robotic assistance, this ensures that the majority of soft tissue balancing can be achieved via accurate bony preparation and component positioning.
Compare optimal and parameterized trajectories
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Whilst the entirety of bone preparation can be performed using the burr, for efficiency most surgeons utilize a hybrid approach for primary TKA. Moreover, the complex dynamics of the spacecraft-manipulator system must be accounted for in the maneuver planning and in its overall maneuver timeline. To confirm the asymptotic stability of the closed-loop systems, some structural properties of the dynamic models must be satisfied. причини за силни болки в кръста
. What are the biomechanical properties of the Taylor Spatial Frame™? Early functional data plays an important role in appraising current robotic systems given the significant upfront costs of the technology. Most current systems, including Mako, incorporate similar soft tissue algorithms into their robotically assisted TKA pathways.21,56 However, this semi-active system additionally provides haptic feedback ensuring bony resections are confined to within 0.5 mm of the original surgical plan.24 This additional accuracy provides protection against inadvertent bony and soft tissue trauma compared to conventional TKA, potentially impacting on long-term clinical and functional outcomes.54,57 A cadaveric study by Hamp et al also highlighted the reduction of iatrogenic soft tissue injuries particularly associated with the posterior cruciate ligament (PCL) using Mako robotic assistance compared to conventional TKA.58 Inadvertent PCL resection should be avoided as it creates gap-balancing mismatch by increasing the flexion gap more than the extension gap.59 Given the importance of optimal gap balancing in reducing instability and minimizing wear, the soft tissue protection offered by semi-active systems via haptic feedback may therefore improve functional outcomes and survivorship in the long term.