There is a paucity of data regarding the incidence of deep prosthetic joint infection (PJI) in robotic TKA. Two recent systematic reviews suggested that the incidence was higher in robotic TKA at 1.6-1.7% compared to 0.44-1.00% in manual TKA.19,71 However, these data were based on a limited number of comparative studies using earlier active robotic technology that is now obsolete.9,14,23,72 Given the small numbers involved, it is questionable whether these figures were a true representation of PJI for each treatment group. The block S11 is composed of the dual inertia matrix for each of the bodies. The base-spacecraft inertia matrix, manipulator inertia matrix, and the dynamic-coupling inertia matrix are thoroughly explained in the following subsections.
Облекчаване На Болката
To achieve a smooth, impact-free capture, the chaser’s manipulator is actuated to obtain a zero relative velocity between the chaser’s end-effector and the target’s grapple fixture. Hb∈ℝ6×6, Hm∈ℝ7×7, Hbm∈ℝ6×7 are the inertia matrices of the whole system, manipulator and the coupling between the base and the manipulator, respectively. 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.
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. This will involve designing the interface with circular fixtures for power and data, and possibly a central exchange for thermal. A randomized controlled trial evaluating Mako robotic TKA compared to conventional TKA is currently underway.76 However, more long-term studies are required to fully appraise and assess this and other newer robotic systems. 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. Survivorship data are currently lacking for robotically assisted TKA utilizing the newer generation of predominantly semi-active systems.
Коляното На Облекчаване На Болката
Incidence of intra-operative conversion to conventional TKA arthroplasty due to ROBODOC technical failure has been reported in up to 30% of cases.68,69 Complication rates associated with newer systems appear to be low. болки в ставите артрит
. These systems have previously been established for uni-compartmental implantation, with early promising survivorship rates noted between 95% and 99% with a mean follow up of 19 to 27 months.73-75 Recent registry data noted a cumulative revision rate of 2.6% at three years for Mako-assisted UKA compared with 5% for the non-robotically assisted group.24 Whether this robotic system can produce similar survivorship data when used for TKA implantation remains to be seen.
More recently, the accuracy of semi-active systems has been evaluated. The Mako Robotic-Arm Assisted System (Stryker, Mako Surgical Corp., Fort Lauderdale, FL, USA) was officially launched for primary TKA in 2017. This image-dependent semi-active system utilizes pre-operative CT imaging to generate a 3D model that is used to plan both femoral and tibial component size and orientation. 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. However, in order to facilitate different configurations for multiple prostheses, implant design specificity and biomechanical data to predict optimal implant positioning was markedly reduced.11,30 Newer robotic systems are predominantly closed platforms.
Several studies highlighted the better alignment accuracy and implant fit using both systems compared to manual TKA.9,22 However, this failed to equate to an improvement in clinical outcomes. In contrast, imageless systems use a more detailed registration of the bony articulating surfaces and joint kinematics recorded intra-operatively post arthrotomy to create this surgical plan. Passive robotic systems have had limited use in TKA. The TSolution One system allows both femoral and tibial preparation for TKA using an autonomous milling system. TSolution One (Think Surgical Inc., Fremont, CA, USA) is an image-dependent active robotic system that incorporates technology originally developed for its predecessor ROBODOC (Curexo Technology, Fremont, CA, USA). 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.
Survivorship data for robotic TKA remains scarce, although long-term data for earlier systems such as ROBODOC have recently been reported. Once activated, the robot completes all femoral and tibial bone cuts autonomously, although, for safety, the surgeon does have a manual override button. 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. For trade (2), a structural analysis was performed of the combined LAR, clamping mechanism and alignment mechanism. This system incorporates the OMNIBot robotic cutting guide for femoral bone cuts combined with a ligament-balancing tool called the BalanceBot. 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. This is equivalent to the moment in which the last joint of the robot has to apply, which is dependent on the choice of the arm delivery point position.
Изчезването на болка, подуване и зачервяване
осигурява подхранване за ставния хрущял
Simultaneous Capture and Detumble Maneuver
The use of redundant twisted pairs and fullduplex is recommended
Възстановяване на физическата активност
Scoop proof and spring loaded tab contacts are recommended physical means of power transfer
This includes Mako robotic TKA which currently limits implant choice to cemented or uncemented versions of the Triathlon (Stryker, Kalamazoo, Michigan, USA) TKA. As it is expected that VLEO spacecraft designers will take this issue into consideration it can be safely assumed that the CoM and CoP, for the target attitude, will be reasonably aligned. For image-dependent systems, this virtual 3D model is derived from pre-operative imaging using computed tomography (CT) or magnetic resonance imaging (MRI). This differs from previous approaches that require the addition of extra terms that are joint-type dependent, and which decouple the rotational and translational dynamics. 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. Additionally, there was no learning curve with regards to achieving planned component positioning and limb alignment.