Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA.Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7-20 robotic TKA cases.Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA.Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA.Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022.

Robotic technology in total knee arthroplasty: a systematic review

The term ‘robot’ originates from the Czech word ‘robota’, which means forced labour or activity. Karel Capek first used the term in his 1921 play Rossum’s Universal Robots, in which robots were a series of factory-manufactured artificial people made from synthetic material that undertook mundane tasks for their human masters. The robots eventually became frustrated with their roles and masterminded a robotic rebellion, leading to the extinction of the human race. Since then, robotics has evolved to describe an array of computer machines that perform preprogrammed, precise, and repetitive procedures. These computer machines have now become integrated into the routine workforce of several industries, including aviation, military, healthcare, finance, construction, and engineering.1,2 Robotic technology has helped each of these sectors to achieve and sustain levels of precision, productivity, and efficiency that were not possible with humans alone. Within each of these sectors that have integrated robotic technology into the workforce, the use of this technology has never diminished or exited from the industry.2 The first robotic surgical procedure was performed by Kwoh et al3 in 1988 using the PUMA 560 robotic system (Westinghouse Electric, Pittsburgh, Pennsylvania) to undertake neurosurgical biopsies with improved precision. The same robotic platform was used by Davies et al4 in 1991 to undertake transurethral resections of the prostate with greater accuracy and reduced iatrogenic soft-tissue injury. over the following two decades, several other surgical robotic devices were developed, including the Zeus (Computer Motion, Inc., Goleta, California) and Da vinci (Intuitive Surgical, Sunnyvale, California) robotic platforms, which enabled a variety of surgical procedures to be performed remotely using robotically controlled arms and a 3D camera to improve the visual field.5,6 These robotic devices have been used to perform cholecystectomy, hysterectomy, lobectomy, mitral valve replacement, coronary artery bypass grafting, and prostatectomy. Compared with conventional open surgery or laparoscopic surgery, robotic surgery with these devices is associated with smaller skin incisions, improved precision of soft-tissue dissection, better visualization of the surgical field, and more comprehensive data capture for surgical training.6,7 Clinically, this has translated to robotic surgery enabling faster postoperative rehabilitation and decreased length of hospital stay compared with conventional and laparoscopic surgery for these procedures.5-8 Total knee arthroplasty (TKA) is an effective and cost-efficient procedure that is performed in over 90 000 patients per year in the United Kingdom.9 Implant survivorship, assessed with revision as the primary endpoint, is greater than 90% at ten years’ follow-up.10,11 However, patient satisfaction and functional outcomes remain inferior to total hip arthroplasty, with up to 20% of patients remaining dissatisfied following TKA.12,13 Accurate implant positioning, balanced flexionextension gaps, proper ligament tensioning, and preservation of the periarticular soft-tissue envelope are important surgeon-controlled variables that affect functional outcomes, implant stability, and long-term implant survivorship.14-16 Conventional jig-based TKA uses preoperative radiographic films, intraoperative anatomical landmarks, and manually positioned alignment jigs to guide bone resection and implant positioning. However, these handheld techniques are associated with poor reproducibility of alignment-guide positioning, inadvertent sawblade injury to the periarticular soft-tissue envelope, and limited intraoperative data on gap measurements or ligamentous tensioning to Robotic total knee arthroplasty

Robotic total knee arthroplasty: clinical outcomes and directions for future research.

Background The aim of our retrospective case-control study is to identify risk factors associated with a persisting flexion contracture after total knee arthroplasty (TKA). This is an important clinical issue as a flexion contraction can lead to poor long-term clinical outcomes and patient satisfaction after TKA. Methods The study group included 120 knees treated for a varus osteoarthritic deformity of the knee using a posterior cruciate-retaining TKA. We evaluated the association between a flexion contracture >10°, 2 years after surgery, and the following potential risk factors, using logistic regression analysis: age, body height, body mass index, preoperative knee extension and hip-knee-ankle angle, and radiological parameters of component alignment, namely the femoral component medial angle, the femoral component flexion angle (FFA), the tibial component medial angle, and the posterior tibial slope. Results Of the 120 knees, a persisting flexion contracture >10° was identified in 33 (28%). The mean FFA in these cases was 7.3° (standard deviation, 1.4) compared to 4.2° (standard deviation, 1.2) for cases with a contracture of ≤10° (P = .034). On multivariate analysis, the FFA (odds ratio, 3.73; 95% confidence interval, 1.16-17.81; P = .034) and body height (odds ratio, 0.43; 95% confidence interval, 0.29-0.57; P = .041) were independent predictive risk factors for a residual flexion contracture >10°. Conclusion Clinicians should be aware that flexed position of the femoral component, particularly in patients of short stature, is associated with increased occurrence of persistent flexion contracture.

Sagittal Alignment of the Femoral Component and Patient Height Are Associated With Persisting Flexion Contracture After Primary Total Knee Arthroplasty.

Background The argument on the clinical effects between gap balancing (GB) and measured resection (MR) in total knee arthroplasty remains to be resolved. A systematic review and meta-analysis was performed to investigate which technique in total knee arthroplasty has better clinical effect. Methods A total of 20 studies involving 2259 cases were included in the meta-analysis. The primary outcome measure was Knee Society Score (KSS), whereas the secondary outcomes included other function assessment systems (eg, range of motion, Western Ontario and McMaster University Osteoarthritis Index), radiological outcomes (eg, femoral component rotation, total outliers), revision rate, complications (eg, infection, loosening, instability), and surgical time. Results The GB technique was associated with statistically significant increases in the primary outcomes of KSS-function in 1 year. However, a mean difference of 2.12 points was below the minimal clinically important difference of 6 points. No differences were found in the analyses of KSS-knee and KSS-function in any other follow-up periods. Secondary outcome assessments showed significant decreased surgical time (mean difference, 16.18; P Conclusion We conclude that both techniques can result in equivalent results when done properly, and each surgeon must understand the strengths and weaknesses of each technique.

Clinical Outcomes of Gap Balancing vs Measured Resection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis Involving 2259 Subjects.

To investigate intraoperative soft tissue balance with femoral component trial in place using a novel medial preserving gap technique, focusing on medial compartment stability and allowing lateral physiological laxity, with compared with using a measured resection technique in posterior-stabilized (PS) total knee arthroplasty (TKA). Primary PS TKA, using either medial preserving gap technique (n = 127) or measured resection technique (n = 148), was performed in 275 subjects with varus knee osteoarthritis. Intraoperative soft tissue balance with femoral component in place was assessed using Offset Repo-Tensor with 40 lbs. of joint distraction force throughout the range of motion, and medial and lateral compartment gaps (mm) were calculated. Medial and lateral joint gap changes (mm) were calculated by subtracting the medial/lateral compartment gap at 0° from the medial/lateral compartment gap at each knee flexion angle, respectively. Medial and lateral joint gap changes in medial preserving gap technique were significantly smaller than measured resection technique respectively (mean difference between two procedures: medial; 0.9 ± 0.2 mm, lateral; 1.0 ± 0.3 mm). Medial and lateral joint gaps were significantly changed during knee flexion in measured resection technique, whereas medial and lateral joint gaps were not significantly changed during mid-to-deep knee flexion (30°–90° in medial, 30°–120° in lateral) in medial preserving gap technique. Medial preserving gap technique provided more consistent intraoperative soft tissue balance during knee flexion than the measured resection technique, suggesting that this novel technique can be utilized to obtain a more stable joint gap in PS TKA. III.

Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique.

Background Traditional Chinese Exercise (TCE) has expanded out of China into the world and is frequently used in the prevention and treatment of many diseases. Although many studies have explored the ability of TCE as an intervention for neurodegenerative diseases, there are limited articles summarizing the research. The aim of this study was to investigate current research trends around TCE for neurodegenerative diseases and predict future directions for such research. Materials and Methods Data was collected from the Web of Science Core Collection (WoSCC). All articles and reviews on TCE in relation to neurodegenerative diseases were retrieved. The data analysis was performed using the CiteSpace (5.8R3) software, and the results were displayed in network maps. Results The search identified 220 publications between 1999 and 2021. The United States was the most productive country (n = 89), followed by China (n = 68). The United States had the greatest centrality, indicating its tremendous global influence and close collaborations with other countries. Fuzhong Li from the Oregon Research Institute, United States, was not only the most prolific author (n = 5), but also the most co-cited author (n = 120). The Shanghai University of Sport contributed to the most publications (n = 12). PLOS ONE was the most published journal, while Movement Disorders was the most cited journal. Tai Chi, Parkinson’s disease, quality of life, balance, and older adult were the most high-frequency keywords, while Alzheimer’s disease had the highest centrality. Conclusion The number of publications on TCE related to neurodegenerative diseases has shown major growth in the past decade. However, there is a need for research institutions to strengthen cooperation between countries and institutions. Tai Chi, Parkinson’s disease (PD), Alzheimer’s disease, older adults and falls reduction have been the recent research focus. It is anticipated that in the future, PD will continue to be a central focus with the effects of Baduanjin, Wuqinxi, and Yijinjing requiring further research.

/pdf/traditional-chinese-exercise-for-neurodegenerative-diseases-3g21qdpt.pdf

Traditional Chinese Exercise for Neurodegenerative Diseases: A Bibliometric and Visualized Analysis With Future Directions

Aims There are two techniques widely used to determine the rotational
alignment of the components in total knee arthroplasty (TKA); gap
balancing (GB) and measured resection (MR). Which technique is the
best remains controversial. We aimed to investigate this in a systematic
review and meta-analysis. Materials and Methods In accordance with the methods of Cochrane, databases were searched
for all randomised controlled trials in the literature between January
1986 and June 2015 comparing radiographic and clinical outcomes
between the use of these two tecniques. Meta-analysis involved the
use of the Revman5.3 software provided by Cochrane collaboration. Results A total of 1464 papers were initially identified, and after the
application of rigourous inclusion and exclusion critera, eight
were included in the study. In total they inolved 980 TKAs. The
meta-analysis showed that GB techniques resulted in statistically
significant improvements in the restoration of mechanical and rotational
alignment and mean Knee Society Scores and Knee Society Function
scores two years post-operatively, but resulted in greater elevation
of the position of the joint line. There is no significant difference
in the other radiographic data. Conclusion This study suggests that GB may provide better radiographic and
clinical outcomes than MR when used to determine mechanical rotation
in TKAs. Cite this article: Bone Joint J 2017;99-B:151–8.

Meta-analysis of gap balancing versus measured resection techniques in total knee arthroplasty.

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Traditional Chinese Exercise for Neurodegenerative Diseases: A Bibliometric and Visualized Analysis With Future Directions

Meta-analysis of gap balancing versus measured resection techniques in total knee arthroplasty.