Robotic-assisted revision total knee arthroplasty: a novel surgical technique

Abstract

Background: Revision total knee arthroplasty is a challenging procedure. The robotic-assisted system has been shown to enhance the accuracy of preoperative planning and improve reproducibility in primary arthroplasty surgeries. The aim of this paper was to describe the surgical technique for robotic-assisted revision total knee arthroplasty and the potential benefits of this technique.

Method: This single-centre retrospective study included a total of 19 patients recruited from April 1, 2021 to April 30, 2022. Inclusion criteria were patients who had Mako™ robotic-assisted revision total knee arthroplasty done within the study period with a more than 6 months follow-up. Statistical analysis was done using Microsoft Excel 16.0.

Results: All 19 patients were followed up for 6 to 18 months. All patients in this study had uneventful recoveries without needing any re-revision surgery when reviewed to date.

Conclusion: With the development of dedicated revision total knee software, robot-assisted revision TKA can be a promising technique that may improve surgical outcomes by increasing the accuracy of implant placement, and soft tissue protection and achieving a better well-balanced knee.

Keywords: Revision total knee arthroplasty; Robotic surgery; Surgical technique.

Fig. 1

CT slice of a femoral component without metal artefact reduction software (MARS)

Fig. 2

CT slice of the same level after MARS

Fig. 3

Scaled image of the preoperative plan for visualization of stem placement

Fig. 4

Placement of femoral and tibial pin with arrays placed away from the knee incision

Fig. 5

Femoral bony landmark registration with a total knee femoral component in situ

Fig. 6

Tibial bony landmark registration with a total knee tibial tray in situ

Fig. 7

Preoperative planning for a patient with an over-sized femoral component with patella baja

Fig. 8

Preoperative planning of a patient with massive bone cyst involving both femoral condyles

Fig. 9

Preoperative planning of a patient with existing UKA revised to a TKA (a mechanically-aligned knee plan)

Fig. 10

Alternative mechanically-aligned knee plan for the patient in Fig. 9

Fig. 11

The non-mechanically-aligned knee plan for the same patient in Fig. 9

Fig. 12

Placement of array pins in knee incision. Existing tibial tray was removed by using the Mako saw to cut distal to it

Fig. 13

Femoral bony landmark registration with a medial unicompartmental knee femoral component in situ

Fig. 14

Tibial bony landmark registration with a medial unicompartmental knee tibial tray in situ

Fig. 15

Preoperative planning of a patient with antibiotic cement spacer for periprosthetic joint infection

Fig. 16

Steps of surgical techniques for robotic-assisted TKA

Fig. 17

Pre- and postoperative radiographs of patient for preoperative planning in Fig. 7

Fig. 18

Pre- and postoperative radiographs of patient for preoperative planning in Fig. 8

Fig. 19

a Preoperative knee radiograph of the patient with the preoperative plan from Fig. 11; b Spect CT of the knee of the same patient showing loosening of the UKA; c Postoperative knee radiograph of the same patient

Fig. 20

Pre- and postoperative radiographs of the patient for the preoperative planning in Fig. 15