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Active Robotic Total Knee Arthroplasty

March 01, 2020

Contributors: William John Long, MD, FAAOS; Dylan Lowe, MD; Omar A Behery, MD

Background Successful total knee arthroplasty (TKA) requires accurate bony resection, component alignment, and positioning. Restoration of the mechanical axis during TKA is associated with improved implant survivorship and outcomes. A novel active robotic TKA system is designed to achieve these goals. Surgical resection is performed based on a preoperative plan. Careful technique is required to safely and accurately achieve planned resection, component positioning, alignment, and rotation. Purpose This video demonstrates a reproducible and efficient technique for the use of an active robotic device for primary TKA in patients with knee osteoarthritis. Methods The video provides an overview on the ideal indications for active robotic TKA. The case presentation of a 61-year-old man who has varus tricompartmental arthritis without considerable deformity is discussed, and treatment options are reviewed. CT is obtained preoperatively for templating and surgical planning. The video reviews the literature on outcomes of active robotic TKA and the outcomes of the primary surgeon's case series of 49 patients who underwent active robotic TKA. The surgical technique for active robotic TKA is demonstrated from skin incision to closure. Clinical and radiographic 6-month outcomes are reviewed. Results Excellent femoral and tibial component positioning and alignment are achieved via an active robotic device during TKA, without any intraoperative fractures, iatrogenic soft-tissue injuries, or prosthetic joint infections. Conclusion An active robotic device allows for reliable templating of femoral and tibial component size, alignment, and positioning. Consistent and efficient surgical technique is necessary to accurately achieve the surgical plan without a surgical time longer than that for conventional TKA.