Download to read offline
![Learning Curve thresholds
(calculated in relation to the operative
time)
6 cases!
[similar with the literature of the other
robot surgical system]](https://image.slidesharecdn.com/roboticsurgerybonanzinga-250918141040-957e41bf/75/ROBOTIC-SURGERY-Total-knee-arthroplasty-19-2048.jpg)
ROBOTIC SURGERY Total knee arthroplasty.
- 1. Robotic knee replacement surgery TOMMASOBONANZINGA, MD, PhD GREGORIO ALBERTO, YAZAN ABU SALEM, LUCA BERTOLINO
- 5.
- 6. TKA and robotics •Total knee arthroplasty (TKA) is an effective and cost-efficient procedure • Implant survivorship, assesed as revision as the primary endpoint, is greater than 90% at 10 years • However patient satisfaction and functional outcomes remain inferior to THA, with up to 20 % of patients remaining dissatisfied following TKA
- 7. • Increased Precision:3D imaging • Improved Patient Outcomes: Pain, recovery, ROM • Consistency and Control: minimize human error, real-time feedback • Minimally Invasive Approach • Adaptation to Patient Anatomy WHY Robotic-assisted surgery ? PRECISION - CONSISTENCY - OUTCOMES
- 8. HOW it works? •Convert anatomical informations into virtual 3D reconstructions • Image based (CT scan) or Image less (intraop mapping) • The surgeon uses this virtual model to plan resection, implant positioning, limg alignement • Intreaoperative robotic device helps execution
- 9. Image based vsImage less Preoperative Imaging Image-Based Robotic Surgery • Uses preoperative imaging, typically a CT scan or MRI, to create a 3D model of the patient's knee. • This 3D model is used to plan implant positioning and alignment before surgery begins. Image-Less Robotic Surgery • No preoperative CT or MRI is needed. • Instead, the 3D model of the knee is generated intraoperatively using real-time data collected from anatomical landmarks and surface mapping during the procedure.
- 10. Accuracy and Detail Image-Based •Provides high-resolution anatomical detail and may offer slightly higher precision. • More beneficial for complex deformities or revision surgeries where detailed anatomy is essential. Image-Less • Still highly accurate, but may have less detailed anatomical modeling compared to CT- based systems. • Accuracy depends more on the surgeon's skill in identifying landmarks.
- 11. Feature Image-Based Image-Less PreoperativeCT/MRI Required Not required Radiation Exposure Yes (if CT used) None Planning Preoperative Intraoperative Accuracy Very high (especially with CT) High (depends on intraop mapping) Setup Time Longer (due to imaging) Shorter Cost Generally higher Lower Best Use Case Complex cases needing detailed imaging Standard primary TKAs Summary Table
- 12.
- 13.
- 14. Key Features • RoboticAssistance (Not Autonomous): • ROSA is a tool for the surgeon, not a replacement. The surgeon remains fully in control. • Real-Time Feedback: • Provides data on patient anatomy, limb alignment, and soft tissue tension during surgery. • Minimally Invasive Compatible: • Can be used in both standard and minimally invasive techniques, potentially reducing recovery time. • No Preoperative CT Scan Required: • Uses X-ray-based planning instead of CT, reducing radiation exposure and cost. • Intraoperative Flexibility: • Allows adjustments during surgery based on real-time information and patient-specific motion.
- 15. Evaluate RA-TKA accuracyand compare its radiographic and clinical outcomes to conventional TKA (cTKA). • RA-TKA demonstrated higher accuracy in the coronal plane compared to the sagittal plane. • Patients undergoing RA-TKA had significantly higher Oxford Knee Scores (OKS) at 6 months postoperatively compared to those undergoing cTKA. • RA-TKA patients experienced slightly longer operative times and higher blood loss but had shorter inpatient stays.
- 16. Learning curve associatedwith the ROSA Knee System and assess its accuracy in femoral component size prediction and knee alignment • A significant reduction in total operative time was observed after the first 10 cases, indicating a rapid learning curve. • The system accurately predicted femoral component size in 92.6% of cases. • The difference between planned and achieved knee alignment was minimal (1.1° ± 0.9°), demonstrating high accuracy. • 60 patiens • Age 48-84 • 12 M : 48 F • RA -TKA
- 17. From NAVIO… toCORI • Reduced occupied space • Improved camera • Optimized display • Faster software A robot-assisted arthroplasty surgery more accurate
- 18. • 500 consecutivecases with CORI • Single surgeon • Medial parapatellar approach • LEGION Total knee Implant System
- 19. Learning Curve thresholds (calculatedin relation to the operative time) 6 cases! [similar with the literature of the other robot surgical system]
- 20. More precision in thealigment of the components with CORI-assisted surgery
- 21. A randomized triple-blindstudy, Ostrow Mazowiecka Hospital (Poland)
- 22. Results • Longer operativetime with NAVIO/CORI • Rotational aligment with better results (p-value= 0,00139 • Not clinical-functional differences…
- 23. A retrospective study:215 ra-TKA (CORI surgical system) vs 215 conventional TKA
- 24.
- 25. Retrospective study with 7746patients
- 26. Results: • Longer operativetimes but shorter lenght of stay in hospital with CORI … total costs are reducted!
- 27. Altough the longeroperative time with CORY, the incidence of DVT is not higher
- 28. CORI system: the«special point function» Optically tracked probe on: - Tibial tubercle - Subcutaneus patellar face (not articular) Mapping of the tibial and patellar landmark during the flexion-estension movments of the knee for the dinamic assestment of the patello-femural tracking
- 29. Patello-femural traking optimized -Rotation or traslation of the tibial component - Femoral component traslation - +/- poly-liner tickness Patellar offset Trochlear groove offset Sagittal tibial offset
- 30. VELYS RAS-TKA DePuySynthes • Imageless • Semi-autonomous • Robotic arm with sawblade
- 31. Surgical tecnique insummary… 1. Tibial resection with the robotic arm’s sawblade 2. Positioning of the ligament tensor to asses the gap between allo of the ROM
- 32. 3. Performing allthe femoral cuts with the robotic arm’s sawblade
- 33. The largest preclinicalstudy: 40 specimens • Performed Velys TKA in one side • Performed conventional TKA in the other side 1. CT scan: evaluation of bone cuts 2. Optical 3D-scan: evaluation of component’s alignment
- 34. RESULTS: Better accuracyin bone resection and implants positioning
- 35. A multicenter, prospectivenon-randomized 1:1 cohort study in USA • Better accuracy in components positioning
- 36. • Good earlyclinical outcome with reduced serious adverse event and reduced pain (measured in a scale from 0 to 10)
- 37. - 827 VRASTKA patients - 16,428 TKA patients treated with other robotic-assisted technologies. Good cost-results for the Velys Robot assisted surgery TKA
- 38. %Revision and %hospitalreadmission inferior for Velys group
- 39. No differences incosts due to: - Increased intraoperative costs due to robot - Decreased post-operative costs: reduction LOS, revision and readmission
- 40.