Achieving functional implant positioning with Mako Total Knee
Message from Kirby Hitt, MD
Baylor Scott & White Health, Texas
Message from Kirby Hitt, MD
Baylor Scott & White Health, Texas
As the Director, Division of Joint Replacement Surgery at Baylor Scott & White Health, I’d like to share with you what I think is one of the most exciting current topics in joint replacement: functional implant positioning.
Despite advancements in TKA instrumentation and surgical techniques alignment, there’s still room for improvement.1, 2 A recent independent surgeon poll conducted by VuMedi showed that properly balancing a knee during TKA continues to be an important challenge for many surgeons.3 Knees with fixed deformities, severe flexion contractures or recurvatum add further complexity to the joint balancing process.
Patients with mal-aligned and unstable knees have reported low patient satisfaction.4, 5, 6 These knees demonstrate a higher incidence of loosening and revision.4, 5, 6 TKA patients with well-aligned and well-balanced knees which function well also demonstrated longer survivorship and higher patient satisfaction.4, 5, 6, 7, 8 So where can functional implant positioning play a role?
Functional implant positioning is patient-specific implant placement to plan as the result of the three unique steps of Mako Robotic-Arm Assisted Surgery: enhanced planning, dynamic joint balancing and robotic-arm assisted bone preparation. Clinical research confirms that this position is patient-specific and determined by both bone structures in the joint and the condition of the ligaments.7,8
Historically, TKA aimed at placing the TKA components in the same spot for all patients irrespective of anatomic differences. Similarly, pre-operative planning in conventional TKA is limited to the classic 2D templating on acetate or digital x-rays.
The Mako Total Knee application has shown accuracy of planning and component size predictability to plan, using patient-specific 3D bone models generated from the patient’s CT scan thanks to enhanced planning capabilities.10
My experience thus far with the Mako Total Knee application suggests these encouraging early results are due to enhanced alignment and accuracy to plan, anatomic patient matching, soft tissue balancing and robotic-arm assisted bone preparation. 9, 10, 11, 12, 13, 14, 15, 16
In closing, I’m excited to share with you this video demonstrating how I have achieved functional implant positioning with Mako Total Knee.
Resources:
References:
1. Blumenfeld TJ. CORR Insights (R): is TKA using patient-specific instruments comparable to conventional TKA? A randomized controlled study of one system. Clin Orthop Relat Res. 2013;471:3996. doi: 10.1007/s11999-013-3283-1.
2. Barrett WP, Mason JB, Moskal JT, Dalury DF, Oliashirazi A, Fisher DA. Comparison of radiographic alignment of imageless computer-assisted surgery vs conventional instrumentation in primary total knee arthroplasty. J Arthroplasty. 2011;26:1273. doi: 10.1016/j.arth.2011.04.037.
3. VuMedi. Why Are Total Knees Failing Today? Etiology of Total Knee Revision in 2010 and 2011. n.d. web browser. 14 February 2018. <https://www.vumedi.com/discussion/why-are-total-knees-failing-today-etiology-of-total-knee-revision-in-2010-and-2011/>.
4. Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: just how important is it? J Arthroplasty. 2009;24(6 Suppl):39. doi: 10.1016/j.arth.2009.04.034.
5. Thomas K. Fehring, M., Odum, MEd, MA, S., Griffin, MD, W. L., Mason, MD, J. B., & Nadaud, MD, M. (2001). Early Failures in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research, 315-318.
6. Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty. (2007) Dec;22(8):1097-106.
7. Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res. 2012;470:45. doi: 10.1007/s11999-011-1936-5.
8. Claudio Carlo Castelli, Daniele Antonio Falvo, Mario Luigi Iapicca, Valerio Gotti Rotational alignment of the femoral component in total knee Arthroplasty Ann Transl Med. 2016 Jan; 4(1): 4
9. Hampp EL, Scholl LY, Chang TC, et al Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy to plan compared to manual technique. 17th annual CAOS Meeting, June 2017, Vol 1, 2017; 1-5
10. Bhimani S, Bhimani R, Feher A, Malkani A. Accuracy of Preoperative Implant Sizing Using 3D Preplanning Software for Robotic-Assisted TKA. 27th annual AAHKS meeting, Dallas, TX, 2-5- Nov 2017.
11. Marchand RC, Sodhi N, Khlopas A, et al. Patient satisfaction outcomes after robotic-arm assisted total knee arthroplasty: a short-term evaluation. J Knee Surg. 2017 Nov;30(9):849-853.
12. Clark, et al. Master Class AOA 2017. My journey from navigation to robotics.
13. Malkani, Arthur. "Does Robotic Assisted Surgery Improve Early Outcome in Total Knee Arthroplasty?" ORS Poster No. 1914. New Orleans, LA, 2018.
14. Kayani, B., Konan, S., Pietrzak, J., Haddad, F. (2018) Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: A prospective cohort study and validation of a new classification system. The Journal of Arthroplasty. Advance online publication. DOI: 10.1016/j.arth.2018.03.042.
15. Kayani, B., Konan, S., Tahmassebi, J., Pietrzak, J., Haddad, F. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty. The Bone and Joint Journal. July 2018
16. Feher, A., Bhimani, S., Bhimani, R., Malkani, A., Gap balanicing in total knee arthroplasty using robotic-arm assisted technology. ORS Poster No. 1914. New Orleans, LA, 2018.
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