An animal experimental study on domestic robot-assisted total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHAI Wei ¹ , XIE Jie ² ^Δ , ZHANG Xiaogang ³ , YAN Tingfang ⁴ , ZHAO Yalan ⁴ ,  HE Chuan ⁵ ,  ZHANG Yuan ⁶

1. Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, 410008, P.R.China;
3. Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830011, P.R.China;
4. Yuanhua Technology Limited, Shenzhen Guangdong, 518000, P.R.China;
5. Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China;
6. Department of Orthopedics, Xinqiao Hospital, Affiliated Hospital of Army Medical University, Chongqing, 400037, P.R.China;

Corresponding author：

HE Chuan, Email: drhechuan@sina.com; ZHANG Yuan, Email: joint_chueng@hotmail.com

Keywords：

Total knee arthroplasty; robot-assisted surgery; assisted osteotomy; goat

DOI：

10.7507/1002-1892.202003173

Video：

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Objective To evaluate the performance, safety, and precision of the Yuanhua robotic-assisted total knee arthroplasty system (YUANHUA-TKA) through animal experiments, which will provide reference data for human clinical trials.Methods Six 18-month-old goats, weighing 30-35 kg, were used in this study. The experimental study was divided into two parts: the preoperative planning and intraoperative bone resection. CT scans of the goats’ lower extremities were firstly performed before the experiments. Then the CT scans were segmented to generate the femoral and tibial three-dimensional (3D) models in the YUANHUA-TKA system. The volumes and angles of each resection plane on the femur and tibia were planned. The bone resection was finally implemented under the assistance of the YUANHUA-TKA system. After completing all bone resections, the lower extremities of each goat were taken to have CT scans. By comparing the femoral and tibial 3D models before and after the experiments, the actual bone resection volumes and angles were calculated and compared with the preoperative values.Results During the experiments, no abnormal bleeding was found; the YUANHUA-TKA system ran smoothly and stably and was able to stop moving and keep the osteotomy in the safe zone all the time. After the experiment, the resection planes were observed immediately and found to be quite flat. There was no significant difference between the planned and actual osteotomy thickness and osteotomy angle (P>0.05); the error of the osteotomy thickness was less than 1 mm, and the error of the osteotomy angle was less than 2°.Conclusion The YUANHUA-TKA system can assist the surgeons to perform osteotomy following the planned thickness and angle values. It is expected to assist surgeons to implement more accurate and efficient osteotomy in the future clinical applications.

Citation： CHAI Wei, XIE Jie, ZHANG Xiaogang, YAN Tingfang, ZHAO Yalan, HE Chuan, ZHANG Yuan. An animal experimental study on domestic robot-assisted total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1376-1381. doi: 10.7507/1002-1892.202003173 Copy

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2.	Wu ZX, Sang HX, Zhou Y, et al. Robot-assisted orthopedic surgery//Pei G. Digital Orthopedics. Berlin: Springer, 2018: 425-447.
3.	Mahdi A, Svantesson M, Wretenberg P, et al. Patients’ experiences of discontentment one year after total knee arthroplasty-a qualitative study. BMC Musculoskeletal Disorders, 2020, 21(1): 29. doi: 10.1186/s12891-019-3017-y.
4.	Goh GS, Liow MHL, Bin Abd Razak HR, et al. Patient-reported outcomes, quality of life, and satisfaction rates in young patients aged 50 years or younger after total knee arthroplasty. J Arthroplasty, 2017, 32(2): 419-425.
5.	Van Onsem S, Van Der Straeten C, Arnout N, et al. A new prediction model for patient satisfaction after total knee arthroplasty. J Arthroplasty, 2016, 31(12): 2660-2667.
6.	King C, Edgington J, Perrone M, et al. The effects of robot-assisted total knee arthroplasty on readmission and postoperative pain: Are the added costs worth it? Orthopaedic Proceedings, 2019, 101-B(SUPP_5): 124.
7.	张国华, 李凯, 赵斌, 等. 机器人辅助人工全膝关节置换与传统手术临床效果比较的 Meta 分析. 中国骨伤, 2019, 32(9): 846-852.
8.	Song EK, Seon JK, Yim JH, et al. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res, 2013, 471(1): 118-126.
9.	Banerjee S, Cherian JJ, Elmallah RK, et al. Robotic-assisted knee arthroplasty. Expert Rev Med Devices, 2015, 12(6): 727-735.
10.	Liow MHL, Goh GS, Wong MK, et al. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(9): 2942-2951.
11.	Jacofsky DJ, Allen M. Robotics in arthroplasty: A comprehensive review. J Arthroplasty, 2016, 31(10): 2353-2363.
12.	Ren Y, Cao S, Wu J, et al. Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J, 2019, 95(1121): 125-133.
13.	Gustke K. Total knee arthroplasty technique: MAKO//Lonner J. Robotics in knee and hip arthroplasty. Berlin: Springer, 2019: 157-166.
14.	Pei GX, Yan YB. Current status and progress of digital orthopaedics in China. Journal of Orthopaedic Translation, 2014, 2(3): 107-17.
15.	韩晓光, 刘亚军, 范明星, 等. 骨科手术机器人技术发展及临床应用. 科技导报, 2017, 35(10): 19-25.
16.	朱科朝, 王俏杰, 陈云苏, 等. 机器人辅助下膝关节单髁置换术短期临床疗效. 中华关节外科杂志 (电子版), 2019, 13(5): 547-553.
17.	郭珀宏, 刘日新, 刘万新, 等. UKA 与 TKA 治疗中国地区中老年人膝单间室骨关节炎疗效对比的 Meta 分析. 当代医学, 2019, 25(35): 25-30.
18.	李艾俐, 周越, 延廷芳, 等. 手术导航仪: 中国, ZL 201930068351. X. 2019-11-01.
19.	李艾俐, 周越, 延廷芳, 等. 手术机械臂: 中国, ZL 201930067140.4. 2019-09-27.
20.	李艾俐, 周越, 延廷芳, 等. 主控端台车: 中国, ZL 201930067138.7. 2019-08-06.
21.	Min Z, Wang J, Meng MQ. Joint rigid registration of multiple generalized point sets with hybrid mixture models. IEEE Transactions on Automation Science and Engineering, 2019. doi: 10.1109/TASE.2019.2906391.
22.	Min Z, Ren H, Meng MQ. Estimation of surgical tool-tip tracking error distribution in coordinate reference frame involving pivot calibration uncertainty. Healthc Technol Lett, 2017, 4(5): 193-198.
23.	Liu L, Siebenrock K, Nolte LP, et al. Computer-assisted planning, simulation, and navigation system for periacetabular osteotomy. Adv Exp Med Biol, 2018, 1093: 143-155.
24.	赵辉, 赵子健, 刘允才, 等. 一种新型计算机辅助全膝关节置换手术系统: 华佗 (WATO). 中国骨与关节外科, 2009, 2(4): 279-283.
25.	Sires JD, Craik JD, Wilson CJ. Accuracy of bone resection in mako total knee robotic-assisted surgery. J Knee Surg, 2019. doi: 10.1055/s-0039-1700570.

1. Panjwani TR, Mullaji A, Doshi K, et al. Comparison of functional outcomes of computer-assisted vs conventional total knee arthroplasty: A systematic review and meta-analysis of high-quality, prospective studies. J Arthroplasty, 2019, 34(3): 586-593.
2. Wu ZX, Sang HX, Zhou Y, et al. Robot-assisted orthopedic surgery//Pei G. Digital Orthopedics. Berlin: Springer, 2018: 425-447.
3. Mahdi A, Svantesson M, Wretenberg P, et al. Patients’ experiences of discontentment one year after total knee arthroplasty-a qualitative study. BMC Musculoskeletal Disorders, 2020, 21(1): 29. doi: 10.1186/s12891-019-3017-y.
4. Goh GS, Liow MHL, Bin Abd Razak HR, et al. Patient-reported outcomes, quality of life, and satisfaction rates in young patients aged 50 years or younger after total knee arthroplasty. J Arthroplasty, 2017, 32(2): 419-425.
5. Van Onsem S, Van Der Straeten C, Arnout N, et al. A new prediction model for patient satisfaction after total knee arthroplasty. J Arthroplasty, 2016, 31(12): 2660-2667.
6. King C, Edgington J, Perrone M, et al. The effects of robot-assisted total knee arthroplasty on readmission and postoperative pain: Are the added costs worth it? Orthopaedic Proceedings, 2019, 101-B(SUPP_5): 124.
7. 张国华, 李凯, 赵斌, 等. 机器人辅助人工全膝关节置换与传统手术临床效果比较的 Meta 分析. 中国骨伤, 2019, 32(9): 846-852.
8. Song EK, Seon JK, Yim JH, et al. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res, 2013, 471(1): 118-126.
9. Banerjee S, Cherian JJ, Elmallah RK, et al. Robotic-assisted knee arthroplasty. Expert Rev Med Devices, 2015, 12(6): 727-735.
10. Liow MHL, Goh GS, Wong MK, et al. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc, 2017, 25(9): 2942-2951.
11. Jacofsky DJ, Allen M. Robotics in arthroplasty: A comprehensive review. J Arthroplasty, 2016, 31(10): 2353-2363.
12. Ren Y, Cao S, Wu J, et al. Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J, 2019, 95(1121): 125-133.
13. Gustke K. Total knee arthroplasty technique: MAKO//Lonner J. Robotics in knee and hip arthroplasty. Berlin: Springer, 2019: 157-166.
14. Pei GX, Yan YB. Current status and progress of digital orthopaedics in China. Journal of Orthopaedic Translation, 2014, 2(3): 107-17.
15. 韩晓光, 刘亚军, 范明星, 等. 骨科手术机器人技术发展及临床应用. 科技导报, 2017, 35(10): 19-25.
16. 朱科朝, 王俏杰, 陈云苏, 等. 机器人辅助下膝关节单髁置换术短期临床疗效. 中华关节外科杂志 (电子版), 2019, 13(5): 547-553.
17. 郭珀宏, 刘日新, 刘万新, 等. UKA 与 TKA 治疗中国地区中老年人膝单间室骨关节炎疗效对比的 Meta 分析. 当代医学, 2019, 25(35): 25-30.
18. 李艾俐, 周越, 延廷芳, 等. 手术导航仪: 中国, ZL 201930068351. X. 2019-11-01.
19. 李艾俐, 周越, 延廷芳, 等. 手术机械臂: 中国, ZL 201930067140.4. 2019-09-27.
20. 李艾俐, 周越, 延廷芳, 等. 主控端台车: 中国, ZL 201930067138.7. 2019-08-06.
21. Min Z, Wang J, Meng MQ. Joint rigid registration of multiple generalized point sets with hybrid mixture models. IEEE Transactions on Automation Science and Engineering, 2019. doi: 10.1109/TASE.2019.2906391.
22. Min Z, Ren H, Meng MQ. Estimation of surgical tool-tip tracking error distribution in coordinate reference frame involving pivot calibration uncertainty. Healthc Technol Lett, 2017, 4(5): 193-198.
23. Liu L, Siebenrock K, Nolte LP, et al. Computer-assisted planning, simulation, and navigation system for periacetabular osteotomy. Adv Exp Med Biol, 2018, 1093: 143-155.
24. 赵辉, 赵子健, 刘允才, 等. 一种新型计算机辅助全膝关节置换手术系统: 华佗 (WATO). 中国骨与关节外科, 2009, 2(4): 279-283.
25. Sires JD, Craik JD, Wilson CJ. Accuracy of bone resection in mako total knee robotic-assisted surgery. J Knee Surg, 2019. doi: 10.1055/s-0039-1700570.

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