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      THINK surgical TSolution-One ® (Robodoc) total knee arthroplasty

      review-article
      1 , * , 2 , 1 , 1 , 1
      SICOT-J
      EDP Sciences
      Robotic-assisted, Robot-assisted, Total knee arthroplasty, TKA, THINK surgical, TSolution-One, Robodoc

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          Abstract

          THINK Surgical TSolution-One ® is an active-autonomous, image-based, robotic milling system which enables the surgeon to attain a consistently accurate implant component positioning. The TSolution-One ® system is capable of achieving this through an image-based preoperative planning system which allows the surgeon to create, view and analyse the surgical outcome in 3D. The accuracy and precision of component positioning have been attributed to the following factors: customized distal femoral resection, accurate determination of the femoral rotational alignment, minimization of errors and maintenance of bone temperature with robotic milling. Despite all these advantages, there is still a paucity of long-term, high-quality data that demonstrates the efficacy of robotic-assisted total knee arthroplasty (TKA). Questions regarding radiation risks, prolonged surgical duration and cost-effectiveness remain unanswered. This paper aims to describe: (1) TSolution-One ® surgical technique; (2) limitations and complications; (3) clinical and radiological outcomes.

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          Most cited references24

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          Coronal alignment after total knee replacement.

          Maquet's line passes from the centre of the femoral head to the centre of the body of the talus. The distance of this line from the centre of the knee on a long-leg radiograph provides the most accurate measure of coronal alignment. Malalignment causes abnormal forces which may lead to loosening after knee replacement. We report a series of 115 Denham knee replacements performed between 1976 and 1981 using the earliest design of components, inserted with intramedullary guide rods. Patients were assessed clinically and long-leg standing radiographs were taken before operation, soon after surgery and up to 12 years later. In two-thirds of the knees (68%) Maquet's line passed through the middle third of the prosthesis on postoperative films and the incidence of subsequent loosening was 3%. When Maquet's line was medial or lateral to this, an error of approximately +/- 3 degrees, the incidence of loosening at a median period of eight years was 24%. This difference is highly significant (p = 0.001). Accurate coronal alignment appears to be an important factor in prevention of loosening. Means of improving the accuracy of alignment and of measuring it on long-leg radiographs are discussed.
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            The effect of alignment and BMI on failure of total knee replacement.

            The purpose of this study was to determine the effect of tibiofemoral alignment, femoral and tibial component alignment, and body-mass index (BMI) on implant survival following total knee replacement. We retrospectively reviewed 6070 knees in 3992 patients with a minimum of two years of follow-up. Each knee was classified on the basis of postoperative alignment (overall tibiofemoral alignment and alignment of the tibial and the femoral component in the coronal plane). Failures (defined as revision for any reason other than infection) were analyzed with use of Cox regression; patient covariates included overall alignment, component alignments, and preoperative BMI. Failure was most likely to occur if the orientation of the tibial component was <90° relative to the tibial axis and the orientation of the femoral component was ≥8° of valgus (failure rate, 8.7%; p < 0.0001). In contrast, failure was least likely to occur if both the tibial and the femoral component were in a neutral orientation (≥90° and <8° of valgus, respectively) (failure rate, 0.2% [nine of 4633]; p < 0.0001). "Correction" of varus or valgus malalignment of the first implanted component by placement of the second component to attain neutral tibiofemoral alignment was associated with a failure rate of 3.2% (p = 0.4922) for varus tibial malalignment and 7.8% (p = 0.0082) for valgus femoral malalignment. A higher BMI was associated with an increased failure rate. Compared with patients with a BMI of 23 to 26 kg/m2, the failure rate in patients with a BMI of ≥41 kg/m2 increased from 0.7% to 2.6% (p = 0.0046) in well-aligned knees, from 1.6% to 2.9% (p = 0.0180) in varus knees, and from 1.0% to 7.1% (p = 0.0260) in valgus knees. Attaining neutrality in all three alignments is important in maximizing total knee implant survival. Substantial "correction" of the alignment of one component in order to compensate for malalignment of the other component and thus produce a neutrally aligned total knee replacement can increase the risk of failure (p = 0.0082). The use of conventional guides to align a total knee replacement provides acceptable alignment; however, the surgeon should be aware that the patient's size, as determined by the BMI, is also a major factor in total knee replacement failure.
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              Periprosthetic Joint Infection Is the Main Cause of Failure for Modern Knee Arthroplasty: An Analysis of 11,134 Knees.

              Although large series from national joint registries may accurately reflect indications for revision TKAs, they may lack the granularity to detect the true incidence and relative importance of such indications, especially periprosthetic joint infections (PJI).
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2017
                30 October 2017
                : 3
                : ( publisher-idID: sicotj/2017/01 )
                : 63
                Affiliations
                [1 ] Department of Orthopaedic Surgery, Singapore General Hospital 20 College Road, Academia, Level 4 Singapore 169865
                [2 ] The Orthopaedic Centre, Mount Elizabeth Medical Centre #08-02 3 Mount Elizabeth Singapore 228510
                Author notes
                [* ]Corresponding author: dr.lincoln.liow@ 123456gmail.com
                Article
                sicotj170060 10.1051/sicotj/2017052
                10.1051/sicotj/2017052
                5663203
                29087292
                de4513d4-40b1-4c72-b5aa-a3d9135e0816
                © The Authors, published by EDP Sciences, 2017

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 May 2017
                : 25 September 2017
                Page count
                Figures: 7, Tables: 0, Equations: 0, References: 28, Pages: 6
                Categories
                Knee
                Special Issue: "Computer Assisted Orthopaedic Surgery - Current State and Impact" Guest Editor: A. Adhikari
                Review Article

                robotic-assisted,robot-assisted,total knee arthroplasty,tka,think surgical,tsolution-one,robodoc

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