Development and Proof-of-Concept Study of a Novel Intraoperative Surgical Planning Tool for Robotic Arm-Assisted Total Knee Arthroplasty

Abstract

Background: Intraoperative surgical planning tools (ISPTs) used in current-generation robotic arm-assisted total knee arthroplasty (RTKA) systems (such as Navio® and MAKO®) involve employment of postoperative passive joint balancing. This results in improper ligament tension, which may negatively impact joint stability, which, in turn, may adversely affect patient function after TKA. Methods: A simulation-enhanced ISPT (SEISPT) that provides insights relating to postoperative active joint mechanics was developed. This involved four steps: 1) validation of a multi-body musculoskeletal model; 2) optimization of the validated model; 3) use of the validated and optimized model to derive knee performance equations (KPEs), which are equations that relate implant component characteristics to implant component biomechanical responses; and 4) optimization of the KPEs with respect to these responses. In a proof-of-concept study, KPEs that involved two com- ponent biomechanical responses that have been shown to strongly correlate with poor proprioception (a common patient complaint post-TKA) were used to calculate optimal positions and orientations of the femoral and tibial components in the TKA design implanted in one subject (as reported in a publicly-available dataset). Results: The differences between the calculated implant positions and orientations and the corresponding achieved values for the implant components in the subject were not similar to component position and orientation errors reported in biomechanical literature studies involving Navio® and MAKO®. Also, we indicate how SEISPT could be incorporated into the surgical workflow of Navio® with minimal disruption and increase in cost. Conclusion: SEISPT is a plausible alternative to current-gen- eration ISPTs.