How Does Robotic Technology Influence TKA Implant Placement For Surgeons In Fellowship Training?

Implant malalignment during TKA may lead to suboptimal outcomes. Accuracy studies are typically performed with experienced surgeons; however, it is important to study less experienced surgeons when considering teaching hospitals where younger surgeons are operating. Therefore, the purpose of this study was to assess whether computer-assisted TKA (CATKA) allows for more accurate and precise implant position to plan when compared to manual TKA (MTKA) when the surgery is performed by less experienced surgeons. Two surgeons, currently in their fellowship training and having minimal CATKA experience, performed a total six MTKA and six CATKA on paired cadaveric knees. Computed tomography (CT) scans were obtained for each knee pre- and post- operatively. CT scans were analyzed to compare post-operative implant position to the pre-operative planned position. Mean system errors and standard deviations were compared between CATKA and MTKA for the femoral component sagittal, coronal, and axial planes and the tibial component in the sagittal and coronal planes. A 2-Variance testing was performed using an alpha=0.05. CATKA had greater accuracy and precision to plan than MTKA for: femoral axial plane (1.1o±1.1o vs. 1.6o±1.3o), coronal plane (0.9o±0.7o vs. 2.2±1.0o), femoral sagittal plane (1.5o±1.3o vs. 3.1o±2.1o), tibial coronal plane (0.9o±0.5o vs. 1.9o±1.3o) and tibial sagittal plane (1.7o±2.6o vs. 4.7o±4.1o). There was no statistical difference between surgical groups or between the two surgeons performing the cases. With limited CATKA experience, the fellows showed increased accuracy and precision to plan for femoral and tibial implant positions. Furthermore, these results are comparable to what has been reported for an experienced surgeon performing CATKA.