Summary

Preoperative planning through the use of Mako semiactive robotic assistance presents a good level of agreement with that planned intraoperatively, with the exception of the insert size. The alignment of the tibia presents a higher level of agreement than that of the femur. Due to these variations, the orthopedic surgeon is decisive in modifying the preoperative plan

Abstract

Introduction

Robotic-assisted total knee arthroplasty (RA-TKA) has generated a
paradigm shift in preoperative planning. Despite being automated, it continues to be
modified and adapted by the surgeon intraoperatively. There is little evidence
regarding the concordance and variation between the preoperative plan and the plan
after the prosthetic balance by the surgeon.

Objective

To evaluate the level of agreement between the preoperative planning of
total knee arthroplasty with semiactive robotic assistance (Mako) and the planning
carried out by the orthopedic surgeon during the intraoperative period.

Material And Method

Descriptive study of prostheses installed between October 2018
and June 2019 with preoperative planning carried out by the Makoplasty software. This
was compared with intraoperative planning by the Orthopedic Surgeon.
Among the variables analyzed, the following were considered: coronal and sagittal
alignment, rotation and size of the components and insert.
The data was analyzed with the STATA v.16.0 software. A qualitative univariate
descriptive analysis was performed, with a 95% confidence interval.

Results

Fifty-one operated knees from 49 patients were included, 69% were women.
The level of agreement after the ligament balancing was:
-Alignment of the femoral component: axial 86.3% [CI = 73.7 - 94.2], coronal 88.2% [CI
= 76.1 - 95.5], sagittal 88.2% [CI = 76.1 - 95.5]
-Alignment of the tibial component: axial 98% [CI = 89.5 - 99.9], coronal 96.1% [CI =
86.5 - 99.5], sagittal 96.1% [CI = 86.5 - 99.5]
-Component size: femur 94.1% [CI = 83.7 - 98.7], tibia 84.3% [CI = 71.4 - 92.9], insert
27.4% [CI = 15.8 - 41.7]

Conclusion

Preoperative planning through the use of Mako semiactive robotic
assistance presents a good level of agreement with that planned intraoperatively, with
the exception of the insert size.
The alignment of the tibia presents a higher level of agreement than that of the femur.
Due to these variations, the orthopedic surgeon is decisive in modifying the
preoperative plan.