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Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study

Phenotypic Differences In Coronal Alignment In Robot-Assisted Total Knee Arthroplasty Do Not Affect Patient-Reported Outcome Measurements In A Three-Dimensional Computed Tomography Analysis: A Single-Center Cohort Study

Takao Kaneko, MD, PhD,, JAPAN Ayakane Yamamoto, MD, JAPAN Kazutaka Takada, MD, JAPAN Shu Yoshizawa, MD, JAPAN Hiroyasu Ikegami, MD, PhD, Prof., JAPAN

Ichinomiya Onsen Hospital, Adult Reconstruction Center , Fuefuki, JAPAN


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Summary: When using robotic-assisted (RA) techniques, the phenotypic differences in the coronal plane did not affect postoperative PROMs. RA surgical procedures that finalize component alignment and bone resection volume intraoperatively based on the soft tissue envelope of each patient over the full ROM are expected to improve PROMS, including patient satisfaction, after TKA.


Purpose

The aims of this study were (1) to use three-dimensional computed tomography (3DCT) measurements to determine whether patients undergoing imageless robotic-assisted total knee arthroplasty (RA-TKA) develop a variety of postoperative distal femoral mechanical angle (FMA), proximal tibial mechanical angle (TMA), and hip-knee-ankle angle (HKA) phenotypes as described by Hirschmann et al, and (2) to compare postoperative patient-reported outcome measurements (PROMs) between these phenotypes.

Methods

Fifty patients with knee osteoarthritis underwent RA-TKA. All surgeries were performed by a single surgeon (T.K.) using bicruciate-stabilized TKA (Journey 2 BCS; Smith & Nephew, Inc., Memphis, TN, USA). In each case, the postoperative HKA, FMA and TMA were classified into one of Hirschmann’s five FMA, five TMA, and seven HKA phenotype categories. We investigated how these phenotypes affected patient satisfaction, 2011 Knee Society Score (KSS) subscale scores, the Forgotten Joint Score-12 (FJS-12) score, and patella scores with anterior knee pain at a mean of 15.1 months after RA-TKA.

Results

Coronal alignment angles were assigned to three FMA, four TMA, and five HKA phenotypes. The most common FMA, TMA, and HKA phenotypes were valgus FMA 3° (58%), valgus TMA 3° (60%), and varus HKA 3° (38%). The FMA, TMA, and HKA phenotypes showed no significant differences in any PROMS.

Conclusions

RA-TKA takes into consideration the soft tissue envelope and can therefore result in a variety of prosthetic positions and osteotomy amounts. In this study, it led to various HKA, FMA and TMA phenotypes in the coronal plane, none of which affected PROMs.


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