Experience in Correcting Varus and Valgus Deformities in Total Knee Arthroplasty Using Robotic Assistance

Experience in Correcting Varus and Valgus Deformities in Total Knee Arthroplasty Using Robotic Assistance

Hector Zamorano, MD, CHILE Roberto Yañez, MD,phD,prof, CHILE Sebastian Valdes, student, CHILE Gaston Caracciolo, CHILE Cristobal Yañez, MD, CHILE Sebastian Yanez, MD, CHILE Leonardo Javier Carabajal Vera, MD, ARGENTINA Lars Raymond Strömback, MD, CHILE Magaly Iñiguez, MD, CHILE

Clinica MEDS, Santiago, Metropolitana, CHILE


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Anatomic Location

Diagnosis / Condition

Treatment / Technique


Summary: ROSA®-assisted total knee arthroplasty significantly reduces preoperative varus and valgus deformities, demonstrating effective correction of knee malalignment and a substantial increase in neutral alignment, supporting robotic surgery as a precise and reliable technique for improved postoperative outcomes.


Introduction

Correcting knee malalignment is essential for optimizing the outcomes of total knee arthroplasty (TKA), particularly in robotic-assisted procedures. Malalignment affects the long-term function and survivorship of the implant. Recent advancements in robotic technology, specifically the ROSA® system, have shown promise in enhancing the precision of TKA. This study aims to evaluate the degree of correction of knee malalignment as observed in radiographic images following robotic TKA, providing further insight into its effectiveness.

Objective

To assess the degree of correction in knee malalignment as evidenced by radiographic changes after robotic TKA.

Methods

A total of 155 patients indicated for TKA were prospectively enrolled between 2021 and 2024, adhering to ethical guidelines and the principles outlined in the Helsinki Declaration. All patients underwent preoperative and 3-month postoperative radiographic assessments of the lower extremity using the ROSA® robotic system (Zimmer Biomet). The changes in alignment were analyzed using a one-tailed paired t-test (α=5%). Normality of the data was assessed via the Shapiro-Wilk test, and the effect size was quantified using Cohen's d.

Results

The average preoperative knee deformity was 6.9±5.11º, with a range from 0º to 24º and a mode of 2º. This significantly decreased postoperatively to 2.3±2.21º, with a range of 0º to 15º and a mode of 0º (p<0.001, Cohen's d = 0.9). Among patients with valgus deformity (n=61), the preoperative mean was 8.4±6.0º (range: 0.2º–24.0º), while in the varus group (n=89), the mean was 6.3±4.2º (range: 0.7º–16.6º). Following surgery, valgus deformity (n=88) improved to a mean of 2.3±1.9º (range: 0.1º–10.0º), and varus deformity (n=40) improved to a mean of 3.0±2.3º (range: 0.1º–15.0º). Additionally, there were 27 neutral cases postoperatively, showing a substantial shift from preoperative deformity.

Discussion And Conclusion

ROSA®-assisted TKA is highly effective in correcting knee malalignment caused by osteoarthritis. There is a significant reduction in preoperative deformities, with both valgus and varus deformities showing substantial improvement. The shift toward neutral alignment was notable, with a 27.4-fold increase in neutral cases postoperatively. These findings underline the precision and efficacy of the ROSA® robotic system in improving alignment accuracy, which could potentially lead to better long-term outcomes in TKA. Robotic-assisted surgery is thus a promising approach for achieving optimal knee alignment and improving overall surgical results.