Bone Resection Planning for Medial Uka Using Stress Views is Efficient: Protocol Validation Using an Image-Based Robotic System

Bone Resection Planning for Medial Uka Using Stress Views is Efficient: Protocol Validation Using an Image-Based Robotic System

Stefano Gaggiotti, MD, ARGENTINA Constant Foissey, MD, FRANCE Valentina Rossi, MD, ITALY Cécile Batailler, MD, PhD, FRANCE Gabriel Gaggiotti, MD, ARGENTINA Santino Gaggiotti, MD, ARGENTINA Elvire Servien, MD, PhD, Prof., FRANCE Sebastien Lustig, MD, PhD, Prof., FRANCE

Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France., Lyon, FRANCE


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Summary: This study describes and validates with robotic information a simple and reproducible preoperative planning method to determine femoral and tibial bone resection for medial UKA implantation using antero-posterior valgus stress radiographs, leaving a medial safety laxity of 2mm.


Purpose

The objective of this study was to describe a planning method for medial UKA implantation using preoperative stress radiographs to measure the thickness of tibial and femoral bone resections, and to validate this method with data from an image-based robotic surgery system. Having such method for preoperative planning would be of interest for surgeons performing UKA in order to anticipate optimal bone resection on both tibia and femoral sides.

Methods

A new planning method for medial UKA based on valgus stress radiographs and validated it with an image-based robotic surgery system (Restoris MCK, MAKO®, Stryker Corporation, Kalamazoo, MI, USA) was proposed. This retrospective study involved radiographic measurements of 76 patients who underwent image-based robotic medial UKA between April 2022 and February 2023. Preoperative anteroposterior stress radiographs of the knee were used to simulate UKA implantation. The UKA technique was based on Cartier's angle and aimed at restoring the joint line. The total dimension measured was 14mm (8mm for minimal tibial component and polyethylene insert + 4mm for femoral component + 2mm for safety laxity). Bone resections were measured in the preoperative valgus stress radiographs and then against the intraoperative bone resection data provided by the robotic system. Inter- and intra-observer reliability was assessed using 25 measurements.

Results

The mean planned tibial resection measured in the radiographs was 4.3 ± 0.4 [2.9-5.8], while the mean robotic resection was 4.2 ± 0.5 [2.7-5.8] (mean difference = 0.15 mm, 95% CI [-0.27 - 0.57]). There was a strong correlation between these two values (Pearson's rank R = 0.79, P < 0.001). Intra- and inter-observer reliability were also very strong (Pearson's rank R = 0.91, P < 0.001, and Pearson's rank R = 0.82, P < 0.001, respectively). The mean planned femoral bone resection measured in the radiographs was 2.7 mm ± 0.7 [1-4.5], while the mean robotic resection was 2.5 ± 0.9 [1-5] (mean difference = 0.21 mm, 95% CI [-0.66 - 1.08]). There was a strong correlation between these two values (Pearson's rank R = 0.82, P < 0.001). Intra- and inter-observer reliability were also strong (Pearson's rank R = 0.88, P < 0.001, and Pearson's rank R = 0.84, P < 0.001, respectively).

Conclusion

This study describes and validates with robotic information a simple and reproducible preoperative planning method to determine femoral and tibial bone resection for medial UKA implantation using antero-posterior valgus stress radiographs, leaving a medial safety laxity of 2mm. It represents a very valuable contribution to the understanding of UKA principles, which can serve to extend its indications, and increase reproducibility of the surgical technique.