Robotic system for TKA requires simple and complex workflow adaptations
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KOLOA, Hawaii — Use of a robotic system for total knee arthroplasty requires simple and complex adaptations to workflow compared with conventional instruments, according to a presenter at Orthopedics Today Hawaii.
In his presentation, Brad L. Penenberg, MD, noted some of the simple adaptations of the Navio Surgical System (Smith & Nephew) include use of a burr, which he questioned as either an upgrade or a necessary evil. Room and OR table setup also need to be taken into consideration. Penenberg recommended surgeons stay on one side of the OR table and not block the arrays.
“Among the more complex adaptations, if you are changing knee implant systems, you have to take a close look at what you are changing to and what you have been doing,” Penenberg said.
He added the Navio Surgical System does not protect the posterior cruciate ligament, requiring surgeons to make adaptations to retain it. The planning screens will also not alert surgeons on whether the patient needs to undergo a release or whether femoral rotation is ideal for a particular patient, according to Penenberg.
“This was one of the surprises for me — that there are no boundaries as you are going through your decision-making process,” Penenberg said.
Penenberg noted surgeons should have a clear idea of the technique they want to use and be prepared to modify or adapt it.
“One of the most important things I was told during the trainings: When you turn on the robot, do not turn off your brain,” Penenberg said. “Unlike one of the other systems on the market, you cannot just set it and forget it. You have to participate with the technique.” – by Casey Tingle
Reference:
Penenberg BL. Navio-assisted TKA learning curve. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Penenberg reports he receives royalties from Microport Orthopedics; receives royalties from and is a consultant for Zimmer Biomet; and is a stockholder and board member for Radlink.
Perspective
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Michael A. Kelly, MD
Penenberg makes valid points in his presentation on the use of a robotic system for TKA. Along with new technology comes new steps, tools and obligatory training of the entire surgical team. Some robotic systems offer a preoperative planning step that may be new to surgeons who do not have experience with existing technology, such as navigation or patient-specific instrumentation.
There are several platforms available to execute the surgery, including the Navio Surgical System mentioned by Penenberg. Systems, such as Mako (Stryker) offer haptic robotics with a proprietary implant, while Think Surgical offers active robotic surgery on an open implant platform. Both of these robots have built-in mechanisms to protect the PCL by observing a cut path that is specific to the implant being used, thereby leaving a bone island intact where the PCL attaches to the tibia. Another platform, the ROSA Knee System (Zimmer Biomet), uses a robotic arm to place cutting guides, leaving the surgeon to make the bone cuts with a traditional saw.
Regardless of the chosen robotic platform, surgical teams should consider optimal workflow in the OR during preoperative planning. For example, if the surgeon knows which implant sizes will be used, trays in the OR could be streamlined, adding a level of efficiency not currently realized with traditional TKA and ultimately leading to lower direct operative costs.
Chairman, department of physical medicine and rehabilitation
Hackensack, New Jersey
Hackensack Meridian School of Medicine at Seton Hall University
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