Intra-incisional metaphyseal pins may be safely utilized in robotic-assisted TKA
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Key takeaways:
- Intra-incisional metaphyseal pins may be safe for use in patients undergoing robotic-assisted TKA.
- The procedures had low rates of periprosthetic fractures and infections.
According to published results, use of intra-incisional metaphyseal pins during robotic-assisted total knee arthroplasty was associated with low rates of periprosthetic fracture and infection.
Researchers from the Cleveland Clinic performed a retrospective cohort study of data from 2,343 patients who underwent robotic-assisted TKA with 4-mm intra-incisional bone array pins fixed into the femur and tibia. According to the study, outcome measures included periprosthetic fracture, infection and reoperation.
Overall, 100% of patients had complete follow-up at 90 days postoperatively, and 70.6% of patients had complete follow-up at 1 year postoperatively.
At 90 days, 0.09% of patients (n = 2) had a pin-related periprosthetic fracture and 1.4% of patients had either a superficial (n = 20) or deep infection (n = 13). Among 1,655 patients with complete 1-year follow-up, researchers found a reoperation rate of 1.8% (n = 29). They noted the most common causes of reoperation were deep infection (0.83%), superficial infection (0.18%), periprosthetic fracture (0.12%), mechanical symptoms (0.12%), instability (0.12%) and hematoma (0.12%).
“Our findings suggest intra-incisional pin placement is safe and has a very low incidence of fractures associated with pin placement/technique,” the researchers wrote in the study.
Perspective
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The study results are consistent with my experience performing robotic-assisted TKA during the last 5 years. Early on, I placed pins outside of the incision but noted some erythema and slight wound issues with the extra-incisional placement and soon transitioned to intra-incisional placement.
After completing more than 1,000 cases, I have only observed one periprosthetic fracture of the femur around an intramedullary nail, subsequent to a fall. In my experience, incision length is the same for traditional and robotic TKA, but I recommend surgeons transitioning to intra-incisional pin placement for TKA start with a slightly larger incision and, with more experience, return to typical incision length.
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