ArticleArthroplasty (London, England)2025
Surgical accuracy of open platform image-based robotic-assisted total knee arthroplasty across different implants: a multicentre trial.
Article in Arthroplasty (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundImplant malalignment in total knee arthroplasty (TKA) correlates with poor outcomes, and robotic-assisted systems aim to improve precision. While closed-platform robotic systems dominate the market, their restriction to proprietary implants limits surgical flexibility. This study evaluates the radiological accuracy of an open-platform robotic system (Yuanhua KUNWU) across four TKA implant designs.
methodsA multi-centre retrospective analysis of 129 robotic-assisted TKAs (Zhengtian Irene, n = 60; DePuy Synthes Attune, n = 32; Zimmer Biomet Persona, n = 20; Smith & Nephew Legion, n = 17) was conducted. Patients with end-stage osteoarthritis (Kellgren-Lawrence grade 3-4) were included, while those with prior knee surgery or complex anatomy were excluded (n = 15). A total of 114 pre-operative and post-operative alignment (hip-knee-ankle angle [HKA], femoral and tibial component coronal angles [FCCA, TCCA], posterior tibial slope [PTS]) were measured on radiographs by two independent reviewers. Interobserver reliability (intra-class correlation [ICC], Cronbach's α) and deviations from planned alignment (paired t-tests) were analysed. Acceptability was defined as ≤ 3° deviation.
resultsInterobserver reliability was excellent (ICC > 0.77, Cronbach's α > 0.87 for all parameters). Mean post-operative deviations from planned alignment were clinically small: HKA (+1.32°, P < 0.001), FCCA (-0.55°, P < 0.001), TCCA (+0.19°, P = 0.097), and PTS (-0.42°, P = 0.018). All mean differences were within the 3° acceptability threshold. Subgroup analysis of pre- and post-operative alignment between implant types also showed deviations of < 3°.
conclusionsThe KUNWU open-platform robotic system achieved high radiological accuracy across four implant designs, with alignment deviations < 1.5°. This suggests open-platform robotics can provide implant versatility without compromising precision. Further studies regarding the assessment of long-term clinical and patient-reported outcomes and comparison with closed-platform systems are warranted.
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