Implementation of Modern Technologies in Total Knee Replacement

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Implementation of Modern Technologies in Total

Knee Replacement
Pawan Padam Nath
MBBS, M.S. Orthopaedic, MCh. Orthopaedic (UK), Orthopaedic Surgeon, Consultant Orthopaedic Surgeon,
Rajiv Gandhi University of Health Sciences, Karnataka
Abstract:- Severe osteoarthritis can be effectively treated results. The development of several novel technologies to
with a total knee replacement (TKR), often referred to as increase surgical accuracy has raised hopes for an
an arthroplasty. Even though TKR patients have good improvement in patient contentment following TKR.
survival rates, up to 20% of them are nevertheless
unhappy. Current improvements in knee arthroplasty Aiming to personalise procedure & consider each
technology exhibit promise & may boost functional patient's unique anatomy & ligament balancing,
results. This study sought to present some unique TKR technologies like PSI, CAS, navigation, computer, smart
technologies, their current ideas, merits, & limitations. tools, & positioning accuracy & reliability enhancement, all
Whilst implant placement & limb positioning may be work to enhance implant positioning. But because novel
improved with patient-specific equipment, functional technologies frequently have drawbacks & limits,
results are unchanged. The sensors must attempt to offer understanding how to effectively use them to enhance
accurate data on equilibrium of ligaments during TKR. surgical results is crucial. The objective of this work is to
The accelerometers are sophisticated instruments introduce some recent developments in TKR technology.
created to enhance TKA positioning. However, their
benefits remain still debatable. The robotic-assisted (RA) II. MATERIAL & METHOD
systems provide an exact & repeatable bone preparation
owing to a robotic interface having a 3D surgical The study is conducted using a descriptive
planning, based on preoperative 3D imaging or not. The methodology that relied on secondary data collected through
new technologies in TKA are highly appealing & have case studies & observational studies. The information was
continually progressed. Future orthopaedic technology gathered on cutting-edge technology utilised in field of
will increasingly serve as a beneficial tool for surgeons TKR, including RA arthroplasty, sensors utilised in TKR,
performing patient-specific arthroplasty with patient- accelerometer smart tools & PSI. The following is a
specific positioning goals. discussion of these advance technologies utilised for TKRs.
Keywords:- Knee Arthroplasty; New Technologies; Patient-  Patient Specific Instrumentation (PSI):
Specific Instrumentation; Sensors; Accelerometers; RA Several orthopaedic implant manufacturers currently
Surgery. provide PSI systems (Smith & Nephew, Wright Medical
Technology, DePuy, Biomet, Medacta, & Zimmer). Both
I. INTRODUCTION complete & single-compartment knee arthroplasty
procedures can be performed using these systems. To
Orthopaedic surgery, an active medical specialty, has simulate anatomy of knee & create a custom surgical plan
experienced swift & creative improvements in both surgery regarding bone resection, component location, &
& treatment. Recent developments in knee replacement positioning, preoperative 3D imaging (CT scan or MRI) is
technology show promise. TKR, sometimes referred to as performed. Cutting blocks or pin guides are produced &
arthroplasty, is an extremely efficient treatment for serious transported to hospital once surgeon has given his or her
osteoarthritis (Naresh, 2022). Benefits of TKR include a approval, typically in sterile packaging suitable for OR. To
high rate of survival, a prompt resumption to daily activities, position implantation of pins into femur & tibia, pin guides
& a general increase in function, all of which help to meet are positioned on front surfaces of distal femur & proximal
patients’ functional expectations. A significant surgical tibia. With help of these unique cutting guides, bone
objetive is still arthroplasty. Despite advancements in resections can be precisely sliced in accordance with
surgical procedures & after care, up to 20% of TKR patients preoperative 3D planning.
still dislike their outcomes (Noble et al., 2016). Just 64% of
patients in a multicenter cohort of 547 non-selected TKR  Sensors in TKR:
patients reported pain-free gait, 35% reported pain-free stair Sensors are utilised to provide unbiased data on soft
climbing or descending, & 40% experienced discomfort tissue balance throughout TKR. These disposable gadgets
when jogging (Bonnin et al.,2020). transmit wireless data to an intra-operative monitor to assist
in making well-informed decisions about implant placement
Since TKR is already a successful procedure, focus is & soft tissue releases to enhance balance & stability
now on raising patient contentment & enhancing functional throughout a wide range of motion. When tibial & femoral
IJISRT23MAY638 www.ijisrt.com 829

ISSN No:-2456-2165
cuts are finished during surgery, system—a wireless, III. RESULT & DISCUSSION
disposable articular loading measurement device—is
inserted in tibial component tray. A few sutures are utilised This section will discuss comparison of advanced
to close capsule. In order to monitor pressures exerted technologies being utilised for TKR to highlight findings
medially and laterally from a fully extended to a fully flexed gathered from earlier studies.
position, surgeon maintains limb in a neutral posture. A
medial & lateral compartment load differential of less than There are studies that have been published that claim
15 pounds is deemed to be sufficiently "balanced". Further that PSI increases implant location accuracy, although
soft tissue releases or bone resection can be done if joint effects of PSI on radiologic outcomes remain unclear
exhibits imbalance following initial ligament balance according to various meta-analyses (Bonnin et al., 2020). De
assessment. et al., (2017) studied postoperative long-leg radiographs
from 155 conventionally conducted TKAs & 569 PSI-
 Accelerometer: performed TKAs. With PSI, they found 9% & 22% fewer
Accelerometers are high-tech instruments designed to HKA angle outliers than they did with conventional
facilitate better femoral & tibial component positioning instrumentation.
during TKR. The chance of functional rehabilitation, patient
contentment, & TKR survival may all be increased with Two meta-analyses comparing positioning accuracy
careful component positioning. There is still some debate found no notable variation in outlier numbers for mechanical
over what best positioning is for TKR. The precision of axis, coronal, sagittal, and axial positioning. (Ng et al.,
tibial & femoral cuts is still crucial, regardless of positioning 2015). Nevertheless, a meta-analysis of 6 trials with 444
technique (mechanical, kinematic, limited kinematic). knees by Mannan et al., (2016) found positive femoral
Having a goal positioning that is presently in varus or valgus rotational outcomes. In a randomised controlled experiment
makes an inaccuracy of 3 degrees in element positioning involving 69 patients, Randelli et al.,(2019) found PSI didn’t
very detrimental. Because of need for precise positioning of increase of femoral component rotation’s precision during
each component during surgery, these aids are invaluable. TKA compared to standard instrumentation. No research has
found any differences in clinical or functional results
 Robotic-Assisted Knee Arthroplasty: between PSI & traditional techniques.
RA surgery’s widespread use is a logical development
from almost 20-year-old practise of computer-assisted The preoperative planning of PSI, which includes
surgery in knee arthroplasties. Whatever technology is implant sizing, rotation, & femoral & tibial excision, should
employed, major advantage of robotics is precise & theoretically shorten surgery time. However, a newly
repeatable bone preparation made possible by a robotic published meta-analysis by Mannan et al.,(2016) that
interface. This RA technology also enables an evaluation of examined 957 patients discovered a pattern without
ligament balancing in accordance with surgically performed statistical significance of shorter operating times, with 5-
bone cuts & implant placement. The surgeon's valgus or minute average per patient. Comparing length of a surgical
varus stress is typically a factor in this ligament balance. procedure using various modern technologies, such as PSI &
Robotic devices are not intended to take position of CAS, would be intriguing & more pertinent.
surgeons, but rather to enhance their effectiveness. The
robotic arm helps surgeon carry out extremely precise bone The outcomes & effects of sensors on TKR’s ligament
cuts in accordance with surgical plan. Preoperative imaging balancing have been described & evaluated in a number of
study costs, inconvenience to patient in having examination studies. In TKA (for measured resection TKA or modified
done at accredited facilities, & radiation exposure are some gap balancing TKA), Lustig et al., (2016) discovered that an
drawbacks. Image-free RA devices need a manual bone objective measurement employing real-time orthosensor
surface mapping performed intraoperatively. The planning is enhanced soft tissue balance. So, in a potential cohort of 50
then carried out during surgery using a 3D virtual model. No sensor-assisted (SA) TKAs (without substantial deformity),
specific preoperative mapping is done, & 3D imaging is not Scholes et al., (2016) reported that 74% of knees needed
required. Because human mistake is possible, intraoperative further rebalancing with sensor following traditional gap
registration depends on surgeon's accuracy in entering balancing using tensiometer. Evaluation with sensor
relevant data points. Robotic systems for knee arthroplasty revealed coronal and sagittal load imbalances even when a
fall into three categories: passive, semiautonomous, & proper gap balance was attained using a tensiometer.
autonomous. A 3D virtual model provided by a passive However, few studies have indicated that functional
system enables precise preoperative planning. The bone outcomes following sensor assisted TKA are better than
preparation system, however, does not exist. Safeguards are those following conventional TKA, & there are frequently
built into autonomous & semiautonomous systems to several limitations. Without a prior radiographic evaluation,
prevent bone from being removed outside of 3D plan. Lustig et al.,(2016) found that clinical ratings & ROM were
notably greater following SA TKA in comparison with post
manually balanced TKA. In a comparison investigation of
50 SA TKAs, Scholes et al., (2016) found no clinical or
radiological differences between two types of TKAs. To
evaluate clinical value of this gadget, clinical follow-up is
still insufficient.

ISSN No:-2456-2165
Accelerometer-based navigation was preferred by the basis of preoperative 3D imaging. As an outcome,
Jiang et al., (2015) for restoration of Hip-Knee-Ankle incorporation of these technologies into TKR has shown to
(HKA), although other research reported no differences be a promising aspect of equipment in future.
between study groups (Ng et al., 2012). At short-term
follow-up, there was no discernible difference between IV. CONCLUSION
functional knee score of iASSIST group (To aid in the
placement of orthopaedic implants, iASSIST Knee System In conclusion promising novel technologies that
is utilised, which is a computer-assisted stereotaxic surgical potentially enhance functional outcomes of TKR have
tool system.) & traditional group (Abdel et al., 2018). recently been discovered. Therefore, while technologies like
According to Scholes et al., (2016) study, using as patient-specific instrumentation can improve implant
accelerometer-based navigation did not result in longer location & limb positioning, functional outcomes are
operating times when compared to traditional methods. unaffected. The customised knee implants aim to function
There hasn't been any analysis of learning curve in literature, similarly to natural knee. The sensors should make every
as it is merely a tool, but not a full navigation system. The effort to provide reliable information on ligament stability
rate of complications with each surgery was found to be during TKA. Accelerometers - ingenious tools utilised to
equivalent. enhance TKA positioning. Their aids haven’t been settled
upon. Accurate & reproducible bone preparation is made
RA systems with image-based & image-free possible by RA systems thanks to a robotic interface & 3D
capabilities have dramatically improved outcomes, surgical planning, which may or may not be based on
particularly about implant location. The level of joint line preoperative 3D imaging. The latest innovations in TKA are
was extremely successfully regulated utilising a robotic incredibly alluring & are always changing. All technologies,
system (RS), as demonstrated by (Randelli et al.,2019). however, need to be critically examined over a long period.
According to research, RA Unicompartmental Knee Predictive modelling & artificial intelligence have ability to
Arthroplasty (UKA) does not necessarily result in a lessen downsides of emerging technologies.
significant improvement in mean implant location. Yet,
decrease in outliers is notable (Naresh, 2022) & hence REFERENCES
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Implementation of Modern Technologies in Total Knee Replacement

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Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology

Implementation of Modern Technologies in Total

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