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Background <p>Implant 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.</p> Methods <p>A multi-centre retrospective analysis of 129 robotic-assisted TKAs (Zhengtian Irene, <i>n</i> = 60; DePuy Synthes Attune, <i>n</i> = 32; Zimmer Biomet Persona, <i>n</i> = 20; Smith &amp; Nephew Legion, <i>n</i> = 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 (<i>n</i> = 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 <i>t</i>-tests) were analysed. Acceptability was defined as ≤ 3° deviation.</p> Results <p>Interobserver reliability was excellent (ICC &gt; 0.77, Cronbach’s α &gt; 0.87 for all parameters). Mean post-operative deviations from planned alignment were clinically small: HKA (+1.32°, <i>P</i> &lt; 0.001), FCCA (−0.55°, <i>P</i> &lt; 0.001), TCCA (+0.19°, <i>P</i> = 0.097), and PTS (−0.42°, <i>P</i> = 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 &lt; 3°.</p> Conclusions <p>The KUNWU open-platform robotic system achieved high radiological accuracy across four implant designs, with alignment deviations &lt; 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.</p>

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Surgical accuracy of open platform image-based robotic-assisted total knee arthroplasty across different implants: a multicentre trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月7日

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  • Michael Tim-Yun Ong,
  • Chuan He,
  • Wei Chai,
  • Rex Wang-Fung Mak,
  • Cham-Kit Wong,
  • Gloria Yan-Ting Lam,
  • Tsz Lung Choi,
  • Patrick Shu-Hang Yung

摘要

Background

Implant 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.

Methods

A 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.

Results

Interobserver 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°.

Conclusions

The 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.