Varus Knee Deformity Classification Based on Degree and Extra- or Intra-Articular Location of Coronal Deformity and Osteoarthritis Grade.

BACKGROUND: Medial coronal plane malalignment, also known as varus alignment, is commonly reported in osteoarthritic knees. Although the degree of deformity provides some insight regarding the severity of the disease, it does not always reflect the potential complexity of the surgical treatment. METHODS: This prospective observational study was conducted by analyzing the radiographs of 100 consecutive knees in patients undergoing total knee arthroplasty. For each knee, coronal alignment, expressed as the hip-knee-ankle angle, was measured on a full-leg standing radiograph and classified in 3 stages. The primary location of the varus deformity was identified as intra-articular and/or extra-articular. Additionally, knees were evaluated to assess for 10 radiographic features of varus deformity and then classified in 3 grades of osteoarthritis severity. RESULTS: The mean (and standard deviation) preoperative varus deformity was 11° ± 6° of varus (hip-knee-ankle, 169°), as measured on standardized full-leg radiographs. Extra-articular varus deformity was observed in 14% of patients. A higher number of radiographic features of varus severity corresponded with higher degrees of deformity. Varus grade correlated strongly with stage of varus deformity. Twenty-three (100%) of 23 stage-III deformities had grade-C features; however, 13 (48%) of 27 stage-I patients also had grade-C disease. CONCLUSIONS: One of every 7 osteoarthritis patients with varus deformity had an extra-articular deformity, and 1 of 2 of these patients had severe intra-articular disease (grade C) despite limited coronal deformity (stage I). These findings reconfirm the need for individual deformity analysis that accounts for the degree, location, and severity of the varus deformity. This insight may help to formulate an algorithmic treatment approach specific to the epiphyseal knee anatomy of the patient and according to the surgical preferences of the surgeon. CLINICAL RELEVANCE: Knee surgeons tend to consider knees with higher degrees of coronal deformity as more technically difficult, but the present study shows that knees with less deformity can still present with severe grades of osteoarthritis inside the knee, leading to more challenging joint reconstruction.

Robotic-Assisted Knee Arthroplasty (RAKA): The Technique, the Technology and the Transition.

BACKGROUND: There has been an exponential increase in knee arthroplasty over the past 20 years. This has led to a quest for improvement in outcomes and patient satisfaction. While the last decade of last century proved to be the decade for Computer-Assisted Surgery (CAS) or Computer Navigation wherein the technology demonstrated a clear benefit in terms of improving mechanical axis alignment and component positioning, this decade is likely to belong to Robotics. Robotics adds an independent dimension to the benefits that CAS offers. The article deals with the generation of robots, technical steps in robotics, advantages and downsides of robotics and way forward in the field of knee arthroplasty. MATERIALS AND METHODS: The review article was designed and edited by six different authors reviewing 32 relevant pubmed-based articles related to robotics in arthroplasty and orthopaedics. The concept, design and the definition of the intellectual content were based on the internationally published literature and insightful articles. The review is also based on the clinical experimental studies published in the literature. DISCUSSION: The robotic arm is actively involved with surgeon to achieve the precision and outcomes that the surgeon aims for. With the concept of haptic boundaries and augmented reality being incorporated in most systems, Robotic Assisted Arthroplasty (RAA) is likely to offer several advantages. The potential advantages of these systems may include accuracy in gap balancing, component positioning, minimal bone resection, reduced soft tissue handling and trauma, patient anatomy specific resection, and real time feedback. They, however, come with their own downsides in terms of capital cost, learning curve, time consumption and unclear advantages in term of long-term clinical outcomes. CONCLUSION: To conclude, this review article offers a balanced view on how the technology is impacting current arthroplasty practice and what can be expected in coming years. The commitment of almost all major implant manufacturers in investing in robotics likely means that the evolution of Robotic technology and this decade will be exciting with rapid strides revealing paradigm shift and evolution of technology with significant reductions of cost enabling it to be available universally. For technology to populate in operating room, I think it will be result of exposure of young surgeons to these computers and robotics, as they grow in with confidence with technology from residency days to offer better precision in future.