Imageless robotic-assisted total knee revision arthroplasty.

OBJECTIVE OF THE SURGERY: Single-stage knee revision arthroplasty under special consideration of bony defects and soft tissue laxity over the full arc of motion.

INDICATIONS: Aseptic loosening, ligamentous instability, or outlier in implant position requiring single-stage knee revision arthroplasty.

CONTRAINDICATIONS: Cases with severe bone loss or ligamentous instability requiring a hinged prosthesis. Loss of knee extensor function.

SURGICAL TECHNIQUE: After establishment of a standardized median parapatellar approach and setup of the imageless robotic system, the implant is mapped while still in situ. The bone-implant interface is highlighted in the 3D reconstruction of the implant by the application of special points during mapping. Soft tissue balance is registered and the component position of the revision implant is determined in the virtual implant planning stage. The implant is then removed and the surgical plan is executed with the robotic bur. If necessary, augments can be used to account for excessive bone loss and reconstruct the native joint line.

POSTOPERATIVE MANAGEMENT: Full weight-bearing as tolerated, free range of motion.

RESULTS

In the literature, robotic-assisted knee revision arthroplasty has mainly been described in the form of case reports and smaller case series; the authors report generally favorable results.