TECH SHOWCASE: Tips and Tricks for Using Robotics in UKA and TKA

    Editor’s Note: A session at ICJR’s 13th Annual Winter Hip & Knee Course was billed as a Technology Showcase, featuring 8 presentations on aspects of technology and techniques intended to help surgeons improve outcomes of hip and knee arthroplasty. We are highlighting those presentations on ICJR.net this week.

    With 700 robots in use in ORs worldwide – 100 of them in ambulatory surgery centers – robotics is no longer a niche technology for performing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), says Mark W. Pagnano, MD.

    Dr. Pagnono, who has been using robotic technology in the OR for many years, believes the robot exceeds computer-assisted surgery in preoperative planning and execution of the plan in the OR. The use of robotic technology is the best way to assess the procedure intraoperatively and make precise adjustments as needed, he says.

    The knock against this technology has been lack of efficiency. No surgeon wants a longer operative time, so in a presentation at ICJR’s 13th Annual Winter Hip & Knee Course, Dr. Pagnano offered tips for improving efficiency when using robotics in UKA and TKA. Among those tips:

    • The tibial array should be placed 4 finger-breadths below the tibial tubercle, with 3-mm pins placed in extension.
    • The femur array can be placed anywhere for UKA, but for TKA, there should be 4 fingerbreadths between the distal joint surface and the first pin. The 4-mm pins for the femur should be placed with the knee in flexion.
    • Place the checkpoints with the knee in flexion as well. The checkpoint should be 2 fingerbreadths below the joint line for the tibia. In TKA, the femur checkpoint should be placed right above the medial epicondyle. In UKA, the femur checkpoint can be placed anywhere.
    • The robot does not track soft tissue, so 1 hand should be on the saw and 1 hand should be on the retractor to help protect the soft tissue.
    • A 90° bent Homan is the retractor of choice when using the robot. It’s versatile and can be used on the lateral side when cutting the tibia or the lateral femur, on the medial side when cutting the tibia for a UKA, and on the midline when burring for a UKA.

    Click the image above to watch Dr. Pagnano’s presentation and get more tips for using robotic technology in UKA and TKA.

    Faculty Bio

    Mark W. Pagnano, MD, is a Professor of Orthopedics and Chair of the Department of Orthopedic Surgery at Mayo Clinic, Rochester, Minnesota.

    Disclosures: Dr. Pagnano has disclosed that he receives royalties from DePuy Synthes and Stryker.