In Vitro Investigations of Conventional vs. Robotic-Assisted Total Knee Arthroplasty

Total knee arthroplasty (TKA) treats severe osteoarthritis (OA) when conservative options fail to relieve pain or restore mobility. This procedure removes diseased tissues from the distal femur and proximal tibia, replacing them with prostheses. Traditionally, manual tools, cutting guides, and sizing jigs determine cut positioning and implant orientation. However, persistent patient dissatisfaction and revision rates highlight limitations with conventional TKA (cTKA) methods. Robotic-assisted TKA (rTKA) systems have been developed to reduce surgical errors, increase the accuracy and precision of bone resections and implant alignment, consequently improving surgical outcomes. However, cTKA and rTKA should be characterized through additional postoperative factors to completely assess their differences. In vitro investigations allow control of variables that may confound clinical results. This thesis compares cTKA and rTKA in bilateral knees from cadaveric donors, operated on by a single surgeon in a controlled laboratory environment. First, resection accuracy was assessed relative to the surgical plan. Both cTKA and rTKA achieved resection greater accuracy in the coronal plane than the sagittal plane. Overall, rTKA experienced fewer outliers (deviations greater than 3° from the plan) than cTKA. Next, postoperative internal/external (IE) rotation and varus/valgus (VV) rotation laxity was assessed at discrete flexion angles and evaluated against a cohort of intact knees. No differences were found in IE or VV rotation laxity at any flexion angle between cohorts. Then, joint kinematics were evaluated across simulated activities of daily living (ADLs). cTKA and rTKA IE kinematics differed from intact knee kinematics at varying points throughout the ADLs but did not differ significantly from each other. Finally, a quadriceps-loaded, gravity-dependent squat was simulated. Tibiofemoral (TF) and patellofemoral (PF) kinematics, and quadriceps force were evaluated across the movement. No significant differences were observed between cTKA and rTKA except for PF anterior/posterior (AP) translation in early flexion. These results demonstrate comparable biomechanical outcomes between cTKA and rTKA, despite differences in resection accuracy. Findings are specific to a cruciate retaining rotating platform (CR RP) implant system, which may be less sensitive to surgical error. These analyses may inform clinical decision-making, guide best practices and support refinement and tailored adoption of cTKA and rTKA methods.

Name thesis:degree_name

Ph D

Discipline thesis:degree_discipline

Biomedical Engineering

Grantor dc:publisher

The University of Western Ontario

Year dc:date.issued

2025

Author dc:creator

• Donnelly, Emma

Advisors dc:contributor.advisor

• Willing, Ryan
• Lanting, Brent

• Total Knee Artrhoplasty
• Robotic-Assisted
• Conventional
• Joint Kinematics
• Laxity
• Accuracy

Statement dc:rights

• Attribution-NonCommercial 4.0 International

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/20.500.14721/39118

OAI identifier oai:identifier

oai:uwo.scholaris.ca:20.500.14721/39118