title: Unicompartmental knee arthroplasties: robot vs. patient specific instrumentation.
abstract: BACKGROUND
  The technical reliability demonstrated by semi active robots in implant placement could render unicompartmental knee arthroplasties (UKAs) more favourable than they are currently. The relatively untested method using patient specific instrumentation (PSI), however, has the potential to match the accuracy produced by robots but without the barriers that have prevented them from being used more widely in clinical practice, namely operative time. Therefore this study took a step towards comparing the accuracy and time taken between the two technologies.
  
  
  METHODS
  Thirty-six UKAs were carried out on identical knee models, 12 with the Sculptor, 12 with PSI and 12 conventionally under timed conditions. Implant placement in these knees was then judged against that in a pre-operative plan.
  
  
  RESULTS
  Tibial implant orientations and femoral implant positions and orientations were significantly more accurate in the PSI group with mean errors of 6°, 2 mm and 4° respectively, than the conventional group which had means of 9°, 4 mm and 10°. There was no significant difference between the robot and PSI generally except in tibial implant orientation (mean robotic error 3°) and tibial implant position did not vary significantly across all three groups. It was also found that use of PSI and conventional methods took half the time taken by the robot (p<0.001).
  
  
  CONCLUSIONS
  With further development, PSI can match and possibly surpass the accuracy of the robot, as it does with the conventional method, and achieve planned surgery in less time.
  
  
  CONCLUSIONS
  This work sets the foundation for clinical trials involving PSI.
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Jaffry
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. Electronic address: m.masjedi@imperial.ac.uk.
authors.forename: Milad
authors.initials: M
authors.lastname: Masjedi
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Susannah
authors.initials: S
authors.lastname: Clarke
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Harris
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Monil
authors.initials: M
authors.lastname: Karia
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Andrews
authors.affiliation: MSk Lab, Department of Orthopaedics, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: Cobb
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation* / Q000379:methods; D017076:Computer-Aided Design; D006801:Humans; D021621:Imaging, Three-Dimensional; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery; D007720:Knee Prosthesis; D008953:Models, Anatomic; D061646:Operative Time; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery; D066330:Printing, Three-Dimensional; D017755:Prosthesis Fitting / Q000295:instrumentation* / Q000379:methods; D065287:Robotic Surgical Procedures; D014057:Tomography, X-Ray Computed
keywords: Osteoarthritis; Surgical accuracy; Surgical technique; Three dimensional analysis; Unicompartmental knee replacement