# Surgical Technique for Complementing Robotic-Assisted Total Knee Arthroplasty in Middle-Aged Patients with Rigid Knee Bones

## TL;DR

A new surgical technique combines robotic and manual methods to improve accuracy in knee replacement for middle-aged patients with hard bones.

## Contribution

A complementary technique combining robotic and manual methods to address bone cutting errors in robotic-assisted TKA.

## Key findings

- A 2.4% re-cutting rate was observed due to improper femoral posterior chamfer cutting.
- Re-cutting attempts were predominantly in middle-aged male patients.
- The combined technique offers a useful alternative for patients with rigid knee bones.

## Abstract

This study reports 12 cases of inaccurate bone cutting from a single-surgeon series of 509 consecutively performed robotic-assisted total knee arthroplasty (TKA) for 1 year. In addition, a complementary technique with the combined benefits of robotic-assisted and manual techniques that address this issue is described. From June 2020 to May 2021, a consecutive series of 509 TKAs was performed on 338 patients using a posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital. The surgical records were reviewed to identify the causative bone locations and bone re-cutting events correlated with improper trial instrument positioning. The re-cutting rate was 2.4% (12/509). All re-cutting attempts occurred because of improper cutting of the femoral posterior chamfer. Re-cutting was attempted mostly on middle-aged male patients. This complementary technique can facilitate manual bone cutting while retaining the advantages of robotic surgery during robotic-assisted TKA. Additionally, the combined technique of manual bone cutting and robotic-assisted surgery can be a useful alternative for middle-aged male patients with rigid knee bones.