Robotic assisted partial knee arthroplasty (PKA) has gained in popularity as a treatment for end stage knee osteoarthritis (OA) that involves only one or two compartments of the knee over total knee arthroplasty (TKA). PKA surgeries are known for their less invasive and more precise treatment of medial or lateral compartmental (+/- patellofemoral) arthritis, improved postoperative range of motion, greater ligament and bone preservation, and a more natural gait. The Robotic Arm Interactive Orthopedic MAKO Stryker (RIO; MAKO Stryker, Fort Lauderdale, Florida) Robot has significantly improved PKA implant alignment by providing real-time feedback during surgery and improving three-dimensional implant placement accuracy. To assess kinematic differences between robotic assisted PKA and manual technique TKA, a 14-camera optoelectronic motion capture system (Optitrack, NaturalPoint, Corvallis, OR USA) was designed and installed in a hospital hallway to collect patient gait outcomes directly after clinic appointments. This thesis investigates the feasibility and validity results from setting up a motion capture system and its associated reliability when using it in a high traffic clinical environment. The first objective of this thesis was to investigate a total of 26 patients (14 TKA, 12 PKA) that underwent a kinematic gait assessment at 4-time points; preoperatively, and postoperatively (3,6,12 months). At 3 and 6 months postoperatively, the TKA group had improved knee flexion range of motion (ROM) during walking compared to the PKA group. This result was statistically significant (3-month p value =0.042, 6-month p value= 0.048). At 6 months, changes in the knee adduction/abduction angles were also significantly different (p value= 0.023), showing less knee ROM in the frontal plane after a PKA comparable to healthy controls. Despite differences in improvements in joint kinematics during walking between the two groups, these factors did not necessarily correlate with better perceived patient reported outcomes (PROMs). The results obtained from this pilot study display initial feasibility and suggest further research is required on a larger sample size to confirm if PKA surgeries are superior to TKA surgeries in terms of gait function. In conclusion, a repeatable, instrumented gait analysis was setup in a busy orthopedic hallway where reliable data can be collected. / Thesis / Master of Applied Science (MASc) / Robotic assisted partial knee replacements have been gaining popularity in recent years due to the perceived benefits over a total knee replacement such as preserving more bone, faster recovery, and improved walking outcomes. A partial knee replacement can either replace one or both compartments of the knee joint, depending on the level of arthritis in the patient's knee. This thesis investigated the differences in walking ability before and after surgery using a specialized system installed in the hospital to collect data during regularly scheduled appointments. Patients in this study either received a partial knee replacement with the help of a surgical robot, or a regular total knee replacement. The results showed that there is a significant difference in how much the knee moves during walking between patients who had the robot surgery and those who had the usual surgery. However, the patient’s experience and their perception of how well they were doing after surgery were not different between the two surgeries. This study provided valuable insight into the current surgical treatments available for knee arthritis.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/28490 |
| Date | January 2023 |
| Creators | Malek, Monica |
| Contributors | Astephen Wilson, Janie, Biomedical Engineering |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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