Title: Personalized Total Knee Arthroplasty: Computer-Assisted Navigation vs. Robotic Assistance (CAN-ARD). Summary: Knee osteoarthritis is frequently treated with Total Knee Arthroplasty (TKA). However, approximately 20% of patients remain dissatisfied following the procedure. This study aims to compare two surgical assistance technologies designed to improve prosthetic placement accuracy: Computer-Assisted Navigation (CAN) and Robotic-Arm Assistance (RA). The primary objective is to determine if there is a significant difference in functional outcomes and the "forgotten joint" sensation (measured by the Forgotten Joint Score - FJS) between patients operated on with robotic assistance versus those with traditional navigation at 3, 12, and 24 months post-surgery. The study's hypothesis is that there is no major clinical difference between these two techniques when applied within a personalized alignment strategy.
Background and Rationale: Personalized alignment in total knee arthroplasty combines the restoration of the patient's unique anatomy (restricted kinematic alignment) with joint stability. While computer-assisted navigation has been successfully used since 2003 to plan and control implant positioning, robotic assistance is gaining popularity due to its ability to perform more precise bone cuts using a haptic robotic arm. This study seeks to investigate whether this technical gain in precision translates into a real clinical benefit for the patient in terms of satisfaction and joint perception. Study Design: This is an interventional, prospective, randomized, single-center study. A total of 140 patients (70 per group) will be enrolled. Interventions: Participants will be randomly assigned to one of the following two arms: Navigation Group: TKA implantation (Attune® CR) guided by an intraoperative computer navigation system. Robotic Group: TKA implantation using a robotic-arm-assisted system (a motorized saw linked to the navigation software). Follow-up and Evaluations: Patients will be followed for 24 months. Evaluations will include: Primary Endpoint: Forgotten Joint Score (FJS) at 3, 12, and 24 months. Secondary Endpoints: Satisfaction and functional scores (KOOS, SKV, Net Promoter Score), range of motion measurements, operative time, and monitoring of any complications. Target Population: Adults (≥ 18 years) scheduled for primary total knee arthroplasty for osteoarthritis, with no history of major bone surgery on the affected limb.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
140
Total Knee Arthroplasty (TKA) performed using a robotic-arm-assisted system connected to navigation software. Like the navigation group, this arm utilizes the personalized alignment strategy and the Attune® CR prosthesis. Instead of manual cutting guides, the surgeon manipulates a robotic arm equipped with a motorized saw to perform the bone cuts according to the pre-planned digital model. This technology is intended to increase the precision of bone resections.
Total Knee Arthroplasty (TKA) performed using an intraoperative computer navigation system. The procedure follows a personalized alignment strategy (restricted kinematic alignment combined with joint stability). After creating a digital model of the knee and mapping anatomical landmarks, the navigation system assists the surgeon in manually positioning the bone cutting guides. The primary implant used is the Attune® CR (Cruciate-Retaining) prosthesis with patellar resurfacing.
Groupe hospitalier Diaconesses Croix Saint Simon
Paris, Paris, France
RECRUITINGForgotten Joint Score (FJS).
Assessment of the patient's ability to forget the artificial joint in daily life. Minimum score: 0, Maximum score: 100. A higher score indicates a better outcome (the patient is less aware of the prosthetic joint)
Time frame: 3, 12, and 24 months postoperatively.
Knee Injury and Osteoarthritis Outcome Score (KOOS).
Evaluation of the patient's opinion about their knee and associated problems. Minimum score: 0, Maximum score: 100. A higher score represents a better outcome.
Time frame: 3, 12, and 24 months postoperatively.
Self Knee Value (SKV).
Patient's subjective assessment of their knee as a percentage of a normal knee. Scale: 0% to 100%. A higher percentage represents a better outcome.
Time frame: 3, 12, and 24 months postoperatively.
Net Promoter Score (NPS)
A single-question survey used to measure patient satisfaction and their willingness to recommend the surgical procedure to others. The score is calculated based on responses to a single question on a scale of 0 to 10 (where 0 is "not at all likely" and 10 is "extremely likely"). Respondents are grouped as Promoters (9-10), Passives (7-8), or Detractors (0-6). The final NPS is calculated by subtracting the percentage of Detractors from the percentage of Promoters, resulting in a score ranging from -100 to +100. A higher score indicates higher patient satisfaction
Time frame: 3, 12, and 24 months postoperatively.
Active Range of Motion.
Measurement of the active flexibility (extension and flexion) of the operated knee using a goniometer. Measured in degrees
Time frame: Preoperatively, and at 3 months, 12 months, and 24 months postoperatively.
Operative Time
Total duration of the surgical procedure, measured from the initial skin incision to the completion of skin closure.
Time frame: During the surgical procedure (Day 0).
Incidence of Surgical and Postoperative Adverse Events.
Documentation of complications including:Intraoperative: Technology-related issues or interruption of surgical assistance. Postoperative: Revision surgery, manipulation under anesthesia, or implant loosening.
Time frame: Through 24 months postoperatively.
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