Concepts and techniques of a new robotically assisted technique for total knee arthroplasty: the ROSA knee system

Introduction The ROSA (Robotic Surgical Assistant) Knee system (Zimmer Biomet, Warsaw, IN) for total knee arthroplasty (TKA) can be considered as collaborative robotics, where the surgeon remains in charge of the procedure and collaborates with a smart robotic tool, to perform the surgery with a high accuracy and reproducibility. The aim was to describe: (1) its concept and surgical technique; (2) its advantages and potential limits; (3) the early experience with this system. Materials and methods The goal during its development phase was to keep the surgeon active and at the center of the operation: the surgeon handles the saw and performs the cuts while the robotic arm places and holds the guide at the right place. The ROSA knee platform assists the surgeon for the distal femoral cut, the femoral component sizing and positioning, the tibial cut and the ligament balance. This robotic system has two options: image-based with 3D virtual model; or image-less, based on intraoperative landmarks acquisition. All the classic surgical techniques can be used: measured resection, gap balancing, functional alignment, kinematic alignment. Some techniques recently developed are more ROSA-specific: Robotic personalized TKA, ROSA-FuZion technique. Results Its advantages as compared to other available systems include: radiographs in standing position, collaborative robotic system where the robot completes the surgeon skills, off-the-shelf implants, predictive robotic with concept of machine learning incorporated into the system. Two cadaveric studies have reported the high accuracy and reproducibility of this device. This robotic system is recent and currently no clinical series has enough follow-up to report clinical outcomes. Conclusion The ROSA knee system is a robotically assisted semi-autonomous surgical system with some specific characteristics. The aim of this collaborative robotic system is to improve the accuracy and reliability of the bone resections and the ligament balancing, without replacing the steps well performed by the surgeon.

Automated summary

The ROSA Knee system is a collaborative robotic system that aims to improve the accuracy and reliability of bone resections and ligament balancing without replacing the steps well performed by the surgeon. This system has advantages such as standing position radiographs, off-the-shelf implants, and predictive robotic capabilities, but further clinical outcomes are needed for evaluation.