Total Knee Arthroplasty Technique: TSolution One (Robodoc)

  • Ming Han Lincoln Liow
  • Pak Lin Chin
  • Seng Jin Yeo


The Think (formerly Robodoc) system was the first robotic system to be used in orthopedic surgery in 1992. Robodoc is an active-autonomous, image-based, robotic milling system which enables the surgeon to attain a consistently accurate implant component positioning. The Robodoc system is capable of achieving this through an image-based preoperative planning system which allows the surgeon to create, view and analyze the surgical outcome in 3D. The accuracy and precision of component positioning have been attributed to the following factors: (1) customized distal femoral resection; (2) accurate determination of the femoral rotational alignment; and (3) minimization of errors and maintenance of bone temperature with robotic milling. Despite all these advantages, there is still a paucity of long term, high-quality data that demonstrates the efficacy of Robodoc TKA. Questions regarding radiation risks, prolonged surgical duration and cost-effectiveness remain unanswered. The objectives of this chapter are to describe: (1) Robodoc surgical technique; (2) limitations and complications; and (3) clinical and radiological outcomes.


Robotic-assisted total knee arthroplasty TKA Total knee arthroplasty Robodoc Think total knee arthroplasty 


  1. 1.
    Paul HA, et al. Development of a surgical robot for cementless total hip arthroplasty. Clin Orthop Relat Res. 1992;(285):57–66.Google Scholar
  2. 2.
    Liow MH, et al. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch ROBODOC(R) surgical system. Singap Med J. 2014;55(10):529–34.CrossRefGoogle Scholar
  3. 3.
    Bargar WL. Robots in orthopaedic surgery: past, present, and future. Clin Orthop Relat Res. 2007;463:31–6.Google Scholar
  4. 4.
    Jakopec M, et al. The first clinical application of a “hands-on” robotic knee surgery system. Comput Aided Surg. 2001;6(6):329–39.CrossRefGoogle Scholar
  5. 5.
    Siebert W, et al. Technique and first clinical results of robot-assisted total knee replacement. Knee. 2002;9(3):173–80.CrossRefGoogle Scholar
  6. 6.
    Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73(5):709–14.CrossRefGoogle Scholar
  7. 7.
    Ritter MA, et al. The effect of alignment and BMI on failure of total knee replacement. J Bone Joint Surg Am. 2011;93(17):1588–96.CrossRefGoogle Scholar
  8. 8.
    Berend ME, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res. 2004;(428):26–34.Google Scholar
  9. 9.
    Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res. 2007;464:111–6.Google Scholar
  10. 10.
    Kharwadkar N, et al. 5 degrees to 6 degrees of distal femoral cut for uncomplicated primary total knee arthroplasty: is it safe? Knee. 2006;13(1):57–60.CrossRefGoogle Scholar
  11. 11.
    Miller MC, et al. Optimizing femoral component rotation in total knee arthroplasty. Clin Orthop Relat Res. 2001;392:38–45.CrossRefGoogle Scholar
  12. 12.
    Bellemans J. Osseointegration in porous coated knee arthroplasty. The influence of component coating type in sheep. Acta Orthop Scand Suppl. 1999;288:1–35.PubMedGoogle Scholar
  13. 13.
    Plaskos C, et al. Bone cutting errors in total knee arthroplasty. J Arthroplast. 2002;17(6):698–705.CrossRefGoogle Scholar
  14. 14.
    Eriksson RA, Albrektsson T. The effect of heat on bone regeneration: an experimental study in the rabbit using the bone growth chamber. J Oral Maxillofac Surg. 1984;42(11):705–11.CrossRefGoogle Scholar
  15. 15.
    Song EK, et al. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc. 2011;19(7):1069–76.CrossRefGoogle Scholar
  16. 16.
    Song EK, et al. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res. 2013;471(1):118–26.CrossRefGoogle Scholar
  17. 17.
    Liow MH, et al. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc. 2017 Sep;25(9):2942–51.CrossRefGoogle Scholar
  18. 18.
    Karthik K, et al. Robotic surgery in trauma and orthopaedics: a systematic review. Bone Joint J. 2015;97-B(3):292–9.CrossRefGoogle Scholar
  19. 19.
    Smith-Bindman R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078–86.CrossRefGoogle Scholar
  20. 20.
    Urish KL, et al. Robotic total knee arthroplasty: surgical assistant for a customized normal kinematic knee. Orthopedics. 2016;39(5):e822–7.CrossRefGoogle Scholar
  21. 21.
    Chun YS, et al. Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplast. 2011;26(4):621–5.CrossRefGoogle Scholar
  22. 22.
    Davey SM, et al. Surgeon opinion on new technologies in orthopaedic surgery. J Med Eng Technol. 2011;35(3–4):139–48.CrossRefGoogle Scholar
  23. 23.
    Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplast. 2016;31(10):2353–63.CrossRefGoogle Scholar
  24. 24.
    Moschetti WE, et al. Can robot-assisted unicompartmental knee arthroplasty be cost-effective? A Markov decision analysis. J Arthroplast. 2016;31(4):759–65.CrossRefGoogle Scholar
  25. 25.
    Kim KI, et al. Robot-assisted total knee arthroplasty in haemophilic arthropathy. Haemophilia. 2016;22(3):446–52.CrossRefGoogle Scholar
  26. 26.
    Park SE, Lee CT. Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplast. 2007;22(7):1054–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ming Han Lincoln Liow
    • 1
  • Pak Lin Chin
    • 2
  • Seng Jin Yeo
    • 1
  1. 1.Department of Orthopaedic SurgerySingapore General HospitalSingaporeSingapore
  2. 2.The Orthopaedic Centre, Mount Elizabeth Medical CentreSingaporeSingapore

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