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All issues Volume 11 (2025) SICOT-J, 11 (2025) 35 Full HTML
Open Access

Table 2

Key tips and tricks for image-based robotic patellofemoral arthroplasty with functional knee positioning.

Step Tips and tricks
Pre-operative planning

  • Use CT-based navigation for 3D modeling and precise implant positioning.

  • Aim for anatomical resurfacing of the femoral trochlea.
Surgical approach and pins placement

  • Use medial mid-vastus approach for optimal exposure.

  • Perform complete cartilage assessment of all compartments.

  • Insert femoral pins through anteromedial stab incisions at mid-diaphysis.
Trochlear mapping, intra-operative planning, and initial patellar tracking

  • Use non-invasive mapping tool to trace trochlear groove and cartilage thickness.

  • Adjust implant position in coronal (varus/valgus), axial (rotation), and sagittal (flexion) planes.

  • Mark the anterior patellar center for reference in patellar tracking.
Bone preparation, trial component implant, and intraoperative patellar tracking

  • Use robotic arm-assisted burr for precision bone cuts.

  • Avoid prosthetic overhang beyond cartilage margins.

  • Reassess patellar tracking after trial components are in place.
Patellar cut and final patellar tracking

  • Leave at least 12 mm of residual patellar bone.

  • Avoid increasing anterior offset; restore or slightly reduce it.

  • Center peg holes medio-laterally and antero-posteriorly.

  • Perform medial or lateral facetectomy if needed.
Final implant cementation and closure

  • Apply manual compression on trochlear component, tool-assisted on patella.

  • Thoroughly remove excess cement.

  • Close capsule and skin properly after cement sets.

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