{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:23:49Z","timestamp":1792409029509,"version":"4.4.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthroplasty"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Major robotic systems for total knee replacements necessitate the use of array pins in the tibia and femur. These extra-incisional pins are placed away from the primary incision and may be associated with soft tissue complications and peri-prosthetic fractures. There is currently no standardized, reproducible method for reliably placing pins in the femur and tibia metaphyses. We have developed an all-intra-incisional pin method within the primary incision. This paper aims to describe our technique, analyse the proximity of the pins to the implants, and study complications arising from both techniques.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A total of 102 robotic-assisted total knee arthroplasties were performed using the ROSA, MAKO, and CORI systems. Patient charts were reviewed for their age, gender, body mass index, and ethnicity. Post-operative day zero radiographs of the operated knee were used for measurements in anteroposterior and lateral views, with X-ray magnifications taken into consideration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Our study demonstrates that intra-incisional pins can be placed 6.52 times closer to the tibial implant compared to extra-incisional pins on the anteroposterior X-ray view radiographs, with no observed significant difference between the complication rates. In anteroposterior view, it allows placement of tibia pins within 8.99\u2009\u00b1\u20091.21\u00a0mm (95% CI: 7.78, 10.2) of the tibial implant, within 5.93\u2009\u00b1\u20091.29\u00a0mm (95% CI: 4.64, 7.22) of the tibia-reamed-surface, and placement of the femoral pins within 6.01\u2009\u00b1\u20091.37\u00a0mm (95% CI: 4.64, 7.37) of the femoral implant. In the lateral X-ray view, it enables the placement of tibial pins within 9.40\u2009\u00b1\u20091.43\u00a0mm (95% CI: 7.97, 10.8) of the implant. Univariate analysis reveals that our technique and pin-distance from the implants are not influenced by patient demographics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Our study has demonstrated that our technique is precise, not affected by patients\u2019 demographics, and eliminates the need for pin repositioning, potentially reducing the incidence of pin-site complications.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s42836-025-00329-8","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:01:45Z","timestamp":1756767705000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Novel all-intra-incisional pin placement technique in robotic total knee arthroplasty: a safer alternative"],"prefix":"10.1186","volume":"7","author":[{"given":"Zi Qiang Glen","family":"Liau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai Keong Ryan","family":"Loke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danakkrisna Vachalam","family":"S.\/O. Rangasamie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"issue":"15","key":"329_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.artd.2022.02.015.PMID:35360676;PMCID:PMC8961076","volume":"24","author":"JC Brinkman","year":"2022","unstructured":"Brinkman JC, Christopher ZK, Moore ML, Pollock JR, Haglin JM, Bingham JS. Patient Interest in Robotic Total Joint Arthroplasty Is Exponential: A 10-Year Google Trends Analysis. Arthroplast Today. 2022;24(15):13\u20138. https:\/\/doi.org\/10.1016\/j.artd.2022.02.015.PMID:35360676;PMCID:PMC8961076.","journal-title":"Arthroplast Today"},{"key":"329_CR2","doi-asserted-by":"publisher","unstructured":"Alrajeb R, Zarti M, Shuia Z, Alzobi O, Ahmed G, Elmhiregh A. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2024;34(3):1333\u20131343. https:\/\/doi.org\/10.1007\/s00590-023-03798-2. Epub 2023 Dec 22. PMID: 38133653; PMCID: PMC10980635.","DOI":"10.1007\/s00590-023-03798-2"},{"issue":"1","key":"329_CR3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1302\/2633-1462.41.BJO-2022-0070.R1","volume":"4","author":"S Walgrave","year":"2023","unstructured":"Walgrave S, Oussedik S. Comparative assessment of current robotic-assisted systems in primary total knee arthroplasty. Bone Jt Open. 2023;4(1):13\u20138. https:\/\/doi.org\/10.1302\/2633-1462.41.BJO-2022-0070.R1.","journal-title":"Bone Jt Open"},{"key":"329_CR4","doi-asserted-by":"publisher","unstructured":"Riantho A, Butarbutar JCP, Fidiasrianto K, Elson E, Irvan I, Haryono H, Prasetio JN. Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JB JS Open Access. 2023 May 15;8(2):e23.00010. https:\/\/doi.org\/10.2106\/JBJS.OA.23.00010. PMID: 37197698; PMCID: PMC10184987.","DOI":"10.2106\/JBJS.OA.23.00010"},{"key":"329_CR5","unstructured":"MAKO TKA e Stryker surgical guide. https:\/\/www.strykermeded.com\/media\/ 2223\/mako-tka-surgical-guide.pdf. [Accessed 15 July 2022]."},{"key":"329_CR6","unstructured":"Zimmer Biomet. ROSA Knee system surgical technique V 1.1. 2020. https:\/\/ www.rosaknee.com.br\/assets\/pdfs\/ROSAKneeSurgicalTechniquev1.1(ingles). pdf."},{"key":"329_CR7","unstructured":"Smith,Nephew.SurgicaltechniqueguideforKneearthroplasty.2019.https:\/\/ www.smith-nephew.com\/global\/assets\/pdf\/products\/surgical\/20375v1% 20500197reva%20navio7allkneessurgicaltechnique0619.pdf%0D%0A."},{"key":"329_CR8","doi-asserted-by":"publisher","unstructured":"Nogalo C, Meena A, Abermann E, Fink C. Complications and downsides of the robotic total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2023;31(3):736\u2013750. https:\/\/doi.org\/10.1007\/s00167-022-07031-1. Epub 2022 Jun 18. PMID: 35716186; PMCID: PMC9958158.","DOI":"10.1007\/s00167-022-07031-1"},{"issue":"11","key":"329_CR9","doi-asserted-by":"publisher","first-page":"2291","DOI":"10.1016\/j.arth.2022.05.012","volume":"37","author":"TL Thomas","year":"2022","unstructured":"Thomas TL, Goh GS, Nguyen MK, Lonner JH. Pin-Related Complications in Computer Navigated and Robotic-Assisted Knee Arthroplasty: A Systematic Review. J Arthroplasty. 2022;37(11):2291-2307.e2. https:\/\/doi.org\/10.1016\/j.arth.2022.05.012. (Epub 2022 May 7 PMID: 35537611).","journal-title":"J Arthroplasty"},{"issue":"1","key":"329_CR10","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.20.00091","volume":"9","author":"TJ Smith","year":"2021","unstructured":"Smith TJ, Siddiqi A, Forte SA, Judice A, Sculco PK, Vigdorchik JM, Schwarzkopf R, Springer BD. Periprosthetic fractures through tracking pin sites following computer navigated and robotic total and unicompartmental knee arthroplasty: a systematic review. JBJS reviews. 2021;9(1): e20.","journal-title":"JBJS reviews"},{"key":"329_CR11","doi-asserted-by":"publisher","first-page":"2291","DOI":"10.1016\/j.arth.2022.05.012","volume":"37","author":"TL Thomas","year":"2022","unstructured":"Thomas TL, Goh GS, Nguyen MK, Lonner JH. Pin-Related Complications in Computer Navigated and Robotic-Assisted Knee Arthroplasty: A Systematic Review. J Arthroplast. 2022;37:2291-2307.e2.","journal-title":"J Arthroplast"},{"key":"329_CR12","doi-asserted-by":"crossref","unstructured":"Emara AK, Klika AK, Piuzzi NS. Evidence-based orthopedic surgerydfrom synthesis to practice. JAMA Surg 2020;155:1009e10.","DOI":"10.1001\/jamasurg.2020.1521"},{"issue":"4","key":"329_CR13","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1016\/j.arth.2023.10.050","volume":"39","author":"M Stetzer","year":"2024","unstructured":"Stetzer M, Bircher J, Klika AK, Rull\u00e1n PJ, Bloomfield MM, Krebs VE, Molloy RM, Piuzzi NS. Intraincisional Pin Placement is Safe for Robotic-Assisted Total Knee Arthroplasty. J Arthroplasty. 2024;39(4):910-915.e1. https:\/\/doi.org\/10.1016\/j.arth.2023.10.050. (Epub 2023 Nov 1 PMID: 37923234).","journal-title":"J Arthroplasty"},{"key":"329_CR14","doi-asserted-by":"publisher","unstructured":"LeBrun DG, Chandi SK, Neitzke CC, Haas SB, Vigdorchik JM. A Comparison of 90-Day Complication Rates Between Intra- and Extra-incisional Pin Sites in Robotic Total Knee Arthroplasty. J Arthroplasty. 2025 Jul;40(7S1):S96-S99. https:\/\/doi.org\/10.1016\/j.arth.2025.01.030. Epub 2025. PMID: 39884481.","DOI":"10.1016\/j.arth.2025.01.030"},{"issue":"4","key":"329_CR15","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1016\/j.arth.2023.10.050","volume":"39","author":"M Stetzer","year":"2024","unstructured":"Stetzer M, Bircher J, Klika AK, Rull\u00e1n PJ, Bloomfield MM, Krebs VE, Molloy RM, Piuzzi NS. Intraincisional Pin Placement is Safe for Robotic-Assisted Total Knee Arthroplasty. J Arthroplasty. 2024;39(4):910-915.e1. https:\/\/doi.org\/10.1016\/j.arth.2023.10.050. (Epub 2023 Nov 1 PMID: 37923234).","journal-title":"J Arthroplasty"},{"key":"329_CR16","doi-asserted-by":"publisher","unstructured":"Bernhart, Frank & Price, H.. (2007). Heron's Formula, Descartes Circles, and Pythagorean Triangles. https:\/\/doi.org\/10.48550\/arXiv.math\/0701624.","DOI":"10.48550\/arXiv.math\/0701624"},{"key":"329_CR17","doi-asserted-by":"publisher","unstructured":"Goessner, Stefan. (2018). Coordinate Free Vector Algebra in R2. https:\/\/doi.org\/10.13140\/RG.2.2.19280.76805.","DOI":"10.13140\/RG.2.2.19280.76805"},{"issue":"6","key":"329_CR18","doi-asserted-by":"publisher","first-page":"92","DOI":"10.13107\/jocr.2025.v15.i06.5676","volume":"15","author":"H Lee","year":"2025","unstructured":"Lee H, Ha Y. Tracking Pin Site Fractures and Measures to Overcome During Robotic-Assisted Total Knee Arthroplasty: Two Case Reports. Journal of Orthopaedic Case Reports. 2025;15(6):92\u20136.","journal-title":"Journal of Orthopaedic Case Reports"},{"key":"329_CR19","unstructured":"Doan, Gary. \"An Accuracy and Precision Analysis of the VELYS\u2122 Robotic Assisted Solution for Total Knee Arthroplasty.\" (2021)."},{"issue":"1","key":"329_CR20","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.70163.PMID:39931150;PMCID:PMC11808256","volume":"12","author":"TB Alton","year":"2025","unstructured":"Alton TB, Severson EP, Ford MC, Lesko J, Leslie IJ. VELYS robotic-assisted total knee arthroplasty: Enhanced accuracy and comparable early outcomes versus manual instrumentation during adoption. J Exp Orthop. 2025;12(1): e70163. https:\/\/doi.org\/10.1002\/jeo2.70163.PMID:39931150;PMCID:PMC11808256.","journal-title":"J Exp Orthop"}],"container-title":["Arthroplasty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-025-00329-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42836-025-00329-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-025-00329-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T19:54:11Z","timestamp":1757447651000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroplasty.biomedcentral.com\/articles\/10.1186\/s42836-025-00329-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["329"],"URL":"https:\/\/doi.org\/10.1186\/s42836-025-00329-8","relation":{},"ISSN":["2524-7948"],"issn-type":[{"value":"2524-7948","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]},"assertion":[{"value":"5 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods were carried out in accordance with the Singapore Medical Council\u2019s Ethical Code and Ethical Guidelines (ECEG) 2018 (latest edition). All experimental protocols were approved by the Head of Department of Orthopaedics from Alexandra Hospital and the National University Hospital. Informed consent was obtained from all the participants themselves as part of their consent-taking process, and none of the participants had legal guardians.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have reviewed and given consent to submit the manuscript for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"45"}}