|
1
|
Daxini A, Mahajan U. Initial Experience With VELYS Robot-Assisted Total Knee Replacement: Coronal Plane Accuracy and Effect of Robotic Training on Outcomes. Cureus 2024; 16:e76323. [PMID: 39850165 PMCID: PMC11756845 DOI: 10.7759/cureus.76323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2024] [Indexed: 01/25/2025] Open
Abstract
INTRODUCTION The use of robots for arthroplasty is gaining momentum in recent times to provide accuracy in bony cuts and alignment. We aimed to study the efficacy of coronal plane correction with a new robotic system (VELYS™ Robotic-Assisted Surgery) and also the effect of the learning curve of robot-assisted total knee arthroplasty (RATKA) on outcomes. We hypothesize that the benefits of RATKA are not limited to only surgeons having specific training in robotic knee replacement. MATERIALS AND METHODS A total of 101 RATKAs were performed between November 1, 2022, and December 1, 2022, by a surgeon and all the cases were included in this study. The first 50 consecutive knees were considered as 'Cohort I' and the next 51 consecutive knees as 'Cohort II'. The intraoperative robotic registration data and tourniquet time were recorded. On three months follow‑up, Oxford Knee Score and lower limb scannogram were recorded. RESULTS All the 101 cases achieved the desired coronal plane alignment within 3 degrees from neutral. There was a significant difference in the tourniquet time between the two groups. There was no significant difference in the mean three months post-operative values of coronal and sagittal deformity correction, range of flexion, and Oxford Knee Score between the two groups. CONCLUSION The VELYS™ robot-assisted system produces an accurate correction of coronal alignment. As the surgeon's experience increases with the system, there is a reduction in tourniquet time; however, the degree of deformity correction is comparable to that when he had no experience. Hence the benefits of RATKA are not limited to only surgeons having specific training in robotic-assisted knee replacement.
Collapse
Affiliation(s)
- Anurag Daxini
- Orthopaedic Surgery, Mahajan Ortho and Surgical Hospital, Nagpur, IND
| | - Unmesh Mahajan
- Orthopaedic Surgery, Mahajan Ortho and Surgical Hospital, Nagpur, IND
| |
Collapse
|
|
2
|
Wong WK, Abu Bakar Sajak A, Chua HS. Real-world accuracy of robotic-assisted total knee arthroplasty and its impact on expedited recovery. J Robot Surg 2024; 18:309. [PMID: 39105997 PMCID: PMC11303575 DOI: 10.1007/s11701-024-02059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/20/2024] [Indexed: 08/07/2024]
Abstract
Despite total knee arthroplasty (TKA) being the gold standard for end-stage knee osteoarthritis, 20% of patients remain dissatisfied. Robotic-assisted arthroplasty promises unparalleled control of the accuracy of bone cuts, implant positioning, control of gap balance, and resultant hip-knee-ankle (HKA) axis. Patients underwent clinical and radiological assessments, including knee CT scans and patient-reported outcome measures (PROMs), preoperatively. Follow-up assessments were conducted at 2 weeks, 6 weeks, and 3 months post-operatively, with imaging repeated at 6 weeks. A total of 155 patients underwent robotic-assisted TKA and have completed 3 months of follow-up. Mean pre-operative HKA axis was 7.39 ± 5.52 degrees varus, improving to 1.34 ± 2.22 degrees varus post-operatively. Restoration of HKA axis was 0.76 ± 1.9 degrees from intra-operative planning (p < 0.0005). Implant placement accuracy in the coronal plane was 0.08 ± 1.36 degrees (p = 0.458) for the femoral component and 0.71 ± 1.3 degrees (p < 0.0005) for the tibial component. Rotational alignment mean deviation was 0.39 ± 1.49 degrees (p = 0.001). Most patients (98.1%) had ≤ 2 mm difference in extension-flexion gaps. PROM scores showed improvement and exceeded pre-operative scores by 6 weeks post-surgery. Robotic-assisted knee arthroplasty provides precise control over traditionally subjective factors, demonstrating excellent early post-operative outcomes.Level of evidence Prospective observational study-II.
Collapse
Affiliation(s)
- Wai Kit Wong
- Department of Orthopaedics and Traumatology, Hospital Ampang, Jalan Mewah Utara, Taman Pandan Mewah, 68000, Ampang, Selangor, Malaysia.
| | - Azliana Abu Bakar Sajak
- Clinical Research Centre, Sunway Medical Centre, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Hwa Sen Chua
- Orthopaedic Centre of Excellence, Sunway Medical Centre, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| |
Collapse
|
|
3
|
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. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1333-1343. [PMID: 38133653 PMCID: PMC10980635 DOI: 10.1007/s00590-023-03798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes. METHODS We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR - 0.82; 95% CI, - 1.027 to - 0.58, p value < 0.00001) and mechanical restoration (OR - 0.95; 95% CI, - 1.49 to - 0.41, p value < 0.0006). While knee range of motion (OR - 2.23; 95% CI - 4.89-0.43, p value 0.1) and femoral prosthesis position (OR - 0.98; 95% CI, - 2.03-0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries. CONCLUSION This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
| | | | | | - Osama Alzobi
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
| | - Ghalib Ahmed
- Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar
| | | |
Collapse
|
|
4
|
Mancino F, Rossi SMP, Sangaletti R, Caredda M, Terragnoli F, Benazzo F. Increased accuracy in component positioning using an image-less robotic arm system in primary total knee arthroplasty: a retrospective study. Arch Orthop Trauma Surg 2024; 144:393-404. [PMID: 37755480 DOI: 10.1007/s00402-023-05062-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (RTKA) and navigated total knee arthroplasty (NTKA) have shown improved knee alignment and reduced radiographic outliers. Recent studies have proven that conventional mechanical alignment may not be the optimal goal for every patient. The aim of this study was to compare the accuracy of the planned implant positioning of a novel image-less robotic technique with an established navigated technique (NTKA). METHOD The study is a retrospective analysis of prospectively collected data that compared the implant positioning and lower-limb alignment of 86 image-less RTKA with 86 image-less NTKA. Radiographic analysis was performed to evaluate the lower-limb overall alignment, femoral and tibial components positioning in the coronal and sagittal planes. Outliers were evaluated with a cutoff of ± 3°. RESULTS No difference was noted between the two groups for radiographic outliers within ± 3° from neutral (p = 0.098). The mean hip-knee-ankle angle deviation from target was 1.3° in the RTKA group compared to 1.9° in the NTKA (p < 0.001). Femoral sagittal deviation (femoral component flexion) was smaller in the RTKA group (0.9° vs 1.9°; p < 0.001). Similarly, tibial coronal deviation (0.8° vs 1.5°; p < 0.001) and tibial sagittal deviation (tibial slope) were smaller in the RTKA group compared to the NTKA group (0.9° vs 1.7°; p < 0.001). CONCLUSIONS The RTKA group reported a substantial and significant reduced error from the planned target angles for both tibial and femoral components. No difference in terms of radiographic outliers was noted between navigation and robotic assistance.
Collapse
Affiliation(s)
- Fabio Mancino
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, WA, Australia
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- Università degli Studi di Pavia, Pavia, Italy
| | - Matteo Caredda
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavio Terragnoli
- U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia, Fondazione Poliambulanza Via Bissolati 57, 25124, Brescia, Italy
- IUSS Istituto Universitario Di Studi Superiori, Pavia, Italy
| |
Collapse
|
|
5
|
Yang P, He R, Lei K, Liu L, Yang L, Guo L. Clinical evaluation of the first semi-active total knee arthroplasty assisting robot made in China: a retrospective propensity score-matched cohort study. Int J Surg 2023; 109:1552-1560. [PMID: 37131329 PMCID: PMC10389537 DOI: 10.1097/js9.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The precision of overall alignment and knee morphotype after robot-assisted total knee arthroplasty has been fully confirmed. This study aims to conduct a clinical evaluation of the first China-made semi-active total knee arthroplasty assisting robot. METHODS After a 1 : 2 propensity score matching, that is, a matched cohort study, patients were matched to the robot group (52 cases) and the conventional group (104 cases). The robot group received osteotomy according to preoperative planning, while the conventional group adopted preoperative planning based on the full-length radiograph and received conventional osteotomy. Perioperative clinical indicators, such as operation time, tourniquet time, hospitalization days, intraoperative bleeding, and hemoglobin level of the two groups were recorded; radiological indicators of postoperative prosthesis position, including hip-knee-ankle angle, frontal femoral component angle, frontal tibial component angle, lateral femoral component angle, and lateral tibial component angle were also recorded; deviations and outliers of the radiological indicators were calculated. RESULTS Compared with the conventional group, the operation time and tourniquet time of the robot group were longer, and the postoperative hemoglobin level decreased less, the differences were statistically significant; the lateral tibial component angle of the conventional group was 80.9°±3.6°, which was smaller than 86.7 °±2.3° of the robot group, the difference was statistically significant ( P <0.001); except for lateral femoral component angle, the absolute deviations of the radiological indicators in the robot group were significantly smaller than that in the conventional group ( P ≤0.001); the outliers of the radiological indicators in the robot group were significantly smaller than that in the conventional group with a statistical difference ( P <0.05). CONCLUSION Compared with the conventional group, the operation time of the robot group was relatively longer, but the perioperation blood loss was less. The robot group could better control the posterior inclination of the tibial prosthesis, and the absolute deviations and outliers of the prosthesis position were relatively smaller. There was no difference in short-term clinical score between the two groups.
Collapse
Affiliation(s)
| | | | | | | | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| |
Collapse
|
|
6
|
Zak SG, Yeroushalmi D, Tang A, Meftah M, Schnaser E, Schwarzkopf R. The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain. J Knee Surg 2023; 36:439-444. [PMID: 34530477 DOI: 10.1055/s-0041-1735313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.
Collapse
Affiliation(s)
| | | | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, New York
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York
| | - Erik Schnaser
- Desert Orthopedic Center, Eisenhower Medical Center, Rancho Mirage, California
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York
| |
Collapse
|
|
7
|
Baek JH, Lee SC, Ryu S, Ahn HS, Nam CH. Coronal Correction for Post-Traumatic Malalignment Using Robot-Assisted Total Knee Arthroplasty: A Case Series. Orthop Res Rev 2022; 14:445-451. [DOI: 10.2147/orr.s387957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
|
|
8
|
Comparison of manipulation rates for robot-assisted, customized, and conventional total knee arthroplasty: a retrospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
9
|
Sarpong NO, Held MB, Grosso MJ, Herndon CL, Santos W, Lakra A, Shah RP, Cooper HJ, Geller JA. No Benefit to Sensor-guided Balancing Compared With Freehand Balancing in TKA: A Randomized Controlled Trial. Clin Orthop Relat Res 2022; 480:1535-1544. [PMID: 35394462 PMCID: PMC9278914 DOI: 10.1097/corr.0000000000002168] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Soft tissue balancing in TKA has traditionally relied on surgeons' subjective tactile feedback. Although sensor-guided balancing devices have been proposed to provide more objective feedback, it is unclear whether their use improves patient outcomes. QUESTIONS/PURPOSES We conducted a randomized controlled trial (RCT) comparing freehand balancing with the use of a sensor-guided balancing device and evaluated (1) knee ROM, (2) patient-reported outcome measures (PROMs) (SF-12, WOMAC, and Knee Society Functional Scores [KSFS]), and (3) various surgical and hospital parameters (such as operative time, length of stay [LOS], and surgical complications) at a minimum of 2 years of follow-up. METHODS A total of 152 patients scheduled for primary TKA were recruited and provided informed consent to participate in this this study. Of these, 22 patients were excluded preoperatively, intraoperatively, or postoperatively due to patient request, surgery cancellation, anatomical exclusion criteria determined during surgery, technical issues with the sensor device, or loss to follow-up. After the minimum 2-year follow-up was accounted for, there were 63 sensor-guided and 67 freehand patients, for a total of 130 patients undergoing primary TKA for osteoarthritis. The procedures were performed by one of three fellowship-trained arthroplasty surgeons (RPS, HJC, JAG) and were randomized to either soft tissue balancing via a freehand technique or with a sensor-guided balancing device at one institution from December 2017 to December 2018. There was no difference in the mean age (72 ± 8 years versus 70 ± 9 years, mean difference 2; p = 0.11), BMI (30 ± 6 kg/m 2 versus 29 ± 6 kg/m 2 , mean difference 1; p = 0.83), gender (79% women versus 70% women; p = 0.22), and American Society of Anesthesiology score (2 ± 1 versus 2 ± 1, mean difference 0; p = 0.92) between the sensor-guided and freehand groups, respectively. For both groups, soft tissue balancing was performed after all bony cuts were completed and trial components inserted, with the primary difference in technique being the ability to quantify the intercompartmental balance using the trial tibial insert embedded with a wireless sensor in the sensor-guided cohort. Implant manufacturers were not standardized. Primary outcomes were knee ROM and PROMs at 3 months, 1 year, and 2 years. Secondary outcomes included pain level evaluated by the VAS, opioid consumption, inpatient physical therapy performance, LOS, discharge disposition, surgical complications, and reoperations. RESULTS There was no difference in the mean knee ROM at 3 months, 1 year, and 2 years postoperatively between the sensor-guided cohort (113° ± 11°, 119° ± 13°, and 116° ± 12°, respectively) and the freehand cohort (116° ± 13° [p = 0.36], 117° ± 13° [p = 0.41], and 117° ± 12° [p = 0.87], respectively). There was no difference in SF-12 physical, SF-12 mental, WOMAC pain, WOMAC stiffness, WOMAC function, and KSFS scores between the cohorts at 3 months, 1 year, and 2 years postoperatively. The mean operative time in the sensor-guided cohort was longer than that in the freehand cohort (107 ± 0.02 versus 84 ± 0.04 minutes, mean difference = 23 minutes; p = 0.008), but there were no differences in LOS, physical therapy performance, VAS pain scores, opioid consumption, discharge disposition, surgical complications, or percentages of patients in each group who underwent reoperation. CONCLUSION This RCT demonstrated that at 2 years postoperatively, the use of a sensor-balancing device for soft tissue balancing in TKA did not confer any additional benefit in terms of knee ROM, PROMs, and clinical outcomes. Given the significantly increased operative time and costs associated with the use of a sensor-balancing device, we recommend against its routine use in clinical practice by experienced surgeons. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- Nana O. Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael B. Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew J. Grosso
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Carl L. Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Walkania Santos
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Akshay Lakra
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Roshan P. Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - H. John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey A. Geller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
|
10
|
Naylor BH, Butler JT, Kuczynski B, Bohm AR, Scuderi GR. Can Component Size in Total Knee Arthroplasty Be Predicted Preoperatively?-An Analysis of Patient Characteristics. J Knee Surg 2022. [PMID: 35820432 DOI: 10.1055/s-0042-1748902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Accurately predicting component sizing in total knee arthroplasty (TKA) can ensure appropriate implants are readily available, avoiding complications from malsizing while also reducing cost by improving workflow efficiency through a reduction in instrumentation. This study investigated the utility of demographic variables to reliably predict TKA component sizes. METHODS AND MATERIALS A retrospective chart review of 337 patients undergoing primary TKA was performed. Patient characteristics (age, sex, race, height, weight) were recorded along with implant and shoe size. Correlation between shoe size and TKA component size was assessed using Pearson's correlation coefficient and linear regression analysis using three models: (A) standard demographic variables, (B) shoe size, and (C) combination of both models. RESULTS Shoe size demonstrated the strongest correlation with femoral anteroposterior (FAP) (p < 0.001) followed by height (p < 0.001). Conversely, height exhibited the strongest correlation with tibial mediolateral (TML) (p < 0.001) followed by shoe size (p < 0.001). Model C was able to correctly predict both the femur and tibia within one and two sizes in 83.09 and 98.14% of cases, respectively. Individually, model C predicted the FAP within one and two sizes in 83.09 and 96.14% of cases, and the TML in 98.81 and 100% of cases, respectively. CONCLUSION A patient's shoe size demonstrates a strong correlation to the TKA implant size, and when combined with standard demographic variables the predictive reliability is further increased. Here, we present a predictive model for implant sizing based solely on easily attainable demographic variables, that will be useful for preoperative planning to improve surgical efficiency. LEVEL OF EVIDENCE II, Diagnostic.
Collapse
Affiliation(s)
- Brandon H Naylor
- Department of Orthopedic Surgery, Northwell Orthopedic Institute, Lenox Hill Hospital, New York, New York
| | - Justin T Butler
- Department of Orthopedic Surgery, Mercy Health, St Vincent Medical Center, Toledo, Ohio
| | - Bozena Kuczynski
- Department of Orthopedic Surgery, Northwell Orthopedic Institute, Lenox Hill Hospital, New York, New York
| | - Andrew R Bohm
- Department of Orthopedic Surgery, Northwell Orthopedic Institute, Lenox Hill Hospital, New York, New York
| | - Giles R Scuderi
- Department of Orthopedic Surgery, Northwell Orthopedic Institute, Lenox Hill Hospital, New York, New York
| |
Collapse
|
|
11
|
He R, Sun ML, Xiong R, Yang PF, Lei K, Liu LM, Yang L, Guo L. A Newly Designed "SkyWalker" Robot Applied in Total Knee Arthroplasty: A Retrospective Cohort Study for Femoral Rotational Alignment Restoration. Orthop Surg 2022; 14:1681-1694. [PMID: 35758336 PMCID: PMC9363748 DOI: 10.1111/os.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective This study explored whether robotic arm‐assisted total knee arthroplasty (RATKA) has the advantage of restoring femoral rotational alignment compared to conventional total knee arthroplasty (COTKA). Methods Sixty patients (45 women and 15 men) attending our department from May 2019 to December 2020 were selected and divided into two groups, with 30 patients in each group, according to whether they underwent COTKA or RATKA. Femoral rotational alignment results, such as, posterior condylar angle (PCA), patella transverse axis‐femoral transepicondylar axis angle (PFA), radiological findings, such as, hip‐knee‐ankle angle (HKA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA), and operative data (operation time, intraoperative blood loss, tourniquet time, and length of stay (LOS), and clinical outcomes, such as maximum knee flexion angle (MKFA), Knee Society Score (KSS), and Western Ontario Mac Master University Index Score (WOMAC) were compared within and between the two groups. Results PCA and PFA in the RATKA group were (0.6 ± 0.3)° and (0.9 ± 0.3)°, respectively, which were smaller than (1.5 ± 2.0)° and (3.1 ± 1.1)° in the COTKA group (P < 0.05), and were closer to 0°; the differences in HKA, LDFA, and MPTA were not statistically significant. With the exception of the LDFA, the HKA, MPTA, PCA, and PFA improved in both groups after surgery (P < 0.05). The blood loss and the LOS of RATKA group were 192.3 ± 23.1 mL and 8.2 ± 1.4 days, which were less than 203.7 ± 29.8 mL and 9.3 ± 1.1 days of the COTKA group, but the operation time showed no statistically significant difference, and the tourniquet time was longer (P < 0.05). The MKFA in the RATKA group was (123.0 ± 3.7)°, which was greater than (116.3 ± 4.6)° in the COTKA group (P < 0.05). In terms of scores, the postoperative results were better than the preoperative results in both groups (P < 0.05). However, there was no statistically significant difference between the groups. Conclusion The accuracy of femoral rotational alignment reconstructed achieved by RATKA is significantly better than that of COTKA and is more conducive to the recovery of knee flexion function after surgery; although RATKA reduces intraoperative blood loss and postoperative LOS, the short‐term clinical efficacy comparison has not yet demonstrated the advantages of robotic technology, and a more optimized design is needed to improve the efficiency of RATKA surgery.
Collapse
Affiliation(s)
- Rui He
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Mao-Lin Sun
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Ran Xiong
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Peng-Fei Yang
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Kai Lei
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Li-Ming Liu
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Liu Yang
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| | - Lin Guo
- Chongqing Key Laboratory of Precision Medicine of Joint Surgery,Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, China
| |
Collapse
|
|
12
|
D’Amore T, Klein G, Lonner J. The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk? Arthroplast Today 2022; 15:132-138. [PMID: 35573981 PMCID: PMC9095648 DOI: 10.1016/j.artd.2022.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
The average background radiation exposure in the United States has nearly doubled over the previous quarter century, with almost all the increase derived from medical imaging. Nearly 2% of all cancers in the United States may be attributable to radiation from computerized tomography (CT) scans. Given the nondiagnostic nature of CT scans that are used in elective knee and hip arthroplasty today, special consideration should be given to the inherent risk of radiation exposure with routine use of this technology. Methods to decrease radiation exposure including modulating the settings of the CT machine and using alternative non-CT-based systems can decrease patient exposure to radiation from CT scans. The rapid evolution of CT technology in arthroplasty has allowed for expanded clinical applications, the benefits of which remain controversial.
Collapse
Affiliation(s)
| | | | - Jess Lonner
- Corresponding author. Rothman Orthopaedic Institute, 925 Chestnut Street5th Floor, Philadelphia PA, 19107, USA. Tel.: +1 800 321 9999.
| |
Collapse
|
|
13
|
Grosso MJ, Li WT, Hozack WJ, Sherman M, Parvizi J, Courtney PM. Short-Term Outcomes Are Comparable between Robotic-Arm Assisted and Traditional Total Knee Arthroplasty. J Knee Surg 2022; 35:798-803. [PMID: 33111268 DOI: 10.1055/s-0040-1718603] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Robotic-arm assisted total knee arthroplasty (rTKA) was developed to provide for increased accuracy of component placement compared with conventional manual TKA (mTKA). Whether or not rTKA is cost-effective in a bundled payment model has yet to be addressed. The purpose of this comparative study was to evaluate the short-term clinical outcomes of rTKA and mTKA. We retrospectively reviewed a series of 4,086 consecutive primary TKA performed by one of five surgeons across six different hospitals at our institution from January 2016 to December 2018. Outcomes for rTKA cases (n = 581) and mTKA cases (n = 3,505) were compared using unmatched multivariate analysis and a matched cohort. We analyzed 90-day outcomes, episode-of-care claims data, and short form (SF-12) outcome scores to 2 years postoperatively. In matched bivariate analysis, there was no difference in episode-of-care costs, postacute care costs, complications, 90-day readmission rates, emergency department/urgent care visits, reoperations, and mortality between rTKA and mTKA patients (p > 0.05). Matched patients undergoing rTKA did have a shorter hospital length of stay (1.46 vs. 1.80 days, p < 0.001) and decreased rates of discharge to rehabilitation facilities (5.5 vs. 14.8%, p < 0.001). SF-12 scores were clinically similar. Multivariate analysis demonstrated no differences in any 90-day outcome. We conclude that patients undergoing rTKA have comparable costs, 90-day outcomes, and clinically similar improvements in functional outcome scores compared with mTKA patients. Further study is needed to determine whether rTKA will result in improved implant survivorship and long-term functional outcomes (Level of evidence III).
Collapse
Affiliation(s)
- Matthew J Grosso
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William T Li
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William J Hozack
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Sherman
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
|
14
|
Chen X, Deng S, Sun ML, He R. Robotic arm-assisted arthroplasty: The latest developments. Chin J Traumatol 2022; 25:125-131. [PMID: 34556374 PMCID: PMC9125720 DOI: 10.1016/j.cjtee.2021.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/18/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023] Open
Abstract
Joint arthroplasty is an effective method for treating end-stage joint lesions and damages. Robotic arm-assisted arthroplasty, a rapidly developing technology that combines navigation technology, minimally invasive technology, and precise control technology of the robotic arm, can achieve accurate preoperative planning, optimal selection of implants, minimally invasive surgery, precise osteotomy, and accurate placement of the artificial joint. It has the characteristics of high accuracy and stability, and thus is more and more widely used in the field of joint surgery. In this paper, we systematically reviewed the application and clinical efficacy of robotic arm-assisted technology in hip and knee arthroplasty to provide reference for its future promotion.
Collapse
|
|
15
|
Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon. J Knee Surg 2022; 35:409-415. [PMID: 32838457 DOI: 10.1055/s-0040-1715126] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The learning curve has been established for robotic-assisted total knee arthroplasty (RATKA) during the first month of use; however, there have been no studies evaluating this on a longer term. Therefore, the purpose of this study was to compare operative times for three cohorts during the first year following adoption of RATKA (initial, 6 months, and 1 year) and a prior cohort of manual TKA. We investigated both mean operative times and the variability of operative time in each cohort. This is a learning curve study comparing a single surgeon's experience using RAKTA. The study groups were made up of two cohorts of 60 cementless RATKAs performed at ∼6 months and 1 year of use. A learning curve was created based on the mean operative times and individual operative times were stratified into different cohorts for comparison. Study groups were compared with the surgeon's initial group of 20 cemented RATKAs and 60 cementless manual cases. Descriptive numbers were compiled and mean operative times were compared using Student's t-tests for significant differences with a p-value of < 0.05. The mean surgical times continued to decrease after 6 months of RATKA. In 1 year, the surgeon was performing 88% of the RATKA between 50 and 69 minutes. The initial cohort and 1-year robotic-assisted mean operative times were 81 and 62 minutes, respectively (p < 0.00001). Mean 6-month robotic-assisted operative times were similar to manual times (p = 0.12). A significant lower time was found between the mean operative times for the 1-year robotic-assisted and manual (p = 0.008) TKAs. The data show continued improvement of operative times at 6 months and 1 year when using this new technology. The results of this study are important because they demonstrate how the complexity of a technology which initially increases operative time can be overcome and become more time-effective than conventional techniques.
Collapse
Affiliation(s)
- Kevin B Marchand
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Joseph Ehiorobo
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Kevin K Mathew
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Robert C Marchand
- South County Orthopaedics, Ortho Rhode Island, Wakefield, Rhode Island
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York
| |
Collapse
|
|
16
|
吴 颖, 卢 伟, 李 之, 谢 慧, 唐 林, 潘 恩. [Analysis of the influence of tibial component posterior slope angle on short- and mid-term effectiveness of unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:189-195. [PMID: 35172404 PMCID: PMC8863541 DOI: 10.7507/1002-1892.202110019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). METHODS The clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m 2, with an average of 40.04 kg/m 2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. RESULTS All 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference ( t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups ( P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups ( P>0.05). CONCLUSION The patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.
Collapse
Affiliation(s)
- 颖斌 吴
- 广州医科大学附属第一医院骨关节外科（广州 510000）Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P. R. China
| | - 伟杰 卢
- 广州医科大学附属第一医院骨关节外科（广州 510000）Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P. R. China
| | - 之琛 李
- 广州医科大学附属第一医院骨关节外科（广州 510000）Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P. R. China
| | - 慧锋 谢
- 广州医科大学附属第一医院骨关节外科（广州 510000）Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P. R. China
| | - 林 唐
- 广州医科大学附属第一医院骨关节外科（广州 510000）Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P. R. China
| | - 恩豪 潘
- 广州医科大学附属第一医院骨关节外科（广州 510000）Department of Joint Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510000, P. R. China
| |
Collapse
|
|
17
|
Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2022; 30:621-626. [PMID: 33165631 DOI: 10.1007/s00167-020-06353-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Correct positioning and alignment of the prosthesis is a very important factor for durability of prosthesis and implant survival which is improved with the use of technology in total knee arthroplasty. However, the long-term functional outcomes and survivorship are unclear. For this study, it was hypothesized that mechanical axis alignment of lower limb, post-operative joint line restoration, femoral and tibial component alignment is more accurate with the new handheld semi-active robotic-assisted TKA. METHOD From April-2019 to March-2020, 60 patients with unilateral knee osteoarthritis who underwent total knee arthroplasties were included in this prospective randomised controlled study. Computer generated randomization was used. Study included 48 female patients and 12 male patients. Pre-operative and post-operative radiographic measurements were done and compared between the two groups. RESULTS There was a significant difference between two groups with respect to mechanical axis deviation, joint line deviation and coronal alignment of femoral and tibial prosthesis. Mechanical axis deviation > 3° was seen in eight cases (28.5%) in C-TKA group compared to one case (3.1%) in RA-TKA (p 0.019). Joint line deviation of 3.5 mm was noted in C-TKA group as compared to 0.9 mm in RA-TKA group (p < 0.001) which was statistically significant. However, whether this difference of 2.6 mm of joint line elevation between C-TKA and RA-TKA leads to any difference in clinical outcome in terms of knee kinematics and knee flexion needs to be investigated with further studies. Clinically restoring normal joint line is important for improved knee function after primary TKA. No significant difference was noted in femoral component rotation on post-operative computed tomography (CT) scan. CONCLUSION The novel imageless, handheld semi-autonomous robotic system for TKA is highly accurate with respect to component positioning in coronal plane and mechanical alignment as compared to conventional TKA. Joint line is elevated in conventional TKA but is accurately restored using the robotic-assisted TKA which may lead to better patellofemoral kinematics. LEVEL OF EVIDENCE I.
Collapse
|
|
18
|
Sicat CS, Chow JC, Kaper B, Mitra R, Xie J, Schwarzkopf R. Component placement accuracy in two generations of handheld robotics-assisted knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:2059-2067. [PMID: 34304279 DOI: 10.1007/s00402-021-04040-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is the gold standard for treatment of end-stage osteoarthritis. Previous studies have shown that successful outcomes following TKA depend on accurate implant alignment and soft tissue balancing. Robotic-assisted TKA have demonstrated improved accuracy in component placement and have been associated with better outcomes and patient satisfaction. This study aims to report on the execution accuracy of two generations of handheld robotic-assisted surgical systems. METHODS This was a retrospective analysis of TKA procedures with two sequential generations of the same handheld robotic-assisted surgical system. Intra-operative data captured included pre-operative limb deformity, limb axes, range of motion, kinematic balance, and the resulting plan for component placement in three-dimensional space. Patients were stratified based on their preoperative coronal lower limb mechanical alignment (> 3° varus, < 3° varus, < 3° valgus, and ≥ 3° valgus). Measurements of component placement (overall lower limb alignment, medial and lateral flexion gaps, and tibial and femoral resection depths) were assessed using descriptive statistics. RESULTS A total of 435 patients were included and stratified based on preoperative lower limb alignment: 229 with ≥ 3° varus, 78 with varus < 3° and 58 with valgus < 3°, and 70 with valgus > 3°. The mean difference between planned and achieved alignment in the lower limb valgus patients was < 1° across all groups. Mean differences between planned and achieved medial flexion gap was higher in the > 3° subgroup in the varus patient cohort ([< 3°]: 1.15 ± 1.92 vs. [> 3°]: 1.90 ± 2.57); this value was higher in the < 3° subgroup for valgus patients ([< 3°]: 1.34 ± 1.83 vs. [> 3°]: 0.956 ± 1.65). Average resection depth ranged from 9.46 to 10.4 mm in the posterior medial femur, 9.25 to 9.95 mm in the posterior lateral femur, 7.45 to 8.79 mm in the distal medial femur, 8.22 to 9.18 mm in the distal lateral femur, 6.70 to 7.07 mm in the medial tibial condyle and 6.40 to 7.19 mm in the lateral tibial condyle. Non-inferiority testing demonstrated the newer generation is non-inferior to the older generation. CONCLUSION Robotic-assisted knee replacement using handheld image-free systems is able to maintain accuracy of component placement. Further investigation of patient reported outcomes as well as long-term implant longevity are needed.
Collapse
Affiliation(s)
- Chelsea S Sicat
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
| | - James C Chow
- Orthopedic Institute of the West, Phoenix, AZ, USA
| | - Bertrand Kaper
- Orthopedic Specialists of Scottsdale, Scottsdale, AZ, USA
| | | | - Jing Xie
- Smith & Nephew, Memphis, TN, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| |
Collapse
|
|
19
|
Bell C, Grau L, Orozco F, Ponzio D, Post Z, Czymek M, Ong A. The successful implementation of the Navio robotic technology required 29 cases. J Robot Surg 2021; 16:495-499. [PMID: 34146231 DOI: 10.1007/s11701-021-01254-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
Robotic-assisted total knee arthroplasty (RA-TKA) has potential benefits of improved restoration of mechanical alignment, accuracy of bony resection, and balancing. The purpose of this study was to determine the number of cases necessary for a single surgeon to achieve a constant, steady-state surgical time. The secondary purpose was to identify which steps demonstrated the most time reduced. This was a prospective study assessing intraoperative time for 60 RA-TKA with the Navio surgical system. Overall arthroplasty time and duration for each step were recorded. Statistical analysis included a nonlinear regression and survival regression. Successful implementation required 29 cases to achieve a steady-state. The average time decreased from 41.8 min for the first cohort to 31.1 min for the last cohort, a 26% decrease. The step with the greatest reduction was the "Review of Intraoperative Plan" with a reduction of 2.1 min. This study demonstrates surgical times averaging below 60 min and a learning curve that is complete in 29 cases with the surgeon reporting a high level of confidence with the system at 10 cases. Though Navio assisted TKA showed a significantly slower operative time, we are hopeful that future generations of robotic technology will be more efficiently implemented by surgeons.
Collapse
Affiliation(s)
- Courtney Bell
- Rothman Orthopaedic Institute, 2500 English Creek Ave., Building 1300, Egg Harbor Township, NJ, 08234, USA
| | - Luis Grau
- Riverside Medical Group, 201 Route 17, Suite 1202, Rutherford, NJ, 07070, USA
| | - Fabio Orozco
- Orozco Orthopedics, 1999 New Road, Suite B, Linwood, NJ, 08221, USA
| | - Danielle Ponzio
- Rothman Orthopaedic Institute, 2500 English Creek Ave., Building 1300, Egg Harbor Township, NJ, 08234, USA
| | - Zachary Post
- Rothman Orthopaedic Institute, 2500 English Creek Ave., Building 1300, Egg Harbor Township, NJ, 08234, USA
| | - Miranda Czymek
- Rothman Orthopaedic Institute, 2500 English Creek Ave., Building 1300, Egg Harbor Township, NJ, 08234, USA.
| | - Alvin Ong
- Rothman Orthopaedic Institute, 2500 English Creek Ave., Building 1300, Egg Harbor Township, NJ, 08234, USA
| |
Collapse
|
|
20
|
Deckey DG, Rosenow CS, Verhey JT, Brinkman JC, Mayfield CK, Clarke HD, Bingham JS. Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques. Bone Joint J 2021; 103-B:74-80. [PMID: 34053292 DOI: 10.1302/0301-620x.103b6.bjj-2020-2003.r1] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Robotic-assisted total knee arthroplasty (RA-TKA) is theoretically more accurate for component positioning than TKA performed with mechanical instruments (M-TKA). Furthermore, the ability to incorporate soft-tissue laxity data into the plan prior to bone resection should reduce variability between the planned polyethylene thickness and the final implanted polyethylene. The purpose of this study was to compare accuracy to plan for component positioning and precision, as demonstrated by deviation from plan for polyethylene insert thickness in measured-resection RA-TKA versus M-TKA. METHODS A total of 220 consecutive primary TKAs between May 2016 and November 2018, performed by a single surgeon, were reviewed. Planned coronal plane component alignment and overall limb alignment were all 0° to the mechanical axis; tibial posterior slope was 2°; and polyethylene thickness was 9 mm. For RA-TKA, individual component position was adjusted to assist gap-balancing but planned coronal plane alignment for the femoral and tibial components and overall limb alignment remained 0 ± 3°; planned tibial posterior slope was 1.5°. Mean deviations from plan for each parameter were compared between groups for positioning and size and outliers were assessed. RESULTS In all, 103 M-TKAs and 96 RA-TKAs were included. In RA-TKA versus M-TKA, respectively: mean femoral positioning (0.9° (SD 1.2°) vs 1.7° (SD 1.1°)), mean tibial positioning (0.3° (SD 0.9°) vs 1.3° (SD 1.0°)), mean posterior tibial slope (-0.3° (SD 1.3°) vs 1.7° (SD 1.1°)), and mean mechanical axis limb alignment (1.0° (SD 1.7°) vs 2.7° (SD 1.9°)) all deviated significantly less from the plan (all p < 0.001); significantly fewer knees required a distal femoral recut (10 (10%) vs 22 (22%), p = 0.033); and deviation from planned polyethylene thickness was significantly less (1.4 mm (SD 1.6) vs 2.7 mm (SD 2.2), p < 0.001). CONCLUSION RA-TKA is significantly more accurate and precise in planning both component positioning and final polyethylene insert thickness. Future studies should investigate whether this increased accuracy and precision has an impact on clinical outcomes. The greater accuracy and reproducibility of RA-TKA may be important as precise new goals for component positioning are developed and can be further individualized to the patient. Cite this article: Bone Joint J 2021;103-B(6 Supple A):74-80.
Collapse
Affiliation(s)
- David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Jens T Verhey
- Alix School of Medicine, Mayo Medical School, Scottsdale, Arizona, USA
| | - Joseph C Brinkman
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Cory K Mayfield
- Department of Orthopedics, University of Southern California, Los Angeles, California, USA
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.,Alix School of Medicine, Mayo Medical School, Scottsdale, Arizona, USA
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.,Alix School of Medicine, Mayo Medical School, Scottsdale, Arizona, USA
| |
Collapse
|
|
21
|
Shah R, Diaz A, Phieffer L, Quatman C, Glassman A, Hyer JM, Tsilimigras D, Pawlik TM. Robotic total knee arthroplasty: A missed opportunity for cost savings in Bundled Payment for Care Improvement initiatives? Surgery 2021; 170:134-139. [PMID: 33608146 DOI: 10.1016/j.surg.2020.12.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of robotic total knee arthroplasty has become increasingly prevalent. Proponents of robotic total knee arthroplasty tout its potential to not only improve outcomes, but also to reduce costs compared with traditional total knee arthroplasty. Despite its potential to deliver on the value proposition, whether robotic total knee arthroplasty has led to improved outcomes and cost savings within Medicare's Bundled Payment for Care Improvement initiative remains unexplored. METHODS Medicare beneficiaries who underwent total knee arthroplasty designated under Medicare severity diagnosis related group 469 or 470 in the year 2017 were identified using the 100% Medicare Inpatient Standard Analytic Files. Hospitals participating in the Bundled Payment for Care Improvement were identified using the Bundled Payment for Care Improvement analytic file. We calculated risk-adjusted, price-standardized payments for the surgical episode from admission through 90-days postdischarge. Outcomes, utilization, and spending were assessed relative to variation between robotic and traditional total knee arthroplasty. RESULTS Overall, 198,371 patients underwent total knee arthroplasty (traditional total knee arthroplasty: n= 194,020, 97.8% versus robotic total knee arthroplasty: n = 4,351, 2.2%). Among the 3,272 hospitals that performed total knee arthroplasty, only 300 (9.3%) performed robotic total knee arthroplasty. Among the 183 participating in the Bundled Payment for Care Improvement, only 40 (19%) hospitals performed robotic total knee arthroplasty. Risk-adjusted 90-day episode spending was $14,263 (95% confidence interval $14,231-$14,294) among patients who underwent traditional total knee arthroplasty versus $13,676 (95% confidence interval $13,467-$13,885) among patients who had robotic total knee arthroplasty. Patients who underwent robotic total knee arthroplasty had a shorter length of stay (traditional total knee arthroplasty: 2.3 days, 95% confidence interval: 2.3-2.3 versus robotic total knee arthroplasty: 1.9 days, 95% confidence interval: 1.9-2.0), as well as a lower incidence of complications (traditional total knee arthroplasty: 3.3%, 95% confidence interval: 3.2-3.3 versus robotic total knee arthroplasty: 2.7%, 95% confidence interval: 2.3-3.1). Of note, patients who underwent robotic total knee arthroplasty were less often discharged to a postacute care facility than patients who underwent traditional total knee arthroplasty (traditional total knee arthroplasty: 32.4%, 95% confidence interval: 32.3-32.5 versus robotic total knee arthroplasty: 16.8%, 95% confidence interval 16.1-17.6). Both Bundled Payment for Care Improvement and non-Bundled Payment for Care Improvement hospitals with greater than 50% robotic total knee arthroplasty utilization had lower spending per episode of care versus spending at hospitals with less than 50% robotic total knee arthroplasty utilization. CONCLUSION Overall 90-day episode spending for robotic total knee arthroplasty was lower than traditional total knee arthroplasty (Δ $-587, 95% confidence interval: $-798 to $-375). The decrease in spending was attributable to shorter length of stay, fewer complications, as well as lower utilization of postacute care facility. The cost savings associated with robotic total knee arthroplasty was only realized when robotic total knee arthroplasty volume surpassed 50% of all total knee arthroplasty volume. Hospitals participating in the Bundled Payment for Care Improvement may experience cost-saving with increased utilization of robotic total knee arthroplasty.
Collapse
Affiliation(s)
- Rohan Shah
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Adrian Diaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
| | - Laura Phieffer
- Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carmen Quatman
- Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Andrew Glassman
- Department of Orthopedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. https://twitter.com/timpawlik
| |
Collapse
|
|
22
|
Thilak J, Babu BC, Thadi M, Mohan V, Arun Kumar T, Mane PP, Ravindran GC. Accuracy in the Execution of Pre-operative Plan for Limb Alignment and Implant Positioning in Robotic-arm Assisted Total Knee Arthroplasty and Manual Total Knee Arthroplasty: A Prospective Observational Study. Indian J Orthop 2021; 55:953-960. [PMID: 34194653 PMCID: PMC8192671 DOI: 10.1007/s43465-020-00324-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/28/2020] [Indexed: 02/04/2023]
Abstract
AIM The objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan. PATIENTS AND METHODS This was a prospective observational study conducted in a tertiary care centre between August 2018 and January 2020. 143 consecutive RATKA(105 patients) and 151 consecutive MTKA(111 patients) performed by two experienced arthroplasty surgeons were included. Two independent observers evaluated the accuracy of implant positioning by measuring the radiological parameters according to the Knee-Society-Roentgenographic-Evaluation-System and limb alignment from postoperative weight-bearing scanogram. Outcomes were defined, based on the degree of deviation of measurements from the planned position and alignment, as excellent(0-1.99°), acceptable(2.00-2.99°) and outlier(≥ 3.00°). RESULTS There were no systematic differences in the demographic and baseline characteristics between RATKA and MTKA. Statistically significant outcomes were observed favouring robotic group for postoperative mechanical axis (p < .001), coronal inclination of the femoral component (p < 0.001), coronal inclination of tibial component (p < 0.001), and sagittal inclination of tibial component (p < 0.001). There was no significant difference in the sagittal inclination of the femoral component (p = 0.566). The percentage of knees in the 'excellent' group were higher in RATKA compared to MTKA. There was absolutely no outlier in terms of limb alignment in the RATKA group versus 23.8% (p < 0.001) in the MTKA group. All the measurements showed high interobserver and intraobserver reliability. CONCLUSION Robotic-arm assisted TKA executed the preoperative plan more accurately with respect to limb alignment and implant positioning compared to manual TKA, even when the surgeons were more experienced in the latter. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-020-00324-y.
Collapse
Affiliation(s)
- Jai Thilak
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Balu C. Babu
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Mohan Thadi
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Vipin Mohan
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - T. Arun Kumar
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Prajwal P. Mane
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Greeshma C. Ravindran
- grid.411370.00000 0000 9081 2061Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala India
| |
Collapse
|
|
23
|
Agarwal N, To K, McDonnell S, Khan W. Clinical and Radiological Outcomes in Robotic-Assisted Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2020; 35:3393-3409.e2. [PMID: 32234326 DOI: 10.1016/j.arth.2020.03.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this systematic review is to determine if robotic-assisted total knee arthroplasty (RATKA) results in improved clinical and radiological outcomes, and to elucidate the breadth and depth of studies conducted on this topic. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted using 4 databases (MEDLINE, EMBASE, Cochrane, and Web of Science) to identify all clinical studies that investigate clinical or radiological outcomes using RATKA. The Critical Appraisal Skills Program checklist for cohort studies was employed for critical appraisal and evaluation of all 22 studies that met the inclusion criteria. RESULTS All studies reviewed determined that knee arthroplasty improved clinical outcomes. Twelve studies found statistically better clinical outcomes with RATKA compared with conventional TKA, whereas 9 studies found no difference. One study did not assess clinical outcomes. When assessing radiological outcomes, 14 studies reported that RATKA resulted in more consistent and accurate postoperative mechanical alignment, whereas 2 studies reported no difference. Six studies did not assess radiological outcomes. CONCLUSION Although knee arthroplasty is one of the most commonly performed orthopedic operations, the level of patient satisfaction varies. The meta-analyses conducted in our systematic review shows that RATKA results in greater improvements in postoperative Hospital for Special Surgery score and Western Ontario and McMaster Universities scores compared to conventional TKA. Furthermore, it shows that RATKA results in more accurate postoperative alignment of prostheses. These together can explain the improved postoperative outcomes. More randomized controlled trials must be conducted before this technique is integrated into routine clinical practice.
Collapse
Affiliation(s)
- Nikhil Agarwal
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom; University of Aberdeen College of Life Sciences and Medicine, Aberdeen, United Kingdom
| | - Kendrick To
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Stephen McDonnell
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Wasim Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
|
24
|
Onggo JR, Onggo JD, De Steiger R, Hau R. Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review. Arch Orthop Trauma Surg 2020; 140:1533-1549. [PMID: 32537660 DOI: 10.1007/s00402-020-03512-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a successful procedure in managing end-stage arthritis when non-operative treatments fail. New technologies such as robotic TKA (rTKA) have been developed to improve the accuracy of prosthesis implantation. While short-term cohort studies on rTKA have shown excellent results, the evidence comparing between rTKA and conventional TKA (cTKA) is not yet well established. This meta-analysis aims to compare the efficacy and safety of rTKA versus cTKA in terms of clinical outcomes, radiographic results, complications, peri-operative parameters and costs. METHODS A multi-database search was performed according to PRISMA guidelines. Data from studies comparing between rTKA and cTKA were extracted and analyzed. RESULTS Eighteen studies were included in this review, consisting of 2234 rTKA and 4300 cTKA. Robotic TKA led to a more precise prosthesis implantation with significantly fewer outliers in the mechanical axis (p < 0.001), femoral coronal (p = 0.002) and tibial sagittal (p = 0.01) alignments. Only the Hospital for Special Surgery (HSS) (p < 0.001) score at final follow-up was significantly better in rTKA than cTKA. rTKA also had a lower mean blood loss (p < 0.001) despite a longer mean operation time (p = 0.006). There were no statistically significant difference in terms of other clinical outcome measures, range of motion and complications. CONCLUSION Both rTKA and cTKA are reliable and safe to perform. However, rTKA is capable of achieving superior alignment in several axes, lower mean blood loss and this may lead to marginally better clinical outcomes than cTKA. EVIDENCE LEVEL Level II, Meta-analysis of non-homogeneous studies.
Collapse
Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.,Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Richard De Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.,Epworth Eastern Hospital, 1 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Melbourne, Vic, 3128, Australia.,Northern Clinical School, University of Melbourne, Epping, Melbourne, Vic, 3076, Australia
| |
Collapse
|
|
25
|
Abstract
Total knee arthroplasty (TKA) is a successful and cost-effective treatment for end-stage degenerative arthritis. The aging of society and an increase in the prevalence of obesity has led to increases in the prevalence of arthritis and the incidence of TKA. Currently, the total number of procedures in Korea per year has reached 90,000. With the rapid growth, we need to know about the current state of TKA. The purpose of this review is to summarize the recent literature regarding TKA. The main indication for TKA is end-stage arthritis with severe pain, reduced function, and no response to conservative management. Metal on the polyethylene-bearing surface and cobalt alloy are used in most TKAs. Despite good clinical outcomes and long-term survival rates after TKA in many papers, 20% of patients are dissatisfied with the outcome of surgery. To improve the patient’s satisfaction, surgeons should understand factors affecting patient’s satisfaction, including patient’s expectations, age, and preoperative mental state. Navigation-assisted surgery and robotic surgery have been introduced in knee arthroplasty to achieve more precise and accurate alignment. There is some evidence to suggest that computer-assisted surgery reduces revision rates. However, clinical efficacy is also controversial, and a long-term follow-up study is required. The common complications of TKA include infection, polyethylene wear, loosening, stiffness, periprosthetic fracture, and thromboembolism. An understanding of the potential complications and pitfalls of TKA is essential for prevention.
Collapse
|
|
26
|
Bagaria V, Sadigale OS, Pawar PP, Bashyal RK, Achalare A, Poduval M. Robotic-Assisted Knee Arthroplasty (RAKA): The Technique, the Technology and the Transition. Indian J Orthop 2020; 54:745-756. [PMID: 33133397 PMCID: PMC7572961 DOI: 10.1007/s43465-020-00088-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND There has been an exponential increase in knee arthroplasty over the past 20 years. This has led to a quest for improvement in outcomes and patient satisfaction. While the last decade of last century proved to be the decade for Computer-Assisted Surgery (CAS) or Computer Navigation wherein the technology demonstrated a clear benefit in terms of improving mechanical axis alignment and component positioning, this decade is likely to belong to Robotics. Robotics adds an independent dimension to the benefits that CAS offers. The article deals with the generation of robots, technical steps in robotics, advantages and downsides of robotics and way forward in the field of knee arthroplasty. MATERIALS AND METHODS The review article was designed and edited by six different authors reviewing 32 relevant pubmed-based articles related to robotics in arthroplasty and orthopaedics. The concept, design and the definition of the intellectual content were based on the internationally published literature and insightful articles. The review is also based on the clinical experimental studies published in the literature. DISCUSSION The robotic arm is actively involved with surgeon to achieve the precision and outcomes that the surgeon aims for. With the concept of haptic boundaries and augmented reality being incorporated in most systems, Robotic Assisted Arthroplasty (RAA) is likely to offer several advantages. The potential advantages of these systems may include accuracy in gap balancing, component positioning, minimal bone resection, reduced soft tissue handling and trauma, patient anatomy specific resection, and real time feedback. They, however, come with their own downsides in terms of capital cost, learning curve, time consumption and unclear advantages in term of long-term clinical outcomes. CONCLUSION To conclude, this review article offers a balanced view on how the technology is impacting current arthroplasty practice and what can be expected in coming years. The commitment of almost all major implant manufacturers in investing in robotics likely means that the evolution of Robotic technology and this decade will be exciting with rapid strides revealing paradigm shift and evolution of technology with significant reductions of cost enabling it to be available universally. For technology to populate in operating room, I think it will be result of exposure of young surgeons to these computers and robotics, as they grow in with confidence with technology from residency days to offer better precision in future.
Collapse
Affiliation(s)
- Vaibhav Bagaria
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai India
| | - Omkar S. Sadigale
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai India
| | - Prashant P. Pawar
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai India
| | - Ravi K. Bashyal
- grid.170205.10000 0004 1936 7822NorthShore University Health System, Orthopaedic Surgery, University of Chicago, Chicago, IL USA
| | - Ajinkya Achalare
- Department of Orthopaedics, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai India
| | - Murali Poduval
- grid.452790.d0000 0001 2167 8812Engineering and Industrial Services, Tata Consultancy Services, Mumbai, India
| |
Collapse
|
|
27
|
Kim YH, Yoon SH, Park JW. Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial. Clin Orthop Relat Res 2020; 478:266-275. [PMID: 31389889 PMCID: PMC7438149 DOI: 10.1097/corr.0000000000000916] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/09/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Robotic-assisted TKA was introduced to enhance the precision of bone preparation and component alignment with the goal of improving the clinical results and survivorship of TKA. Although numerous reports suggest that bone preparation and knee component alignment may be improved using robotic assistance, no long-term randomized trials of robotic-assisted TKA have shown whether this results in improved clinical function or survivorship of the TKA. QUESTIONS/PURPOSES In this randomized trial, we compared robotic-assisted TKA to manual-alignment techniques at long-term follow-up in terms of (1) functional results based on Knee Society, WOMAC, and UCLA Activity scores; (2) numerous radiographic parameters, including component and limb alignment; (3) Kaplan-Meier survivorship; and (4) complications specific to robotic-assistance, including pin-tract infection, peroneal nerve palsy, pin-site fracture, or patellar complications. METHODS This study was a registered prospective, randomized, controlled trial. From January 2002 to February 2008, one surgeon performed 975 robotic-assisted TKAs in 850 patients and 990 conventional TKAs in 849 patients. Among these patients 1406 patients were eligible for participation in this study based on prespecified inclusion criteria. Of those, 100% (1406) patients agreed to participate and were randomized, with 700 patients (750 knees) receiving robotic-assisted TKA and 706 patients (766 knees) receiving conventional TKA. Of those, 96% (674 patients) in the robotic-assisted TKA group and 95% (674 patients) in the conventional TKA group were available for follow-up at a mean of 13 (± 5) years. In both groups, no patient older than 65 years was randomized because we anticipated long-term follow-up. We evaluated 674 patients (724 knees) in each group for clinical and radiographic outcomes, and we examined Kaplan-Meier survivorship for the endpoint of aseptic loosening or revision. Clinical evaluation was performed using the original Knee Society knee score, the WOMAC score, and the UCLA activity score preoperatively and at latest follow-up visit. We also assessed loosening (defined as change in the position of the components) using plain radiographs, osteolysis using CT scans at the latest follow-up visit, and component, and limb alignment on mechanical axis radiographs. To minimize the chance of type-2 error and increase the power of our study, we assumed the difference in the Knee Society score to be 25 points to match the MCID of the Knee Society score with a SD of 5; to be able to detect a difference of this size, we calculated that a total of 628 patients would be needed in each group in order to achieve 80% power at the α = 0.05 level. RESULTS Clinical parameters at the latest follow-up including the Knee Society knee scores (93 ± 5 points in the robotic-assisted TKA group versus 92 ± 6 points in the conventional TKA group [95% confidence interval 90 to 98]; p = 0.321) and Knee Society knee function scores (83 ± 7 points in the robotic-assisted TKA group versus 85 ± 6 points in the conventional TKA group [95% CI 75 to 88]; p = 0.992), WOMAC scores (18 ± 14 points in the robotic-assisted TKA group versus 19 ± 15 points in the conventional TKA group [95% CI 16 to 22]; p = 0.981), range of knee motion (125 ± 6° in the robotic-assisted TKA group versus 128 ± 7° in the conventional TKA group [95% CI 121 to 135]; p = 0.321), and UCLA patient activity scores (7 points versus 7 points in each group [95% CI 5 to 10]; p = 1.000) were not different between the two groups at a mean of 13 years' follow-up. Radiographic parameters such as the femorotibial angle (mean 2° ± 2° valgus in the robotic-assisted TKA group versus 3° ± 3° valgus in the conventional TKA group [95% CI 1 to 5]; p = 0.897), femoral component position (coronal plane: mean 98° in the robotic-assisted TKA group versus 97° in the conventional TKA group [95% CI 96 to 99]; p = 0.953; sagittal plane: mean 3° in the robotic-assisted TKA group versus 2° in the conventional TKA group [95% CI 1 to 4]; p = 0.612) and tibial component position (coronal plane: mean 90° in the robotic-assisted TKA group versus 89° in the conventional TKA group [95% CI 87 to 92]; p = 0.721; sagittal plane: 87° in the robotic-assisted TKA group versus 86° in the conventional TKA group [95% CI 84 to 89]; p = 0.792), joint line (16 mm in the robotic-assisted TKA group versus 16 mm in the conventional TKA group [95% CI 14 to 18]; p = 0.512), and posterior femoral condylar offset (24 mm in the robotic-assisted TKA group versus 24 mm in the conventional TKA group [95% CI 21 to 27 ]; p = 0.817) also were not different between the two groups (p > 0.05). The aseptic loosening rate was 2% in each group, and this was not different between the two groups. With the endpoint of revision or aseptic loosening of the components, Kaplan-Meier survivorship of the TKA components was 98% in both groups (95% CI 94 to 100) at 15 years (p = 0.972). There were no between-group differences in terms of the frequency with which complications occurred. In all, 0.6% of knees (four) in each group had a superficial infection, and they were treated with intravenous antibiotics for 2 weeks [corrected]. No deep infection occurred in these knees. In the conventional TKA group, 0.6% of knees (four) had motion limitation (< 60°) [corrected]. CONCLUSIONS At a minimum follow-up of 10 years, we found no differences between robotic-assisted TKA and conventional TKA in terms of functional outcome scores, aseptic loosening, overall survivorship, and complications. Considering the additional time and expense associated with robotic-assisted TKA, we cannot recommend its widespread use. LEVEL OF EVIDENCE Level I, therapeutic study.
Collapse
Affiliation(s)
- Young-Hoo Kim
- Y.-H. Kim, The Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Sung-Hwan Yoon
- S.-H. Yoon, The Joint Replacement Center, Lee Chun Teck Hospital, Suwon, Seoul, Republic of Korea
| | - Jang-Won Park
- J.-W. Park, The Joint Replacement Center, Ewha Womans University Ewha Seoul Hospital, Seoul, Republic of Korea
| |
Collapse
|
|
28
|
Jeon SW, Kim KI, Song SJ. Robot-Assisted Total Knee Arthroplasty Does Not Improve Long-Term Clinical and Radiologic Outcomes. J Arthroplasty 2019; 34:1656-1661. [PMID: 31036450 DOI: 10.1016/j.arth.2019.04.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Whether robot-assisted total knee arthroplasty (TKA) improves the accuracy of radiographic alignment leading to improved patient satisfaction and implant survivorship in the long term has thus far been inconclusive. METHODS We retrospectively compared the long-term clinical and radiological outcomes of 84 knees that had undergone robot-assisted TKA using ROBODOC vs 79 knees that had undergone conventional TKA. The mean duration of the follow-up period was 129.1 months (range: 108-147 months). Clinical outcomes were evaluated using the Knee Society Score and 36-item Short Form Survey, as well as by assessing the range of motion, operation time, and complications. Radiologic outcomes were evaluated by assessing the hip-knee-ankle angle, coronal and sagittal alignments of the femoral and tibial components, and any radiologic abnormalities such as loosening or osteolysis. RESULTS There was no significant difference in clinical outcomes between the two groups. The prevalence of an outlier for the hip-knee-ankle angle in the robot-assisted group was 10.7%, whereas it was 16.5% in the conventional group (P = .172). The other component alignments (α°, β°, γ°, δ°) revealed a tendency toward a lower rate of outliers in the robot-assisted group, but without statistical significance (P > .05). In addition, there was no significant difference in complications, including revision surgery, between both groups. CONCLUSION Robot-assisted TKA does not improve long-term clinical or radiologic outcomes compared with conventional TKA.
Collapse
Affiliation(s)
- Sang-Woo Jeon
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
|
29
|
Ren Y, Cao S, Wu J, Weng X, Feng B. Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J 2019; 95:125-133. [PMID: 30808721 PMCID: PMC6585281 DOI: 10.1136/postgradmedj-2018-136190] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/08/2023]
Abstract
Background In the field of prosthetics, the ultimate goal is to improve the clinical outcome by using a technique that prolongs the longevity of prosthesis. Active robotic-assisted total knee arthroplasty (TKA) is one such technique that is capable of providing accurate implant position and restoring mechanical alignment. Although relevant studies have been carried out, the differences in the efficacy and reliability between active robotic-assisted TKA and conventional arthroplasty have not yet been adequately discussed. Methods We referenced articles, including randomised controlled trials and comparative retrospective research, from PubMed, Embase, Cochrane Library and Web of Science, in order to compare active robotic-assisted TKA with the conventional technique. Data extraction and quality assessment were conducted for each study. Statistical analysis was performed using Revman V. 5.3. Results Seven studies with a total of 517 knees undergoing TKA were included. Compared with conventional surgery, active robotic TKA showed better outcomes in precise mechanical alignment (mean difference, MD: − 0.82, 95% CI: −1.15 to − 0.49, p < 0.05) and implant position, with lower outliers (p < 0.05), better functional score (Western Ontario and McMaster University, Knee Society Score functional score) and less drainage (MD: − 293.28, 95% CI: − 417.77 to − 168.79, p < 0.05). No significant differences were observed when comparing the operation time, range of motion and complication rates. Conclusion The current research demonstrates that active robotic-assisted TKA surgeries are more capable of improving mechanical alignment and prosthesis implantation when compared with conventional surgery. Further studies are required to investigate the potential benefits and long-term clinical outcomes of active robotic-assisted TKA.
Collapse
Affiliation(s)
- Yi Ren
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Shiliang Cao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Jinxuan Wu
- Molecular, Cellular and Developmental Biology Department, University of California, Santa Barbara, California, USA
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| |
Collapse
|
|
30
|
Battenberg AK, Netravali NA, Lonner JH. A novel handheld robotic-assisted system for unicompartmental knee arthroplasty: surgical technique and early survivorship. J Robot Surg 2019; 14:55-60. [PMID: 30762173 PMCID: PMC7000507 DOI: 10.1007/s11701-018-00907-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022]
Abstract
Technology, including robotics, has been developed for use in unicompartmental knee arthroplasty (UKA) to improve accuracy and precision of bone preparation, implant positioning, and soft tissue balance. The NAVIO™ System (Smith and Nephew, Pittsburgh, PA, United States) is a handheld robotic system that assists surgeons in planning implant positioning based on an individual patient’s anatomy and then preparing the bone surface to accurately achieve the plan. The surgical technique is presented herein. In addition, initial results are presented for 128 patients (mean age 64.7 years; 57.8% male) undergoing UKA with NAVIO. After a mean of follow-up period of 2.3 years, overall survivorship of the knee implant was 99.2% (95% confidence interval 94.6–99.9%). There was one revision encountered during the study, which was due to persistent soft tissue pain, without evidence of loosening, subsidence, malposition or infection. These initial results suggest a greater survivorship than achieved in the same follow-up time intervals in national registries and cohort studies, though further follow-up is needed to confirm whether this difference is maintained at longer durations.
Collapse
Affiliation(s)
- Andrew K Battenberg
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | - Jess H Lonner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| |
Collapse
|
|
31
|
Mont MA, Khlopas A, Chughtai M, Newman JM, Deren M, Sultan AA. Value proposition of robotic total knee arthroplasty: what can robotic technology deliver in 2018 and beyond? Expert Rev Med Devices 2018; 15:619-630. [DOI: 10.1080/17434440.2018.1515011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Michael A. Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Lenox-Hill Hospital, New York, NY, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jared M. Newman
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Mathew Deren
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
|
32
|
Lonner JH, Fillingham YA. Pros and Cons: A Balanced View of Robotics in Knee Arthroplasty. J Arthroplasty 2018; 33:2007-2013. [PMID: 29680583 DOI: 10.1016/j.arth.2018.03.056] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 02/01/2023] Open
Abstract
In both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), compared with conventional techniques robotic technology has been shown to optimize the precision of bone preparation and component alignment, reducing outliers and increasing the percentage of components aligned within 2° or 3° of the target goal. In addition, soft tissue balance can be quantified through a range of motion in UKA and TKA using the various robotic technologies available. Although the presumption has been that the improved alignment associated with robotics will improve function and implant durability, there are limited data to support that notion. Based on recent and emerging data, it may be unreasonable to presume that robotics is necessary for both UKA and TKA. In fact, despite improvements in various proxy measures, the precision of robotics may be more important for UKA than TKA, although if system costs and surgical efficiencies continue to improve, streamlining perioperative processes, reducing instrument inventory, and achieving comparable outcomes in TKA may be a reasonable goal of robotic surgery.
Collapse
Affiliation(s)
- Jess H Lonner
- Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Yale A Fillingham
- Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
|
33
|
Chen X, Xiong J, Wang P, Zhu S, Qi W, Peng H, Yu L, Qian W. Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis. Postgrad Med J 2018; 94:335-341. [PMID: 29776983 PMCID: PMC5992373 DOI: 10.1136/postgradmedj-2017-135352] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/21/2018] [Accepted: 04/15/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Robotic-assisted total hip arthroplasty (THA) allows for accurate preoperative planning and component positioning, potentially enhancing implant survival and long-term outcomes. The relative efficacy and safety of robotic-assisted and conventional THA, however, are unclear. This systematic review and meta-analysis compared the safety and efficacy of robotic-assisted and conventional THA. METHODS Medline, Embase and the Cochrane Library were comprehensively searched in September 2017 to identify studies comparing the safety and efficacy of robotic-assisted and conventional THA. Seven studies were included. Data of interest were extracted and analysed using Review Manager 5.3. RESULTS The seven included studies involved 1516 patients, with 522 undergoing robotic-assisted and 994 undergoing conventional THA. Compared with conventional THA, robotic-assisted THA was associated with longer surgical time (not significant); lower intraoperative complication rates (OR: 0.12, 95% CI: 0.05 to 0.34, p<0.0001 I2); better cup placement, stem placement and global offset and a higher rate of heterotopic ossifications. Functional scores, limb length discrepancy and rates of revision and stress shielding were similar in the two groups. The relative amount of blood loss was unclear. CONCLUSION The results of this meta-analysis suggest that robotic-assisted THA has certain advantages over conventional THA, including the results of component positioning and rates of intraoperative complications. Additional comparative studies are required to determine the long-term clinical outcomes of robotic-assisted THA.
Collapse
Affiliation(s)
- Xi Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianping Xiong
- Department of Liver Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Peipei Wang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China, Beijing, China
| | - Shibai Zhu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenting Qi
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Huiming Peng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lingjia Yu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenwei Qian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
|
34
|
Abstract
Recent advances and review of literature
Collapse
Affiliation(s)
| | - Joydeep Sinha
- King's College Hospital , London ; Joint CAG Leader, King's Health Partners, King's College London
| |
Collapse
|
|
35
|
Liow MHL, Goh GSH, Wong MK, Chin PL, Tay DKJ, Yeo SJ. 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; 25:2942-2951. [PMID: 27017214 DOI: 10.1007/s00167-016-4076-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/01/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Despite reduction in radiological outliers in previous randomized trials comparing robotic-assisted versus conventional total knee arthroplasty (TKA), no differences in short-term functional outcomes were observed. The aim of this study was to determine whether there was improvement in functional outcomes and quality-of-life (QoL) measures between robotic-assisted and conventional TKA. METHODS All 60 knees (31 robotic-assisted; 29 conventional) from a previous randomized trial were available for analysis. Differences in range of motion, Knee Society (KSS) knee and function scores, Oxford Knee scores (OKS), SF-36 subscale and summative (physical PCS/mental component scores MCS) were analysed. In addition, patient satisfaction, fulfilment of expectations and the proportion attaining a minimum clinically important difference (MCID) in KSS, OKS and SF-36 were studied. RESULTS Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years. Despite having a higher rate of complications, the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures, with significant differences in SF-36 vitality (p = 0.03), role emotional (p = 0.02) and a larger proportion of patients achieving SF-36 vitality MCID (48.4 vs 13.8 %, p = 0.009). No significant differences in KSS, OKS or satisfaction/expectation rates were noted. CONCLUSION Subtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA. This finding suggests that QoL measures may be more sensitive and clinically important than surgeon-driven objective scores in detecting subtle functional improvements in robotic-assisted TKA patients. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Graham Seow-Hng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Merng Koon Wong
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Pak Lin Chin
- The Orthopaedic Centre (Orchard), Mount Elizabeth Medical Centre, 3 Mount Elizabeth, #08-02, Singapore, 228510, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| |
Collapse
|
|
36
|
Yang HY, Seon JK, Shin YJ, Lim HA, Song EK. Robotic Total Knee Arthroplasty with a Cruciate-Retaining Implant: A 10-Year Follow-up Study. Clin Orthop Surg 2017; 9:169-176. [PMID: 28567218 PMCID: PMC5435654 DOI: 10.4055/cios.2017.9.2.169] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/28/2017] [Indexed: 11/26/2022] Open
Abstract
Background This study compared clinical and radiological results between robotic total knee arthroplasty (TKA) and conventional TKA with a cruciate-retaining implant at 10-year follow-up. The hypothesis was that robotic TKA would allow for more accurate leg alignment and component placement, and thus enhance clinical and radiological results and long-term survival rates. Methods A total of 113 primary TKAs performed using a cruciate-retaining implant in 102 patients from 2004 to 2007 were reviewed retrospectively. Of the 113 TKAs, 71 were robotic TKAs and 42 were conventional TKAs. Clinical outcomes (visual analogue scale pain score, Hospital for Special Surgery score, Western Ontario and McMaster University score, range of motion, and complications), radiological outcomes, and long-term survival rates were evaluated at a mean follow-up of 10 years. Results Clinical outcomes and long-term survival rates were similar between the two groups. Regarding the radiological outcomes, the robotic TKA group had significantly fewer postoperative leg alignment outliers (femoral coronal inclination, tibial coronal inclination, femoral sagittal inclination, tibial sagittal inclination, and mechanical axis) and fewer radiolucent lines than the conventional TKA group. Conclusions Both robotic and conventional TKAs resulted in good clinical outcomes and postoperative leg alignments. Robotic TKA appeared to reduce the incidence of leg alignment outliers and radiolucent lines compared to conventional TKA.
Collapse
Affiliation(s)
- Hong Yeol Yang
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Jong Keun Seon
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Young Joo Shin
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Hong An Lim
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Eun Kyoo Song
- Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Bitgoeul Hospital, Gwangju, Korea.,Chonnam National University Research Institute of Medical Science, Gwangju, Korea
| |
Collapse
|
|
37
|
Kim K, Kim D, Juh H, Khurana S, Rhyu K. Robot‐assisted total knee arthroplasty in haemophilic arthropathy. Haemophilia 2016; 22:446-52. [DOI: 10.1111/hae.12875] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Affiliation(s)
- K.‐I. Kim
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - D.‐K. Kim
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - H.‐S. Juh
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - S. Khurana
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| | - K.‐H. Rhyu
- Department of Orthopaedic Surgery Center for Joint Diseases and Rheumatism Kyung Hee University Hospital at Gangdong Seoul Korea
| |
Collapse
|
|
38
|
Liow MHL, Chin PL, Tay KJD, Chia SL, Lo NN, Yeo SJ. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch™ ROBODOC® surgical system. Singapore Med J 2016; 55:529-34. [PMID: 25631894 DOI: 10.11622/smedj.2014136] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The use of robotics in total knee arthroplasty (TKA) has been shown to minimise human error, as well as improve the accuracy and precision of component implantation and mechanical axis alignment. The present study aimed to demonstrate that robot-assisted TKA using ROBODOC® is safe and capable of producing a consistent and accurate postoperative mechanical axis. METHODS We prospectively recruited 27 consecutive patients who underwent robot-assisted TKA between May and December 2012. Two patients were excluded from the study due to intraoperative technical problems with the robot. Long-leg radiography and computed tomography were performed prior to surgery, and used for mechanical axis measurements and component sizing. DigiMatch™ ROBODOC® Surgical System software version 4.3.6 (Curexo Technology Corp, Fremont, CA, USA) was used in all cases to perform bone cuts in accordance with the preoperative plan. RESULTS The postoperative coronal mechanical alignment was within 3 degrees, with a mean alignment of -0.4 ± 1.7 degrees, confirming the accuracy of the preoperative surgical plan and bone cuts. The mean operating time was 96 ± 15 min, and preoperative planning yielded 100% implant sizing accuracy. CONCLUSION Robotics has the potential to enable surgeons to consistently attain ideal postoperative alignment. The use of bone movement monitors and an integrated navigation system enhances the safety profile of ROBODOC® by minimising errors. However, the role of the surgeon in TKA is still vital, as the surgeon is ultimately in charge of planning the surgery, its execution and ensuring soft tissue balance during TKA.
Collapse
Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore 169865.
| | | | | | | | | | | |
Collapse
|
|
39
|
Paschos NK. Recent advances and future directions in the management of knee osteoarthritis: Can biological joint reconstruction replace joint arthroplasty and when? World J Orthop 2015; 6:655-659. [PMID: 26495242 PMCID: PMC4610907 DOI: 10.5312/wjo.v6.i9.655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/12/2015] [Accepted: 08/21/2015] [Indexed: 02/06/2023] Open
Abstract
In this article, a concise description of the recent advances in the field of osteoarthritis management is presented. The main focus is to highlight the most promising techniques that emerge in both biological joint replacement and artificial joint arthroplasty. A critical view of high quality evidence regarding outcome and safety profile of these techniques is presented. The potential role of kinematically aligned total knee replacement, navigation, and robotic-assisted surgery is outlined. A critical description of both primary and stem cell-based therapies, the cell homing theory, the use of biologic factors and recent advancements in tissue engineering and regenerative medicine is provided. Based on the current evidence, some thoughts on a realistic approach towards answering these questions are attempted.
Collapse
|
|
40
|
Preoperative Mapping in Unicompartmental Knee Arthroplasty Using Computed Tomography Scans Is Associated with Radiation Exposure and Carries High Cost. J Arthroplasty 2015; 30:964-7. [PMID: 25840872 DOI: 10.1016/j.arth.2014.10.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/08/2014] [Accepted: 10/11/2014] [Indexed: 02/01/2023] Open
Abstract
Robotic-assisted knee arthroplasty with some systems requires the use of computed tomography (CT) scans. The associated radiation dose has not been studied. The effective dose (ED, mSv) of radiation was calculated for 236 preoperative CT scans used for planning of robotic assisted surgery. The mean ED was 4.8±3.0 mSv. There was a 3-fold difference in ED between institutions. One or more additional CT scans were obtained in 25% of patients, amounting to a cumulative ED per patient up to 103 mSv. Preoperative CT is a disadvantage of some robotic-assisted knee arthroplasty systems due to additional cost and radiation exposure. Newer image-free robotic technologies are an alternative to CT-dependent surgery if accuracy and safety are not compromised.
Collapse
|
|
41
|
Karthik K, Colegate-Stone T, Dasgupta P, Tavakkolizadeh A, Sinha J. Robotic surgery in trauma and orthopaedics: a systematic review. Bone Joint J 2015; 97-B:292-9. [PMID: 25737510 DOI: 10.1302/0301-620x.97b3.35107] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.
Collapse
Affiliation(s)
- K Karthik
- King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | | | - P Dasgupta
- Guy's Hospital, Great Maze Pond London SE1 9RT, UK
| | | | - J Sinha
- King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| |
Collapse
|
|
42
|
Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 2014; 29:2373-7. [PMID: 24439796 DOI: 10.1016/j.arth.2013.12.010] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/07/2013] [Accepted: 12/09/2013] [Indexed: 02/01/2023] Open
Abstract
Robot-assisted Total Knee Arthroplasty (TKA) improves the accuracy and precision of component implantation and mechanical axis (MA) alignment. Joint-line restoration in robot-assisted TKA is not widely described and joint-line deviation of>5mm results in mid-flexion instability and poor outcomes. We prospectively randomised 60 patients into two groups: 31 patients (robot-assisted), 29 patients (conventional). No MA outliers (>±3° from neutral) or notching was noted in the robot-assisted group as compared with 19.4% (P=0.049) and 10.3% (P=0.238) respectively in the conventional group. The robot-assisted group had 3.23% joint-line outliers (>5mm) as compared to 20.6% in the conventional group (P=0.049). Robot-assisted TKA produces similar short-term clinical outcomes when compared to conventional methods with reduction of MA alignment and joint-line deviation outliers.
Collapse
|
|
43
|
Thienpont E, Fennema P, Price A. Can technology improve alignment during knee arthroplasty. Knee 2013; 20 Suppl 1:S21-8. [PMID: 24034591 DOI: 10.1016/s0968-0160(13)70005-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 02/02/2023]
Abstract
Component malalignment remains a concern in total knee arthroplasty (TKA); therefore, a series of technologies have been developed to improve alignment. The authors conducted a systematic review to compare computer-assisted navigation with conventional instrumentation, and assess the current evidence for patient-matched instrumentation and robot-assisted implantation. An extensive search of the PubMed database for relevant meta-analyses, systematic reviews and original articles was performed, with each study scrutinised by two reviewers. Data on study characteristics and outcomes were extracted from each study and compared. In total 30 studies were included: 10 meta-analyses comparing computer-assisted navigation and conventional instrumentation, 13 studies examining patient-matched instrumentation, and seven investigating robot-assisted implantation. Computer-assisted navigation showed significant and reproducible improvements in mechanical alignment over conventional instrumentation. Patient-matched instrumentation appeared to achieve a high degree of mechanical alignment, although the majority of studies were of poor quality. The data for robot-assisted surgery was less indicative. Computer-assisted navigation improves alignment during TKA over conventional instrumentation. For patient-matched instrumentation and robot-assisted implantation, alignment benefits have not been reliably demonstrated. For all three technologies, clinical benefits cannot currently be assumed, and further studies are required. Although current technologies to improve alignment during TKA appear to result in intra-operative benefits, their clinical impact remains unclear, and surgeons should take this into account when considering their adoption.
Collapse
|
|
44
|
Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 2013; 471:118-26. [PMID: 22669549 PMCID: PMC3528918 DOI: 10.1007/s11999-012-2407-3] [Citation(s) in RCA: 267] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several studies have shown mechanical alignment influences the outcome of TKA. Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment. QUESTIONS/PURPOSES We determined whether robotic-assisted implantation for TKA (1) improved clinical outcome; (2) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes; (3) improved the balance (flexion and extension gaps); and (4) reduced complications, postoperative drainage, and operative time when compared to conventionally implanted TKA over an intermediate-term (minimum 3-year) followup period. METHODS We prospectively randomized 100 patients who underwent unilateral TKA into one of two groups: 50 using a robotic-assisted procedure and 50 using conventional manual techniques. Outcome variables considered were postoperative ROM, WOMAC scores, Hospital for Special Surgery (HSS) knee scores, mechanical axis alignment, flexion/extension gap balance, complications, postoperative drainage, and operative time. Minimum followup was 41 months (mean, 65 months; range, 41-81 months). RESULTS There were no differences in postoperative ROM, WOMAC scores, and HSS knee scores. The robotic-assisted group resulted in no mechanical axis outliers (> ± 3° from neutral) compared to 24% in the conventional group. There were fewer robotic-assisted knees where the flexion gap exceeded the extension gap by 2 mm. The robotic-assisted procedures took an average of 25 minutes longer than the conventional procedures but had less postoperative blood drainage. There were no differences in complications between groups. CONCLUSIONS Robotic-assisted TKA appears to reduce the number of mechanical axis alignment outliers and improve the ability to achieve flexion-extension gap balance, without any differences in clinical scores or complications when compared to conventional manual techniques.
Collapse
Affiliation(s)
- Eun-Kyoo Song
- />Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam, Korea
| | - Jong-Keun Seon
- />Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam, Korea
| | - Ji-Hyeon Yim
- />Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam, Korea
| | | | - William L. Bargar
- />Department of Orthopaedics, University of California at Davis School of Medicine, Sutter General Hospital, 1020 29th Street, #450, Sacramento, CA 95816 USA
| |
Collapse
|
|
45
|
Kim SM, Park YS, Ha CW, Lim SJ, Moon YW. Robot-assisted implantation improves the precision of component position in minimally invasive TKA. Orthopedics 2012; 35:e1334-9. [PMID: 22955398 DOI: 10.3928/01477447-20120822-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Minimally invasive and robot-assisted procedures have potential advantages when used for total knee arthroplasty (TKA). The purpose of this cadaveric study was to examine whether robot-assisted minimally invasive procedures improve TKA alignment after modifying the robotic techniques and instruments. Total knee arthroplasties were performed on 10 pairs of fresh cadaveric femora. Ten knees were replaced using the robot-assisted minimally invasive technique and 10 using the conventional minimally invasive technique. After prosthesis implantation, limb and prosthesis alignments were investigated by measuring mechanical axis deviation, femoral and tibial sagittal and coronal inclination, and femoral rotational alignment with 3-dimensional computed tomography scans. Postoperative alignment accuracy of the implanted prostheses was better in the robot-assisted minimally invasive TKA group than in the conventional minimally invasive TKA group as judged by the rotational alignment of the femoral component (0.7°±″.3° vs 3.6°±2.2°, respectively) and the tibial component sagittal angle (7.8°±1.1° vs 5.5°±3.6°, respectively). One sagittal inclination outlier for the tibial side existed in the robotic minimally invasive TKA group, and 2 outliers for the mechanical axis, 2 for the tibial side sagittal inclination, and 2 for the femoral rotational alignment existed in the conventional minimally invasive TKA group. Higher implanted prostheses accuracy and fewer outliers in postoperative radiographic alignments can be attained with robot-assisted TKA. Minimally invasive TKA in combination with an improved robot-assisted technique is an alternative option to compensate for the shortcomings of conventional minimally invasive TKA.
Collapse
Affiliation(s)
- Sang-Min Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Changwon, Korea
| | | | | | | | | |
Collapse
|
|
46
|
Moon YW, Ha CW, Do KH, Kim CY, Han JH, Na SE, Lee CH, Kim JG, Park YS. Comparison of robot-assisted and conventional total knee arthroplasty: a controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. ACTA ACUST UNITED AC 2012; 17:86-95. [PMID: 22348661 DOI: 10.3109/10929088.2012.654408] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A functional total knee replacement has to be well aligned, which implies that it should lie along the mechanical axis and in the correct axial and rotational planes. Incorrect alignment will lead to abnormal wear, early mechanical loosening, and patellofemoral problems. There has been increased interest of late in total knee arthroplasty with robotic assistance. This study was conducted to determine whether robot-assisted total knee arthroplasty is superior to the conventional surgical method with regard to the precision of implant positioning. MATERIALS AND METHODS Twenty knee replacements, comprising ten robot-assisted procedures and ten conventional operations, were performed on ten cadavers. Two experienced surgeons performed the surgeries. Both procedures on each cadaver were performed by the same surgeon. The choice of which procedure was to be performed first was randomized. Following implantation of the prosthesis, the mechanical axis deviation, femoral coronal angle, tibial coronal angle, femoral sagittal angle, tibial sagittal angle, and femoral rotational alignment were measured via 3D CT scanning. These variables were then compared with the preoperatively planned values. RESULTS In the knees that underwent robot-assisted surgery, the mechanical axis deviation ranged from -1.94° to 2.13° (mean: -0.21°), the femoral coronal angle from 88.08° to 90.99° (mean: 89.81°), the tibial coronal angle from 89.01° to 92.36° (mean: 90.42°), the tibial sagittal angle from 81.72° to 86.24° (mean: 83.20°), and the femoral rotational alignment from 0.02° to 1.15° (mean: 0.52°) in relation to the transepicondylar axis. In the knees that underwent conventional surgery, the mechanical axis deviation ranged from -3.19° to 3.84° (mean: -0.48°), the femoral coronal angle from 88.36° to 92.29° (mean: 90.50°), the tibial coronal angle from 88.15° to 91.51° (mean: 89.83°), the tibial sagittal angle from 80.06° to 87.34° (mean: 84.50°), and the femoral rotational alignment from 0.32° to 4.13° (mean: 2.76°) in relation to the transepicondylar axis. In the conventional knee replacement group, there were two instances of outliers outside the range of 3° varus/valgus for the mechanical axis deviation. The robot-assisted knee replacements showed significantly superior femoral rotational alignment results compared with conventional surgery (p = 0.006). There was no statistically significant difference between robot-assisted and conventional total knee arthroplasty with regard to the other variables. All the measurements showed high intra-observer and inter-observer reliability. CONCLUSION Robot-assisted total knee arthroplasty showed excellent precision in the sagittal and coronal planes of the 3D CT scan. In particular, the robot-assisted technique showed better accuracy in femoral rotational alignment compared to the conventional surgery, despite the fact that the surgeons who performed the operations were more experienced and familiar with the conventional method than with robot-assisted surgery. It can thus be concluded that robot-assisted total knee arthroplasty is superior to conventional total knee arthroplasty.
Collapse
Affiliation(s)
- Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
|
47
|
Song EK, Seon JK, Park SJ, Jung WB, Park HW, Lee GW. Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2011; 19:1069-76. [PMID: 21311869 DOI: 10.1007/s00167-011-1400-9] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 01/13/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE The authors performed this study to compare the outcomes of robotic-assisted and conventional TKA in same patient simultaneously. It was hypothesized that the robotic-assisted procedure would produce better leg alignment and component orientation, and thus, improve patient satisfaction and clinical and radiological outcomes. METHODS Thirty patients underwent bilateral sequential total knee replacement. One knee was replaced by robotic-assisted implantation and the other by conventional implantation. RESULTS Radiographic results showed significantly more postoperative leg alignment outliers of conventional sides than robotic-assisted sides (mechanical axis, coronal inclination of the femoral prosthesis, and sagittal inclination of the tibial prosthesis). Robotic-assisted sides had non-significantly better postoperative knee scores and ROMs. Robotic-assisted sides needed longer operation times (25 min, SD ± 18) and longer skin incisions. Nevertheless, postoperative bleeding was significantly less for robotic-assisted sides. CONCLUSION The better alignment accuracy of robotic TKA and the good clinical results achieved may favorably influence clinical and radiological outcomes.
Collapse
Affiliation(s)
- Eun-Kyoo Song
- Center for Joint Diseases, Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasuneup, Hwasungun, Jeonnam 519-809, Korea
| | | | | | | | | | | |
Collapse
|
|
48
|
Chun YS, Kim KI, Cho YJ, Kim YH, Yoo MC, Rhyu KH. Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplasty 2011; 26:621-5. [PMID: 20647164 DOI: 10.1016/j.arth.2010.05.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 05/18/2010] [Indexed: 02/01/2023] Open
Abstract
For a successful robot-assisted arthroplasty, every step should be executed harmoniously. However, when we encounter serious obstacles during surgery, it is sometimes better to abort the procedure in a timely manner. This study investigated the possible causes and patterns of aborted robot-assisted arthroplasties. Of 100 consecutively planned robot-assisted arthroplasties, 22 cases were aborted. Most involved total knee arthroplasty (21/22 cases). We classified the causes according to the stage at which they occurred and the type of error. Abortions after starting the milling procedure and abortions due to an interactive factor were the most common. We believe that this study can guide surgeons to effective decision making during robot-assisted arthroplasty.
Collapse
Affiliation(s)
- Young Soo Chun
- Center for Joint Disease, Kyung Hee University East-West Neo Medical Center, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
|
49
|
Han HS, Chang CB, Seong SC, Lee S, Lee MC. Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16:373-7. [PMID: 18270685 DOI: 10.1007/s00167-008-0486-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 01/07/2008] [Indexed: 12/31/2022]
Abstract
The authors aimed to demonstrate the relationship between the sagittal mechanical axis of the tibia and other reference axes of the tibia and fibula in patients with advanced osteoarthritis of the knee joints, and then to identify a reliable landmark in order to minimize posterior tibial slope measurement errors. We evaluated 133 osteoarthritic knees with neutral or varus deformity in 64 female and 8 male patients. Axial computed tomographic images of whole tibiae including knee and ankle joints were obtained and reconstructed using 3-dimensional imaging software. Angles between the mechanical axis (MA), the tibial anatomical axis (TAA), the anterior tibial cortex (ATC) and the fibular shaft axis (FSA) were measured, and then medial and lateral tibial slope angles were measured using all axes. Mean angles between MA and the other anatomical reference lines (TAA, ATC and FSA) were 0.9, 2.2 and -2.1 degrees, respectively. The mean values of lateral tibial slopes with respect to MA, TAA, ATC and FSA were 8.7, 10, 12 and 7.3, respectively, and their intra- and inter-observer reliabilities were higher than those of medial tibial slopes. Although posterior tibial slope change markedly according to the reference axis used, the axes used in conventional TKA showed significant correlations with each other, and thus, may be used safely if differences with the mechanical axis are considered. Moreover, the lateral tibial slope might have advantages over the medial tibial slope in terms of restoration of the natural tibial slope.
Collapse
Affiliation(s)
- Hyuk Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 28 Yongondong, Chongnogu, Seoul 110-744, South Korea
| | | | | | | | | |
Collapse
|
|
50
|
Abstract
UNLABELLED Increasing evidence suggests performing total knee arthroplasty using computer navigation can lead to more accurate surgical positioning of the components and knee alignment compared to a conventional operating technique without computer assistance. The use of robotic technology could theoretically take this accuracy one level further because it uses navigation in combination with ultimate mechanical precision, which could eliminate or reduce the inevitable margin of error during mechanical preparation of the bony cuts of total knee arthroplasty by the surgeon. We prospectively followed 25 consecutive cases using an active surgical robot. The minimum followup was 5.1 years (mean, 5.5 years; range, 5.1-5.8 years). Our results demonstrate excellent implant positioning and alignment was achieved within the 1 degree error of neutral alignment in all three planes in all cases. Despite this technical precision, the excessive operating time required for the robotic implantation, the technical complexity of the system, and the extremely high operational costs have led us to abandon this procedure and direct our interest more toward smart semiactive robotic systems. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Johan Bellemans
- University Hospitals of the Catholic University, Leuven, Belgium.
| | | | | |
Collapse
|