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Navigation and robotics improved alignment compared with PSI and conventional instrument, while clinical outcomes were similar in TKA: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:721-733. [PMID: 33492410 DOI: 10.1007/s00167-021-06436-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE To achieve the desired alignment more accurately and improve postoperative outcomes, new techniques such as computer navigation (Navigation), patient-specific instruments (PSI) and surgical robots (Robot) are applied in Total Knee Arthroplasty (TKA). This network meta-analysis aims to compare the radiological and clinical outcomes among the above-mentioned techniques and conventional instruments (CON). METHODS A PRISMA network meta-analysis was conducted and study protocol was published online at INPLASY (INPLASY202060018). Three databases (PubMed, EMBASE and Cochrane) were searched up to June 1, 2020. Randomised controlled trials (RCTs) comparing any two of the four techniques were included. A Bayesian network meta-analysis was performed focusing on radiological and clinical outcomes. The odds ratio (OR) or mean difference (MD) in various outcomes were calculated, and the interventions were ranked by the surface under the cumulative ranking area (SUCRA) value. RESULTS Seventy-three RCTs were included, with a total of 4209 TKAs. Navigation and Robot could significantly reduce the occurrence of malalignment and malposition compared with PSI and CON, and Navigation could obtain higher medium-and-long-term KSS knee scores than CON. Robot had the greatest advantage in achieving the desired alignment accurately, followed by Navigation; Navigation had the greatest advantage in the KSS score. CONCLUSION Navigation and Robot did improve the accuracy of alignment compared with PSI and conventional instrument in TKA, but the above four techniques showed no clinical significance in postoperative outcomes. LEVEL OF EVIDENCE I.
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Zhang J, Ndou WS, Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2677-2695. [PMID: 33547914 PMCID: PMC9309123 DOI: 10.1007/s00167-021-06464-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022]
Abstract
This systematic review and meta-analysis were conducted to compare the accuracy of component positioning, alignment and balancing techniques employed, patient-reported outcomes, and complications of robotic-arm assisted total knee arthroplasty (RATKA) with manual TKA (mTKA) and the associated learning curve. Searches of PubMed, Medline and Google Scholar were performed in October 2020 using PRISMA guidelines. Search terms included "robotic", "knee" and "arthroplasty". The criteria for inclusion were published clinical research articles reporting the learning curve for RATKA and those comparing the component position accuracy, alignment and balancing techniques, functional outcomes, or complications with mTKA. There were 198 articles identified, following full text screening, 16 studies satisfied the inclusion criteria and reported the learning curve of rTKA (n=5), component positioning accuracy (n=6), alignment and balancing techniques (n=7), functional outcomes (n=7), or complications (n=5). Two studies reported the learning curve using CUSUM analysis to establish an inflexion point for proficiency which ranged from 7 to 11 cases and there was no learning curve for component positioning accuracy. The meta-analysis showed a significantly lower difference between planned component position and implanted component position, and the spread was narrower for RATKA compared with the mTKA group (Femur coronal: mean 1.31, 95% confidence interval (CI) 1.08-1.55, p<0.00001; Tibia coronal: mean 1.56, 95% CI 1.32-1.81, p<0.00001). Three studies reported using different alignment and balancing techniques between mTKA and RATKA, two studies used the same for both group and two studies did not state the methods used in their RATKA groups. RATKA resulted in better Knee Society Score compared to mTKA in the short-to-mid-term follow up (95%CI [- 1.23, - 0.51], p=0.004). There was no difference in arthrofibrosis, superficial and deep infection, wound dehiscence, or overall complication rates. RATKA demonstrated improved accuracy of component positioning and patient-reported outcomes. The learning curve of RATKA for operating time was between 7 and 11 cases. Future well-powered studies on RATKAs should report on the knee alignment and balancing techniques utilised to enable better comparisons on which techniques maximise patient outcomes.Level of evidence III.
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Affiliation(s)
- Junren Zhang
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK.
| | - Wofhatwa Solomon Ndou
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Nathan Ng
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Paul Gaston
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Philip M Simpson
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Gavin J Macpherson
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - James T Patton
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
| | - Nicholas D Clement
- Department of Orthopedics and Trauma, The Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK
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Robotic-arm-assisted Knee Arthroplasty Associated With Favorable In-hospital Metrics and Exponentially Rising Adoption Compared With Manual Knee Arthroplasty. J Am Acad Orthop Surg 2021; 29:e1328-e1342. [PMID: 34037576 DOI: 10.5435/jaaos-d-21-00146] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/14/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Technology-assisted knee arthroplasty (KA), including robotic-arm-assisted knee arthroplasty (RA-KA) and computer-assisted (CA-KA) knee arthroplasty, was developed to improve surgical accuracy of implant positioning and alignment, which may influence implant stability, longevity, and functional outcomes. However, despite increased adoption over the past decade; its value is still to be determined. QUESTIONS/PURPOSE This study aimed to compare robotic-arm (RA)-KA, CA-KA, and manual (M)-KA regarding (1) in-hospital metrics (length of stay [LOS], discharge disposition, in-hospital complications, and hospitalization-episode costs), (2) characterize annual utilization trends, and (3) future RA-KA and CA-KA utilization projections. METHODS National Inpatient Sample was queried for primary KAs (unicompartmental/total; 2008 to 2018). KAs were classified by modality (M-KA/CA-KA/RA-KA) using International Classification of Disease-9/10 codes. A propensity score-matched comparison of LOS, discharge disposition, in-hospital complications (implant-related mechanical or procedure-related nonmechanical complications), and costs was conducted. Trends and projected utilization rates were estimated. RESULTS After propensity score matched to their respective M-KA cohorts, RA-KA and CA-KA exhibited shorter LOS (RA-KA versus M-KA: 2.0 ± 1.4 days versus 2.5 ± 1.8 days; P < 0.001; CA-KA versus M-KA: 2.7 ± 1.4 days versus 2.9 ± 1.6 days; P < 0.001) and in-hospital implant-related mechanical complications (P < 0.05, each). RA-KA demonstrated lower nonhome discharge (P < 0.001) and in-hospital procedure-related nonmechanical complications (P = 0.005). RA-KA had lower in-hospital costs ($16,881 ± 7,085 versus $17,320 ± 12,820; P < 0.001), whereas CA-KA exhibited higher costs ($18,411 ± 7,783 versus $17,716 ± 8,451; P < 0.001). RA-KA utilization increased from <0.1% in 2008 to 4.3% in 2018. CA-KA utilization rose temporarily to 6.2% in 2014, then declined to pre-2010 levels in 2018 (4.5%). Projections indicate that RA-KA and CA-KA will represent 49.9% (95% confidence interval, 41.1 to 59.9) and 6.2% (95% confidence interval, 5.3% to 7.2%) of KAs by 2030. DISCUSSION RA-KA may provide value through improving in-hospital metrics and mitigating net costs. Similar advantages may not be reliably attainable with CA-RA. Because RA-KA is projected to reach half of all knee arthroplasties done in the United States by 2030, further cost analyses and long-term studies are warranted.
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[Clinical studies in trauma surgery and orthopedics: read, interpret and implement]. Unfallchirurg 2021; 124:1007-1017. [PMID: 34761281 PMCID: PMC8579904 DOI: 10.1007/s00113-021-01101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 12/01/2022]
Abstract
Für eine informierte, partizipative ärztliche Entscheidungsfindung müssen Sie neben Ihrem Erfahrungswissen aktuelle wissenschaftliche Daten berücksichtigen. Die digitale Informationsflut macht es im klinischen Alltag allerdings schwer, immer auf dem Stand des Wissens zu bleiben. Der Beitrag bietet einige Hilfen an, wie mit diesem Problem umgegangen werden kann. Ein grundlegendes Verständnis über Vor- und Nachwahrscheinlichkeiten sowie systematische Fehler (Bias) erleichtert die Abwägung zwischen Nutzen und Risiko z. B. einer (chirurgischen) Intervention im Vergleich zu einer nichtoperativen Therapie. Randomisierte Studien („randomized controlled trials“, RCT, mit allen modernen Modifikationen) liefern unverzerrte Ergebnisse, führen in Orthopädie und Unfallchirurgie evtl. zu einer stark selektierten, nichtrepräsentativen Stichprobe, und ihre Resultate müssen durch weitere, unabhängige RCT bestätigt oder widerlegt werden. Große beobachtende Datenmengen (z. B. aus Registern) können quasiexperimentell modelliert werden und RCT in der Gesundheitstechnologiebewertung flankieren.
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MAKO CT-based robotic arm-assisted system is a reliable procedure for total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:3585-3598. [PMID: 32975626 DOI: 10.1007/s00167-020-06283-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate the clinical and radiological results of the MAKO CT-based robotic-assisted system for total knee arthroplasty (TKA). METHODS A PRISMA systematic review was conducted using four databases (MEDLINE, EMBASE, Pubmed, GOOGLE SCHOLAR) to identify all clinical and radiological studies reporting information regarding the use and results of the CT-based robotic-assisted system to perform TKA between 2016 and 2020. The main investigated outcome criteria were postoperative pain, analgesia requirements, clinical scores, knee range of motion, implant positioning and the revision rate. The ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions) was used to evaluate the quality of included studies and the risk of bias. RESULTS A total of 36 studies were identified, of which 26 met inclusion criteria. Of these 26 studies, 14 were comparative. The follow-up varied from 30 days to 17 months. This CT-based, saw cutting Robotic TKA is associated with a significantly lower postoperative pain score (2.6 versus 4.5) and with significantly reduced time to hospital discharge (77 h versus 105), compared with conventional TKA. The two comparative studies assessing functional outcomes at 1 year reported significantly better functional scores with CT-based robotic TKA compared with conventional TKA (WOMAC score: 6 ± 6 versus 9 ± 8 (p < 0.05); KSS function score: 80 versus 73 (p = 0.005)). Only three comparative studies assessed implant positioning, and these reported better implant positioning with CT-based robotic-assisted TKA. CONCLUSION The CT-based robotic-assisted system for TKA reduced postoperative pain and improved implant positioning with equal or slightly superior improvement of the functional outcomes at one year, compared to conventional TKA. LEVEL OF EVIDENCE Systematic review level IV.
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Yuan M, Shi X, Su Q, Wan X, Zhou Z. [A prospective randomized controlled trial on the short-term effectiveness of domestic robot-assisted total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1251-1258. [PMID: 34651477 DOI: 10.7507/1002-1892.202106047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To explore the short-term effectiveness of domestic robot-assisted total knee arthroplasty (RATKA) conducted by a prospective randomized controlled trial. Methods Patients who were scheduled for primary unilateral TKA between October 2020 and December 2020 were eligible in this randomized controlled trial. According to the random number table method, they were allocated to the traditional TKA group and the RATKA group [application of the Yuanhua robotic-assisted TKA (YUANHUA-TKA) system during operation]. A total of 63 patients met the selection criteria were enrolled in the study, of which 3 cases voluntarily withdrew from the trial. And finally 60 cases were enrolled for analysis; of which 28 cases were in the RATKA group and 32 cases were in the traditional TKA group. There was no significant difference in gender, age, body mass index, American Society of Anesthesiologists (ASA) classification, duration of osteoarthritis, surgical side, and preoperative knee visual analogue scale (VAS) resting and motion scores, joint range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, and function scores, hip-knee-ankle angle (HKA) deviation ( P>0.05). The operation time and intraoperative blood loss of the two groups were recorded. Knee joint VAS resting and motion scores, ROM, KSS scores, and WOMAC pain, stiffness, and function scores were used to evaluate the knee joint function and pain. Gait analysis (flexion and extension angle) was conducted at 3 months after operation. The full length X-ray films of lower limbs and anteroposterior and lateral X-ray films of knee joint were taken. The HKA deviation, lateral tibia component (LTC), frontal femoral component (FFC), frontal tibia component (FTC), and lateral femoral component (LFC) measured on the X-ray films were used to evaluat the lower limb alignment and prosthesis position. Results The operations of the two groups completed successfully; the incisions healed by first intention after operation, and no complications related to the operation occurred. The operation time of the RATKA group was significantly longer than that of the traditional TKA group ( t=12.253, P=0.001), and there was no significant difference in intraoperative blood loss between the two groups ( t=3.382, P=0.071). All patients were followed up 3 months. At 3 months after operation, the knee joint VAS resting and motion scores, ROM, KSS scores, and WOMAC pain, stiffness, and function scores improved significantly when compared with preoperatively in the two groups ( P<0.05); there was no significant difference of pre- and post-operative indicators between the two groups ( P>0.05). The gait analysis showed that the flexion and extension angle in the RATKA group was significantly bigger than that in the traditional TKA group ( t=9.469, P=0.003). X-ray films reexamination at 3 months after operation showed that the prostheses in the two groups were in good positions, and there was no adverse events such as prosthesis loosening or sinking. There were significant differences in the HKA deviation between pre- and post-operation in the two groups ( P<0.05), but the difference of pre- and post-operative HKA deviation between the two groups was not significant ( t=1.254, P=0.267). There was no significant difference in FFC, FTC, and LFC between the two groups ( P>0.05); the LTC was significantly smaller in the RATKA group than in the traditional TKA group ( t=17.819, P=0.000), which was closer to the ideal value. Conclusion YUANHUA-TKA system can improve the accuracy of osteotomy and the prosthesis placement as well as the lower limb alignment. Its short-term effectiveness can be promised, but long-term effectiveness needs to be further studied.
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Affiliation(s)
- Mingcheng Yuan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xiaojun Shi
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Qiang Su
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xufeng Wan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Fu J, Ni M, Chen J. [Robot-assisted joint arthroplasty-An emerging technology of the present and the future]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1217-1220. [PMID: 34651471 DOI: 10.7507/1002-1892.202106086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review and evaluate the research progress of the robot-assisted joint arthroplasty. Methods The domestic and foreign related research literature on robot-assisted joint arthroplasty was extensively consulted. The advantages, disadvantages, effectiveness, and future prospects were mainly reviewed and summarized. Results The widely recognized advantages of robot-assisted joint arthroplasty are digital and intelligent preoperative planning, accurate intraoperative prosthesis implantation, and quantitative soft tissue balance, as well as good postoperative imaging prosthesis position and alignment. However, the advantages of effectiveness are still controversial. The main disadvantages of robot-assisted joint arthroplasty are the high price of the robot system, the prolonged operation time, and the increased radioactive damage of the imaging-dependent system. Conclusion Compared to traditional arthroplasty, robot-assisted joint arthroplasty can improve the accuracy of the prosthesis position and assist in the quantitative assessment of soft tissue tension, and the repeatability rate is high. In the future, further research is needed to evaluate the clinical function and survival rate of the prosthesis, as well as to optimize the robot system.
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Affiliation(s)
- Jun Fu
- Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China.,Department of Orthopedics,the First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Ming Ni
- Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China.,Department of Orthopedics,the First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Jiying Chen
- Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P.R.China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China.,Department of Orthopedics,the First Medical Centre of Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Thiengwittayaporn S, Uthaitas P, Senwiruch C, Hongku N, Tunyasuwanakul R. Imageless robotic-assisted total knee arthroplasty accurately restores the radiological alignment with a short learning curve: a randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2021; 45:2851-2858. [PMID: 34392382 DOI: 10.1007/s00264-021-05179-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/30/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The study compared a novel imageless robotic-assisted total knee arthroplasty (RATKA) and conventional TKA by considering (1) radiological outcomes, (2) outliers of radiological outcomes, and (3) learning curve. METHODS This prospective randomized controlled study performed by a single surgeon evaluated 152 patients (152 knees): 75 patients undergoing RATKA and 77 patients undergoing conventional TKA. Mechanical alignment, radiological implant positioning, and outliers were analyzed for radiological outcomes. Cumulative summation (CUSUM) analysis was used to assess the learning curve for operative time in RATKA. RESULTS The RATKA had significantly better accuracy of knee alignment and component positioning than conventional TKA. The hip-knee-ankle axis and implant position outliers were significantly lower in the RATKA, with 94.7% of patients had achieved an overall mechanical alignment within 3° of a neutral mechanical axis. Changes in posterior condylar offset and joint line were significantly lower in the RATKA. A learning curve of seven cases for operative time was obtained for the RATKA. CONCLUSION The imageless RATKA has better alignment accuracy with a short learning curve; thus, it presents an attractive option for TKA.
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Affiliation(s)
- Satit Thiengwittayaporn
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok, 10300, Thailand.
| | - Pinyong Uthaitas
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok, 10300, Thailand
| | - Chaipipathn Senwiruch
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok, 10300, Thailand
| | - Natthapong Hongku
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok, 10300, Thailand
| | - Revit Tunyasuwanakul
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Rd, Dusit, Bangkok, 10300, Thailand
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Buchlak QD, Clair J, Esmaili N, Barmare A, Chandrasekaran S. Clinical outcomes associated with robotic and computer-navigated total knee arthroplasty: a machine learning-augmented systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:915-931. [PMID: 34173066 DOI: 10.1007/s00590-021-03059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Robotic (RTKA) and computer-navigated total knee arthroplasty (CNTKA) are increasingly replacing manual techniques in orthopaedic surgery. This systematic review compared clinical outcomes associated with RTKA and CNTKA and investigated the utility of natural language processing (NLP) for the literature synthesis. METHODS A comprehensive search strategy was implemented. Results of included studies were combined and analysed. A transfer learning approach was applied to train deep NLP classifiers (BERT, RoBERTa and XLNet), with cross-validation, to partially automate the systematic review process. RESULTS 52 studies were included, comprising 5,067 RTKA and 2,108 CNTKA. Complication rates were 0-22% and 0-16% and surgical time was 70-116 and 77-102 min for RTKA and CNTKA, respectively. Technical failures were more commonly associated with RTKA (8%) than CNTKA (2-4%). Patient satisfaction was equivalent (94%). RTKA was associated with a higher likelihood of achieving target alignment, less femoral notching, shorter operative time and shorter length of stay. NLP models demonstrated moderate performance (AUC = 0.65-0.68). CONCLUSIONS RTKA and CNTKA appear to be associated with similarly positive clinical outcomes. Further work is required to determine whether the two techniques differ significantly with regard to specific outcome measures. NLP shows promise for facilitating the systematic review process.
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Affiliation(s)
- Quinlan D Buchlak
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Joe Clair
- Department of Orthopaedics, Werribee Mercy Hospital, Melbourne, VIC, Australia
| | - Nazanin Esmaili
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW, Australia
| | - Arshad Barmare
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia.,Department of Orthopaedics, Werribee Mercy Hospital, Melbourne, VIC, Australia
| | - Siva Chandrasekaran
- Department of Orthopaedics, Werribee Mercy Hospital, Melbourne, VIC, Australia
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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: 5.0] [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.
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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
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Sweet MC, Borrelli GJ, Manawar SS, Miladore N. Comparison of Outcomes After Robotic-Assisted or Conventional Total Hip Arthroplasty at a Minimum 2-Year Follow-up: A Systematic Review. JBJS Rev 2021; 9:01874474-202106000-00011. [PMID: 34130305 DOI: 10.2106/jbjs.rvw.20.00144] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This systematic review aimed to present an updated analysis of the evidence comparing outcomes between robotic-assisted total hip arthroplasty (robotic THA) and conventional manual total hip arthroplasty (manual THA). METHODS A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic review was performed using the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and Embase. Controlled studies comparing primary robotic THA and manual THA utilizing patient-reported outcome measures (PROMs) at a minimum follow-up of 2 years were included. We also compared radiographic outcomes, dislocation rates, and revision surgical procedures between groups. The ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) and Cochrane Risk of Bias 2.0 tools were used to assess study quality and risk of bias. RESULTS Of 765 studies identified, 7 articles comparing robotic THA with manual THA met inclusion criteria. A total of 658 patients were assessed, 335 of whom underwent robotic THA. The majority of studies found no significant differences (p > 0.05) in PROMs between the 2 techniques. Two low-quality studies (Level III) found significantly better postoperative PROMs favoring robotic THA at 2 years. When assessing radiographic outcomes, 6 studies showed that robotic THA resulted in more consistent and accurate component placement. No differences in postoperative dislocations, complications, or revision rates were found between groups except in 1 study, which found significantly more dislocations and revisions in the robotic THA cohort. Reported operative times were a mean of 12 to 25 minutes longer when using robotic THA. CONCLUSIONS The existing literature comparing robotic THA and manual THA is scarce and low-quality, with findings limited by methodological flaws in study design. Although evidence exists to support increased accuracy and reproducibility of THA component placement with robotic THA, this has not been shown to reduce postoperative dislocation and revision rates. Based on the available evidence, functional outcomes are comparable between techniques, and robotic THA appears to be associated with longer operative times. To fully evaluate the utility of robotic THA, additional well-designed, prospective controlled studies with continuous long-term monitoring are required. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matthew C Sweet
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - George J Borrelli
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Shaan S Manawar
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
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Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Barnes CL, Kavolus JJ. Online Crowdsourcing to Explore Public Perceptions of Robotic-Assisted Orthopedic Surgery. J Arthroplasty 2021; 36:1887-1894.e3. [PMID: 33741241 DOI: 10.1016/j.arth.2021.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The clinical benefits of robotic-assisted technology in total joint arthroplasty are unclear, but its use is increasing. This study employed online crowdsourcing to explore public perceptions and beliefs regarding robotic-assisted orthopedic surgery. METHODS A 30-question survey was completed by 588 members of the public using Amazon Mechanical Turk. Participants answered questions regarding robotic-assisted orthopedic surgery, sociodemographic factors, and validated assessments of health literacy and patient engagement. Multivariable logistic regression modeling was used to determine population characteristics associated with preference for robotic technology. RESULTS Most respondents believe robotic-assisted surgery leads to better results (69%), fewer complications (69%), less pain (59%), and faster recovery (62%) than conventional manual methods. About half (49%) would prefer a low-volume surgeon using robotic technology to a high-volume surgeon using conventional manual methods. The 3 main concerns regarding robotic technology included lack of surgeon experience with robotic surgery, robot malfunction causing harm, and increased cost. Only half of respondents accurately understand the actual role of the robot in the operating room. Overall, 34% of participants have a clear preference for robotic-assisted surgery over a conventional manual approach. After multivariable regression analysis, Asian race, working in healthcare, early technology adoption, and prior knowledge of robotic surgery were independent predictors of preferring robotic-assisted surgery. CONCLUSION The public's unawareness of the dubious outcome superiority associated with robotic-assisted orthopedic surgery may contribute to misinformed decisions in some patients. Robotic-assisted technology appears to be a powerful marketing tool for surgeons and hospitals.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA
| | - Michael A Moverman
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Joseph J Kavolus
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA
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Chen X, Li Z, Zhang X, Yan J, Ding L, Song Y, Huo Y, Chan MTV, Wu WKK, Lin J. A new robotically assisted system for total knee arthroplasty: A sheep model study. Int J Med Robot 2021; 17:e2264. [PMID: 33855810 DOI: 10.1002/rcs.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We investigated the accuracy and safety of a new HURWA robotic-assisted total knee arthroplasty (TKA) system in a sheep model. METHODS Ten male small-tailed Han sheep were used in this study. Sheep were imaged by computed tomography scan before and after bone resection and the cutting errors between actual bone preparation and preoperative planning of the femur and tibia in three dimensions were measured. RESULTS The overall accuracies after surgery compared with that from preoperative surgical planning of the left and right femurs were 1.93 ± 1.02° and 1.93 ± 1.23°, respectively. Additionally, similarly high overall accuracies for the left and right tibia of 1.26 ± 1.04 and 1.68 ± 0.92°, respectively, were obtained. The gap distances of the distal cut, anterior chamfer, anterior cut, posterior chamfer and posterior cut on the medial side were 0.47 ± 0.35 mm, 0.41 ± 0.37 mm, 0.12 ± 0.26 mm, 0.41 ± 0.44 mm and 0.12 ± 0.23 mm, respectively. No intraoperative complications, such as intraoperative fracture, massive bleeding or death, occurred. CONCLUSION This new HURWA robotic-assisted TKA system is an accurate and safe tool for TKA surgery based on the sheep model.
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Affiliation(s)
- Xin Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zhang
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Jun Yan
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Lele Ding
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Youdong Song
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Yujia Huo
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China.,State Key Laboratory of Digestive Diseases, Centre for Gut Microbiota Research, Institute of Digestive Diseases and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Han S, Rodriguez-Quintana D, Freedhand AM, Mathis KB, Boiwka AV, Noble PC. Contemporary Robotic Systems in Total Knee Arthroplasty: A Review of Accuracy and Outcomes. Orthop Clin North Am 2021; 52:83-92. [PMID: 33752841 DOI: 10.1016/j.ocl.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The success of total knee arthroplasty (TKA) depends on restoration of the stability and biomechanical efficiency of the native knee. The emergence of robotic surgical technologies has greatly increased the precision and reproducibility. We discuss contemporary robotic TKA systems by reviewing the features of the individual platforms, their accuracy, and the clinical outcomes. While early results suggest significant gains in patient outcomes, long-term evidence is still awaited from multicenter prospective clinical trials. Moreover, advances in this technology are needed to address knee laxity while individualizing the functional performance of each patient's new joint.
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Affiliation(s)
- Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth-Houston, 5420 West Loop South, Suite 1300, Houston, TX 77401, USA
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth-Houston, 5420 West Loop South, Suite 1300, Houston, TX 77401, USA
| | - Adam M Freedhand
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth-Houston, 5420 West Loop South, Suite 1300, Houston, TX 77401, USA
| | - Kenneth B Mathis
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth-Houston, 5420 West Loop South, Suite 1300, Houston, TX 77401, USA
| | - Alexander V Boiwka
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth-Houston, 5420 West Loop South, Suite 1300, Houston, TX 77401, USA
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, UTHealth-Houston, 5420 West Loop South, Suite 1300, Houston, TX 77401, USA.
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Kwan H, To K, Bojanic C, Romain K, Khan W. A meta-analysis of clinical and radiological outcomes in simultaneous bilateral unicompartmental knee arthroplasty. J Orthop 2021; 23:128-137. [PMID: 33510553 PMCID: PMC7815461 DOI: 10.1016/j.jor.2020.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The most common pattern seen in bilateral knee osteoarthritis involves only the medial compartment in both knees. In such cases, bilateral Unicompartmental Knee Arthroplasty (UKA) would be a suitable surgery, this can be done simultaneously in one surgery or in stages with a period of time between each UKA. Simultaneous bilateral UKA in appropriately selected patients have the potential advantages of a lower cost, a shorter hospital stay, and a shorter overall recovery process. Despite this, there are concerns that operating on both knees in one surgery may increase the risk of complications, revisions and mortality. METHODS A PRISMA systematic review and meta-analysis was conducted using three databases (MEDLINE, EMBASE, and Scopus) to identify all studies which investigated either clinical or radiological outcomes in simultaneous bilateral UKA. RESULTS All sixteen studies included found that simultaneous bilateral UKA improved clinical and radiological outcomes. Eight studies compared clinical or radiological outcomes between simultaneous and staged bilateral UKA. Simultaneous bilateral UKA was found to have a significantly shorter length of operation, length of hospital stay, and a lower treatment cost (P < 0.001). Our meta-analysis found no statistically significant difference in the all-cause complication rate between simultaneous and staged bilateral UKA (P = 0.36). Only one study compared radiological outcomes between simultaneous and staged bilateral UKA which found no significant difference. CONCLUSION Our review suggests that simultaneous bilateral UKA is comparable to staged bilateral UKA in terms of clinical and radiological outcomes and has the potential to be increasingly adopted in clinical practice due to its superior cost-effectiveness.
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Affiliation(s)
- Haowen Kwan
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kendrick To
- Division of Trauma and Orthopaedics, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
| | - Christine Bojanic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Karl Romain
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Wasim Khan
- Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK
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Sherman WF, Wu VJ. Robotic Surgery in Total Joint Arthroplasty: A Survey of the AAHKS Membership to Understand the Utilization, Motivations, and Perceptions of Total Joint Surgeons. J Arthroplasty 2020; 35:3474-3481.e2. [PMID: 32731999 DOI: 10.1016/j.arth.2020.06.072] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In the past decade, the popularity of robot arm assistance in total joint arthroplasty has outpaced the reporting of long-term data. This study aimed to understand the motivations for use and perceptions of the technology among total joint surgeons. METHODS An online survey was distributed to the membership of the American Association of Hip and Knee Surgeons. The questions were asked for respondent's motivations for utilization of the technology, perceptions regarding outcomes and training, and personal characteristics that may have influenced responses. RESULTS Increased precision was the primary reason for users (73.1%) to utilize robot arm assistance in total joint procedures. Nonusers were just as likely to consider adopting the technology because of increase precision and marketing (P = .590). Nonclinical reasons such as marketing, administrative pressure, and peer pressure were primary motivators for 19.7% of users of the technology. Respondents regardless of financial interest and use of the technology felt that robot arm assistance increased operative time (76.5%) and was not more cost-effective than traditional methods (78.7%). Most American Association of Hip and Knee Surgeons members felt that 20-40 surgical cases were needed to become competent with the technique (54.1%). A unique finding of this study is that a larger proportion of orthopedic surgeons considered themselves "innovators" or "early adopters," based on Roger's diffusion of innovations, than was expected for the general population. CONCLUSION This study demonstrates that the decision to adopt robot arm assistance in total joint arthroplasty is multifactorial and may have a significant contribution from nonclinical factors and inherent surgeon characteristics. Continued evaluation of surgeon perceptions will be valuable as new evidence emerges regarding long-term outcomes.
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Affiliation(s)
- William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Victor J Wu
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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Agarwal N, To K, Zhang B, Khan W. Obesity does not adversely impact the outcome of unicompartmental knee arthroplasty for osteoarthritis: a meta-analysis of 80,798 subjects. Int J Obes (Lond) 2020; 45:715-724. [PMID: 33214703 DOI: 10.1038/s41366-020-00718-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with end-stage single compartment osteoarthritis benefit from the less invasive unicompartmental knee arthroplasty (UKA). With increasing financial restraints, some healthcare services have set specific BMI cut-offs when determining patient eligibility for knee arthroplasty due to perceived obesity-related complications. The aim of this systematic review is to determine the effect obesity has on outcomes following UKA, and thus elucidate whether obesity should be a contraindication for UKA. METHODS A PRISMA systematic review was conducted using five databases (MEDLINE, EMBASE, Cochrane, PubMed and Web of Science) to identify all clinical studies that examined the effect of obesity on outcomes following UKA. Quantitative meta-analysis was carried out using RevMan 5.3 software. Quality assessment was carried out using the Critical Appraisal Skills Programme (CASP) checklist. RESULTS Thirty studies, including a total of 80 798 patients were analysed. The mean follow- up duration was 5.42 years. Subgroup meta-analyses showed no statistically significant difference following UKA between patients cohorts with and without obesity in overall complication rates (95% CI, P = 0.52), infection rates (95% CI, P = 0.81), and revision surgeries (95% CI, P = 0.06). When further analysing complications, no differences were identified in minor (95% CI, P = 0.23) and major complications (95% CI, P = 0.68), or venous thromboembolism rates (95% CI, P = 0.06). When further analysing revision surgeries, no differences were identified for revisions specifically for infection (95% CI, P = 0.71) or aseptic loosening (95% CI, P = 0.75). CONCLUSIONS This meta-analysis shows that obesity does not result in poorer post-operative outcomes following UKA and should not be considered a contraindication for UKA. Future studies, including long-term follow-up RCTs and registry-level analyses, should examine factors associated with obesity and consider stratifying obesity to better delineate any potential differences in outcomes.
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Affiliation(s)
- Nikhil Agarwal
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK. .,MBChB Office, University of Aberdeen College of Life Sciences and Medicine, Foresterhill Rd, Aberdeen, AB25 2ZD, UK.
| | - Kendrick To
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Bridget Zhang
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Wasim Khan
- Division of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB2 0QQ, UK
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Stübig T, Windhagen H, Krettek C, Ettinger M. Computer-Assisted Orthopedic and Trauma Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:793-800. [PMID: 33549155 PMCID: PMC7947640 DOI: 10.3238/arztebl.2020.0793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/06/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are many ways in which computer-assisted orthopedic and trauma surgery (CAOS) procedures can help surgeons to plan and execute an intervention. METHODS This study is based on data derived from a selective search of the literature in the PubMed database, supported by a Google Scholar search. RESULTS For most applications the evidence is weak. In no sector did the use of computer-assisted surgery yield any relevant clinical or functional improvement. In trauma surgery, 3D-navigated sacroiliac screw fixation has become clinically established for the treatment of pelvic fractures. One randomized controlled trial showed a reduction in the rate of screw misplacement: 0% with 3D navigation versus 20.4% with the conventional procedure und 16.6% with 2D navigation. Moreover, navigation-assisted pedicle screw stabilization lowers the misplacement rate. In joint replacements, the long-term results showed no difference in respect of clinical/functional scores, the time for which the implant remained in place, or aseptic loosening. CONCLUSION Computer-assisted procedures can improve the precision of certain surgical interventions. Particularly in joint replacement and spinal surgery, the research is moving away from navigation in the direction of robotic procedures. Future studies should place greater emphasis on clinical and functional results.
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Affiliation(s)
- Timo Stübig
- Department of Traumatology, Hannover Medical School
| | - Henning Windhagen
- Department of Orthopedic Surgery, Hannover Medical School, Annastift
| | | | - Max Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Annastift
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