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Emanuele D, Lettner J, Adriani M, Robert P, Mikhail S, Roland B. High accuracy of component positioning and restoration of lower limb alignment using robotic medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39369428 DOI: 10.1002/ksa.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 09/13/2024] [Accepted: 09/14/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE Unicondylar arthroplasty was performed using robotic medial unicompartmental knee arthroplasty (R-mUKA) and gap-balancing instrumentation. Our hypothesis was that robotic unicondylar knee arthroplasty accurately restores component positioning and lower limb alignment when compared to preoperative planning with actual implantation throughout the range of knee motion due to proper knee balancing. METHODS Data were collected prospectively and were analysed for patients undergoing RM-UKA. A cemented UKA was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded of the native knee, with the trial components in place and finally after component implantation. A spacer according to the femorotibial gap was introduced and the alignment was measured. The position of the final component was planned based on three-dimensional computed tomography images before making the bone cuts. The positioning of the femoral and tibial components was analysed in all three planes. RESULTS A total of 52 patients were included (mean age 66.3 ± 6.7 years; 34 males, 18 females). The difference in femoral component position after planning and final implantation was 0.04° ± 0.58° more valgus in the coronal plane (p = 0.326) and 0.6° ± 1.4° more flexion relative to the sagittal plane (p = 0.034). The tibial component was placed in the coronal plane in 0.3° ± 0.8° of more varus (p = 0.113) and in the sagittal plane in 0.6° ± 1.2° of more posterior tibial slope (p = 0.001). Lower limb alignment of the native knee in extension was 5.8° ± 2.6° of varus and changed to 3° ± 2.1° varus after UKA (p ≤ 0.01). CONCLUSION R-mUKA helps to achieve the target of alignment and component position without any significant differences to the planning. Ligament balancing causes non-significant changes in component position. It allows optimal component position even for off-the-shelf implants respecting the patient's specific anatomy. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Diquattro Emanuele
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jonathan Lettner
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg, Germany
| | - Marco Adriani
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Prill Robert
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences, Potsdam, Germany
| | - Salzmann Mikhail
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg, Germany
| | - Becker Roland
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences, Potsdam, Germany
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Long-term study of functional outcomes of robotic assisted medial UKA using mid-vastus approach in a high-volume centre. J Robot Surg 2023:10.1007/s11701-023-01564-4. [PMID: 36928748 DOI: 10.1007/s11701-023-01564-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
Robotic UKA is one of the recent advancement in surgical management for medial compartment knee osteoarthritis. Over the years, there have been many studies which have showed results of various conventional UKA, high tibial osteotomy and even robotic uka for medial OA of knee all over the world. But still there is very less work on long-term outcome-based analysis of functional outcomes of robotic assisted medial UKA using mid-vastus approach, which was the aim of the study. A total of 680 patients with medial OA knee that were undergone robotic assisted UKA. The study was done at tertiary teaching institute and hospital from November 2016 to October 2022. The assessment of pain, clinical-functional assessment, walking ability, range of motion were assessed by KSS, SF-12 at pre-operatively, mid-term follow-ups and at final follow-up -5.03(± 0.52) years after surgery. 680 patients suited for medial UKA in our study with mean age of 65 ± 10.6 years. Average operating time was 42 ± 4.7 min. The mean postoperative KSS was 93 ± 4.3, the mean SF-12 was 49 ± 9.1, 55 ± 8.7 for PS and MS, respectively. The patient had better KSS and SF-12 when compared pre-operatively and final follow-up (p -0.012 and -9.320, p -0.017 and -7.475, p -0.014 and -5.196, p -0.021 and -7.418, respectively). Complications were also very less. Robotic UKA using mid-vastus approach is effective treatment for medial compartmental OA knee. On short/long-term follow-up of patients, functional and radiological outcomes were good with few complications rates.
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Tay ML, Carter M, Bolam SM, Zeng N, Young SW. Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time. Knee Surg Sports Traumatol Arthrosc 2023; 31:793-802. [PMID: 34981161 DOI: 10.1007/s00167-021-06814-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE UKA has higher revision risk, particularly for lower volume surgeons. While robotic-arm assisted systems allow for increased accuracy, introduction of new systems has been associated with learning curves. The aim of this study was to determine the learning curve of a UKA robotic-arm assisted system. The hypothesis was that this may affect operative times, patient outcomes, limb alignment, and component placement. METHODS Between 2017 and 2021, five surgeons performed 152 consecutive robotic-arm assisted primary medial UKA, and measurements of interest were recorded. Patient outcomes were measured with Oxford Knee Score, EuroQol-5D, and Forgotten Joint Score at 6 weeks, 1 year, and 2 years. Surgeons were grouped into 'low' and 'high' usage groups based on total UKA (manual and robotic) performed per year. RESULTS A learning curve of 11 cases was found with operative time (p < 0.01), femoral rotation (p = 0.02), and insert sizing (p = 0.03), which highlighted areas that require care during the learning phase. Despite decreased 6-week EQ-5D-5L VAS in the proficiency group (77 cf. 85, p < 0.01), no difference was found with implant survival (98.2%) between phases (p = 0.15), or between 'high' and 'low' usage surgeons (p = 0.23) at 36 months. This suggested that the learning curve did not lead to early adverse effects in this patient cohort. CONCLUSION Introduction of a UKA robotic-arm assisted system showed learning curves for operative times and insert sizing but not for implant survival at early follow-up. The short learning curve regardless of UKA usage indicated that robotic-arm assisted UKA may be particularly useful for low-usage surgeons. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand. .,Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand.
| | | | - Scott M Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland DHB, Auckland, New Zealand
| | - Nina Zeng
- Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand
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4
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Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees. INTERNATIONAL ORTHOPAEDICS 2023; 47:533-541. [PMID: 36434294 DOI: 10.1007/s00264-022-05640-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Implant malpositioning, joint line (JL) lowering, and malalignment have been identified as risk factors for implant failure in unicompartmental knee arthroplasty (UKA). The aims of this study were to compare the accuracy of implant positioning in robotic-assisted UKA versus conventional UKA in a large cohort and examine the correlation with implant survival at mid-term follow-up. METHODS This retrospective study included 356 medial UKAs from 2011 to 2019. The radiological measurements performed were coronal positioning of tibial implant according to Cartier angle (Δ Cartier), posterior tibial slope (PTS), residual hip-knee-ankle (HKA), and JL restoration. Outliers were defined as follows: post-operative HKA < 175° or > 180°, Δ Cartier > 3° or < - 3°, JL change ≥ 2 mm, and PTS < 2° or > 8°. The survival probability was reported at the last follow-up. RESULTS Out of the 356 knees included, 159 underwent conventional UKA (44.5%) and 197 (55.5%) robotic-assisted UKA. The mean follow-up was 61.3 months ± 24.0. Robotic UKA was associated with better accuracy compared to conventional UKA in relation to HKA (67% vs 56%, p = 0.023), JL restoration (70% vs 44%, p < 0.0001), PTS (83% vs 55%, p < 0.0001), and tibial varus restoration (65% vs 55%, p = 0.049). Implant survival in the robotic group was found to be superior at the last follow-up (96.4% versus 87.3% at 9 years, p = 0.004). CONCLUSION Robotic assistance in patients undergoing medial UKA was associated with better accuracy compared to conventional UKA with respect to tibial implant positioning, post-operative limb alignment, and JL restoration. This was translated in improved survival at mid-term follow-up favouring the robotic group.
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Gaudiani MA, Samuel LT, Diana JN, DeBattista JL, Coon TM, Moore RE, Kamath AF. Robotic-arm assisted lateral unicompartmental knee arthroplasty: 5-Year outcomes & survivorship. J Orthop Surg (Hong Kong) 2023; 31:10225536221138986. [PMID: 36775979 DOI: 10.1177/10225536221138986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION Robotic-arm assisted unicompartmental knee arthroplasty (RA-UKA) has demonstrated accurate component positioning and excellent outcomes for medial components. However, there is a paucity of literature on lateral compartment RA-UKA. The purpose of our study was to assess the midterm clinical outcomes and survivorship of lateral RA-UKA. METHODS This study was a retrospective review of a single-center prospectively maintained cohort of 33 patients (36 knees) indicated for lateral UKA. Perioperative, and postoperative two- and five-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) patient reported outcome measures were collected. Five-year follow-up was recorded in 29 patients (32 knees). RESULTS Mean follow up was 5.1 ± 0.1 years. Mean age and BMI was 70.9 ± 7.2 years and 29.0 ± 4.2 kg/m2, respectively. At discharge, mean distance walked was 273.4 ± 70.4 feet, and mean pain score was 2.0 ± 2.5. At 2-year follow up, mean KOOS, WOMAC, and FJS were 75.1 ± 13.5, 15.0 ± 7.2, and 81.0 ± 23.3, respectively. At 5-year follow up, mean KOOS, WOMAC, and FJS were 75.3 ± 14.6, 14.9 ± 5.0, and 75.8 ± 27.4, respectively. Mean change in KOOS and WOMAC were 35.6 ± 27.1 and 11.7 ± 13.4 (p< .001 and p< .001). 94% of patients were very satisfied/satisfied, 3% neutral, and 3% dissatisfied. 91% met activity expectations, and 59% were more active than before. Survivorship was 100% at 5 years. DISCUSSION In this study, lateral RA-UKA demonstrated significantly improved clinical outcomes, high patient satisfaction, met expectations, and excellent functional recovery at midterm follow up. Comparative studies are needed to determine differences between robotic-assisted and conventional lateral UKA, as well as TKA.
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Affiliation(s)
- Michael A Gaudiani
- Department of Orthopaedic Surgery, 2569Cleveland Clinic Foundation, Cleveland, OH, USA.,Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, 2569Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John N Diana
- Coon Joint Replacement Institute, St. Helena, CA, USA
| | | | - Thomas M Coon
- Coon Joint Replacement Institute, St. Helena, CA, USA
| | - Ryan E Moore
- Coon Joint Replacement Institute, St. Helena, CA, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, 2569Cleveland Clinic Foundation, Cleveland, OH, USA
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Lonner JH, Seidenstein AD, Charters MA, North WT, Cafferky NL, Durbhakula SM, Kamath AF. Improved accuracy and reproducibility of a novel CT-free robotic surgical assistant for medial unicompartmental knee arthroplasty compared to conventional instrumentation: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2022; 30:2759-2767. [PMID: 34120210 DOI: 10.1007/s00167-021-06626-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Alignment errors in medial unicompartmental knee arthroplasty (UKA) predispose to premature implant loosening and polyethylene wear. The purpose of this study was to determine whether a novel CT-free robotic surgical assistant improves the accuracy and reproducibility of bone resections in UKA compared to conventional manual instrumentation. METHODS Sixty matched cadaveric limbs received medial UKA with either the ROSA® Partial Knee System or conventional instrumentation. Fifteen board-certified orthopaedic surgeons with no prior experience with this robotic application performed the procedures with the same implant system. Bone resection angles in the coronal, sagittal and transverse planes were determined using optical navigation while resection depth was obtained using calliper measurements. Group comparison was performed using Student's t test (mean absolute error), F test (variance) and Fisher's exact test (% within a value), with significance at p < 0.05. RESULTS Compared to conventional instrumentation, the accuracy of bone resections with CT-free robotic assistance was significantly improved for all bone resection parameters (p < 0.05), other than distal femoral resection depth, which did not differ significantly. Moreover, the variance was significantly lower (i.e. fewer chances of outliers) for five of seven parameters in the robotic group (p < 0.05). All values in the robotic group had a higher percentage of cases within 2° and 3° of the intraoperative plan. No re-cuts of the proximal tibia were required in the robotic group compared with 40% of cases in the conventional group. CONCLUSION The ROSA® Partial Knee System was significantly more accurate, with fewer outliers, compared to conventional instrumentation. The data reported in our current study are comparable to other semiautonomous robotic devices and support the use of this robotic technology for medial UKA. LEVEL OF EVIDENCE Cadaveric study, Level V.
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Affiliation(s)
- Jess H Lonner
- Rothman Orthopaedic Institute, 925 Chestnut St, Philadelphia, PA, 19107, USA. .,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Ari D Seidenstein
- Rothman Orthopaedics, Montvale, NJ, 07645, USA.,Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | | | | | | | | | - Atul F Kamath
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, 44113, USA
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Kenanidis E, Paparoidamis G, Milonakis N, Potoupnis M, Tsiridis E. Comparative outcomes between a new robotically assisted and a manual technique for total knee arthroplasty in patients with osteoarthritis: a prospective matched comparative cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1231-1236. [PMID: 35552535 DOI: 10.1007/s00590-022-03274-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Studies comparing clinical outcomes between manual (mTKA) and robotic-assisted TKA (raTKA) are limited. This prospective comparative cohort study aimed to compare early postoperative outcomes, satisfaction, and patient-reported outcome measures (PROMS) between patients undergoing mTKA and ROSA raTKA (Zimmer Biomet, Warsaw, IN) performed by one surgeon. METHODS Thirty ROSA raTKAs and 30 mTKAs performed by one surgeon during 2020-2021 were prospectively evaluated. Groups were matched for age, sex, and body mass index. All procedures were primary unilateral TKAs using the same posterior-stabilized prosthesis (Nexgen Legacy, Zimmer Biomet, Warsaw, IN). Length of hospital stay (LOS) and blood transfusion rate were recorded. Complications, visual analogue scale score (VAS), and Oxford Knee Score (OKS) were assessed preoperatively and for six postoperative months. The Forgotten Joint Score (FJS) and patient satisfaction were evaluated 6 months postoperatively. RESULTS No complications and similar blood transfusion rate were recorded between groups (p = 0.228). The LOS was non-significantly shorter in raTKA than in the mTKA group (p = 0.120). Mean preoperative and third-month OKS and VAS scores were comparable between groups. However, the mean 6-month OKS (p = 0.006) and VAS score (p = 0.025) were significantly better for the raTKA group. The 6-month FJS was significantly greater for raTKA than the mTKA group (p < 0.001). One patient was unhappy in raTKA, and three in the mTKA group (p = 0.301). Significantly more raTKA patients answered that they would undergo surgery again (p = 0.038). CONCLUSION raTKA was associated with the same complication risk, less pain level, better patient satisfaction, and PROMs on 6-month follow-up than the mTKA group.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece. .,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece. .,Department of Robotic Orthopaedic Surgery, Interbalkan European Medical Center, 54636, Thessaloniki, Greece.
| | - George Paparoidamis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Nikolaos Milonakis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Balkan Center, Aristotle University of Thessaloniki (AUTH), Buildings A & B10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece.,Department of Robotic Orthopaedic Surgery, Interbalkan European Medical Center, 54636, Thessaloniki, Greece
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Wu C, Fukui N, Lin YK, Lee CY, Chou SH, Huang TJ, Chen JY, Wu MH. Comparison of Robotic and Conventional Unicompartmental Knee Arthroplasty Outcomes in Patients with Osteoarthritis: A Retrospective Cohort Study. J Clin Med 2021; 11:220. [PMID: 35011960 PMCID: PMC8745819 DOI: 10.3390/jcm11010220] [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] [Received: 11/23/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
Robotic-arm-assisted unicompartmental knee arthroplasty (RUKA) was developed to increase the accuracy of bone alignment and implant positioning. This retrospective study explored whether RUKA has more favorable overall outcomes than conventional unicompartmental knee arthroplasty (CUKA). A total of 158 patients with medial compartment osteoarthritis were recruited, of which 85 had undergone RUKA with the Mako system and 73 had undergone CUKA. The accuracy of component positioning and bone anatomical alignment was compared using preoperative and postoperative radiograph. Clinical outcomes were evaluated using questionnaires, which the patients completed preoperatively and then postoperatively at six months, one year, and two years. In total, 52 patients from the RUKA group and 61 from the CUKA group were eligible for analysis. The preoperative health scores and Kellgren-Lawrence scores were higher in the RUKA group. RUKA exhibited higher implant positioning accuracy, thus providing a superior femoral implant angle, properly aligned implant placement, and a low rate of overhang. RUKA also achieved higher accuracy in bone anatomical alignment (tibial axis angle and anatomical axis angle) than CUKA, but surgical time was longer, and blood loss was greater. No significant differences were observed in the clinical outcomes of the two procedures.
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Affiliation(s)
- Christopher Wu
- College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - Nobuei Fukui
- Department of Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan;
| | - Yen-Kuang Lin
- Research Center of Statistics, College of Management, Taipei Medical University, Taipei 110, Taiwan;
| | - Ching-Yu Lee
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaoshiung Medical University Hospital, Kaoshiung 807, Taiwan;
- Regenerative Medicine and Cell Therapy Research Center, Kaoshiung Medical University, Kaoshiung 807, Taiwan
- Orthopedic Research Center, Kaoshiung Medical University, Kaoshiung 807, Taiwan
| | - Tsung-Jen Huang
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jen-Yuh Chen
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, Postal Hospital, Taipei 100, Taiwan
| | - Meng-Huang Wu
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 110, Taiwan; (C.-Y.L.); (T.-J.H.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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Robotic-assisted knee arthroplasty: an evolution in progress. A concise review of the available systems and the data supporting them. Arch Orthop Trauma Surg 2021; 141:2099-2117. [PMID: 34491411 DOI: 10.1007/s00402-021-04134-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A review of the data supporting robotic systems currently available is presented focussing on precision and reproducibility, radiological outcomes, clinical outcomes, and survivorship. MATERIALS AND METHODS Scientific literature published on robotic systems for knee arthroplasty was reviewed using the reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were any study involving robotic-assisted UKA or TKA that reported precision of implant positioning or functional outcomes or range of motion or survivorship, including cadaveric or dry bone studies with a minimum of 6-month follow-up. RESULTS Thirty-nine studies were identified for robotic-assisted unicompartmental knee arthroplasty, and 24 studies for robotic-assisted total knee arthroplasty. Those that reported on radiological outcomes or cadaver studies consistently demonstrated improved precision with the use of robotic systems irrespective of the system. PROMS and survival data demonstrated equivalent short-term results. However, many studies reported outcomes inconsistently and few had long-term clinical follow-up or survivorship data. CONCLUSIONS This review adds to the body of evidence supporting improved precision and reproducibility with robotic assistance in knee arthroplasty. Despite intensive funding of research into robotic knee systems, there remains considerable heterogeneity in exposure and outcome analysis and few quality long-term studies demonstrating translation to better clinical outcomes and implant survivorship.
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10
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Zambianchi F, Daffara V, Franceschi G, Banchelli F, Marcovigi A, Catani F. Robotic arm-assisted unicompartmental knee arthroplasty: high survivorship and good patient-related outcomes at a minimum five years of follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:3316-3322. [PMID: 32737526 DOI: 10.1007/s00167-020-06198-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Robotic arm-assisted unicompartmental knee arthroplasty (RA-UKA) has been shown to improve component placement, reduce intraoperative variability, increase patient satisfaction and improve short-term survivorship results. The aim of this retrospective study was to determine the incidence of revision and the clinical performance at a minimum of 5-year follow-up for a cohort of patients who received a medial RA-UKA. METHODS Between April 2011 and July 2013, a total of 254 patients underwent medial RA-UKA at a single centre. Clinical performance was investigated using the Forgotten Joint Score-12 (FJS-12) and a 5-level Likert scale made of five items to assess joint perception and patient satisfaction. Kaplan-Meier implant survivorship was calculated and reasons for revision were collected. The effect of age, gender and body mass index (BMI) on the probability of reporting high FJS-12 and satisfaction were assessed. RESULTS After considering exclusion criteria and loss to follow-up, a total of 216 patients (224 medial RA-UKAs) were assessed at a mean 5.9 years of follow-up. Five RA-UKAs underwent implant revision, resulting in an overall Kaplan-Meier survivorship of 97.8%. Unexplained knee pain (0.9%) was the most common reason for RA-UKA revision. Good-to-excellent FJS-12 scores and high satisfaction levels were reported at mid-term follow-up. Male patients had higher probability of having FJS-12 > 90 (p < 0.05) and high satisfaction levels (p < 0.05). CONCLUSIONS RA-UKAs demonstrated high survivorship and good-to-excellent patient-reported outcome measures and satisfaction levels at minimum 5-year follow-up. Results for male patients had improved clinical performance when compared to female subjects. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy.
| | - Valerio Daffara
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Giorgio Franceschi
- Department of Knee Surgery, Policlinico di Abano Terme, Abano Terme, PD, Italy
| | - Federico Banchelli
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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11
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Kaneko T, Igarashi T, Takada K, Yoshizawa S, Ikegami H, Musha Y. Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements. Knee 2021; 31:64-76. [PMID: 34118583 DOI: 10.1016/j.knee.2021.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/06/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study was to compare the accuracy of prosthetic alignment with three-dimensional computed tomography (3DCT) measurements following total knee arthroplasty (TKA) performed using a robotic-assisted surgical technique versus a conventional TKA. METHODS 41 TKAs were performed with a handheld robotic-assisted surgical procedure (Robot group) between 2019 and 2020. Another 41 patients underwent TKA with a conventional manual surgical procedure (Manual group) using the same prosthesis. The operation durations between both groups were investigated. 3DCT scans of the entire lower extremities were taken before and after the surgery and femoral and tibial alignments in the coronal, sagittal, and axial planes were measured using computer software. The differences in prosthetic alignment and translation between the preoperative 3DCT plan and postoperative 3DCT image were also measured. RESULTS There were no statistically significant differences in the post-operative outliers of the femorotibial angle between the groups. In the tibial-axial plane, the mean of prosthetic alignment in the anteroposterior plane was 4.0° in the Robot group and 6.7° in the Manual group (p < 0.01). The rate of outliers for tibial-axial alignment in the Robot group was significantly less than in the Manual group (p < 0.01). There were no statistically significant differences in prosthetic translation in the proximal-distal, anterior-posterior and medial-lateral orientations between the groups. CONCLUSIONS In a radiologic study using 3DCT, robotic-assisted TKA reduced the outliers for rotational alignment of the tibial prosthesis in comparison to conventional TKA, which can lead to improved tracking of the femoral-tibial bearing surfaces.
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Affiliation(s)
- Takao Kaneko
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | | | - Kazutaka Takada
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | - Shu Yoshizawa
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | - Hiroyasu Ikegami
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
| | - Yoshiro Musha
- Department of Orthopedic Surgery, Toho University School of Medicine, Japan.
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12
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Mittal A, Meshram P, Kim TK. What is the evidence for clinical use of advanced technology in unicompartmental knee arthroplasty? Int J Med Robot 2021; 17:e2302. [PMID: 34196097 DOI: 10.1002/rcs.2302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND With an aim of improving prosthesis survivorship of unicompartmental knee arthroplasty (UKA), use of computer-assisted technologies (CATs) such as robotics, has been on the rise to reduce intraoperative errors in surgical technique. In light of recent influx of CATs in the UKA, a review of these innovations will help providers to understand their clinical utility. METHOD A systematic literature search was performed following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. RESULTS Among 19 studies comparing robot-assisted UKA with conventional UKA, only 32% were randomized control trials, 47% reported minimum mean follow-up of 2 years, and 21% evaluated prosthesis survival. Similar results were obtained for navigation-assisted UKA and UKA performed with patient-specific instrumentation. CONCLUSION While CATs seem to reduce the surgical errors in UKA, the evidence on the efficacy of any of the studied CATs to improve survivorship remains limited and there are issues related to cost-effectiveness, learning curve, and increase in operating time.
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Affiliation(s)
- Anurag Mittal
- Department of Orthopedics, Max Super Speciality Hospital, Dehradun, Uttarakhand, India
| | - Prashant Meshram
- Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tae Kyun Kim
- TK Orthopaedic Institution, Seongnam, Bundang, South Korea
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13
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Banger M, Doonan J, Rowe P, Jones B, MacLean A, Blyth MJB. Robotic arm-assisted versus conventional medial unicompartmental knee arthroplasty: five-year clinical outcomes of a randomized controlled trial. Bone Joint J 2021; 103-B:1088-1095. [PMID: 34058870 PMCID: PMC8153511 DOI: 10.1302/0301-620x.103b6.bjj-2020-1355.r2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarthritis localized to a single compartment in the knee. The success of the procedure is sensitive to patient selection and alignment errors. Robotic arm-assisted UKA provides technological assistance to intraoperative bony resection accuracy, which is thought to improve ligament balancing. This paper presents the five-year outcomes of a comparison between manual and robotically assisted UKAs. Methods The trial design was a prospective, randomized, parallel, single-centre study comparing surgical alignment in patients undergoing UKA for the treatment of medial compartment osteoarthritis (ISRCTN77119437). Participants underwent surgery using either robotic arm-assisted surgery or conventional manual instrumentation. The primary outcome measure (surgical accuracy) has previously been reported, and, along with secondary outcomes, were collected at one-, two-, and five-year timepoints. Analysis of five-year results and longitudinal analysis for all timepoints was performed to compare the two groups. Results Overall, 104 (80%) patients of the original 130 who received surgery were available at five years (55 robotic, 49 manual). Both procedures reported successful results over all outcomes. At five years, there were no statistical differences between the groups in any of the patient reported or clinical outcomes. There was a lower reintervention rate in the robotic arm-assisted group with 0% requiring further surgery compared with six (9%) of the manual group requiring additional surgical intervention (p < 0.001). Conclusion This study has shown excellent clinical outcomes in both groups with no statistical or clinical differences in the patient-reported outcome measures. The notable difference was the lower reintervention rate at five years for roboticarm-assisted UKA when compared with a manual approach. Cite this article: Bone Joint J 2021;103-B(6):1088–1095.
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Affiliation(s)
- Matthew Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Bryn Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Mark J B Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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14
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Mergenthaler G, Batailler C, Lording T, Servien E, Lustig S. Is robotic-assisted unicompartmental knee arthroplasty a safe procedure? A case control study. Knee Surg Sports Traumatol Arthrosc 2021; 29:931-938. [PMID: 32390119 DOI: 10.1007/s00167-020-06051-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The hypotheses were that firstly there is few early specific complications due to the use of a robotic-assisted system for unicompartimental knee arthroplasty (UKA), and secondly there are less revisions and complications after robotic-assisted UKA than after conventional UKA. METHODS 200 robotic-assisted UKA (175 patients) and 191 conventional UKA (179 patients) were performed between 2013 and 2018 from the same center. Revisions, intraoperative and postoperative complications, functional and radiological results were collected at the most recent follow-up. RESULTS At the most recent follow-up (≥ 1 year), revision rates were 4% (n = 8/200) for robotic-assisted UKA and 11% (n = 21/191) for conventional UKA (p = 0.014). Reoperation rates without implant removal were comparable in the robotic and conventional group (7.3% vs 8.6%). Complication rates for stiffness (4.7% vs 4.2%) and infection (1% vs 1.6%) were comparable in both groups. There was no specific complication related to the robotic-assisted system (no soft tissue or bone lesion caused by the use of the robotic-assistance and no complication related to the use of navigation pins). The KSS function scores were higher following robotic-assisted UKA (p = 0.01). Satisfaction rates and contralateral OA were comparable in the two groups. CONCLUSION No complications due to the robotic-assisted system were found in this study. There was no difference in the general complications rate between both groups. Robotic-assisted UKA has a lower revision rate compared to conventional technique UKA at the short-term follow-up. LEVEL OF EVIDENCE III. CLINICAL RELEVANCE This is the first paper comparing revision rate and clinical outcome between UKA performed using the NAVIO robotic system and a conventional technique and searching for specific complication related to the use of the NAVIO robotic system.
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Affiliation(s)
- Guillaume Mergenthaler
- Department of Orthopedic Surgery and Sport Medicine, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Timothy Lording
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, 3181, Australia
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
- EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
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15
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Kim TK, Mittal A, Meshram P, Kim WH, Choi SM. Evidence-based surgical technique for medial unicompartmental knee arthroplasty. Knee Surg Relat Res 2021; 33:2. [PMID: 33413698 PMCID: PMC7792201 DOI: 10.1186/s43019-020-00084-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/26/2020] [Indexed: 01/04/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) is a successful treatment modality in selected patients having advanced, single-compartment osteoarthritis of the knee. The bone and ligament preservation leading to shorter recovery periods, better functional outcomes, lower perioperative complication rates, and easier revision, if needed, are proposed as some of the advantages of UKA over total knee arthroplasty (TKA). Despite several advantages, UKA is reported to have higher failure rates as compared to TKA. The prosthesis failure of UKA is directly correlated to intraoperative technique-related factors like malpositioning of components and the inability to replicate the target-limb alignment as per preoperative planning. An evidence-based surgical technique for UKA may help surgeons to avoid the intraoperative technique-related errors. The purpose of this paper is to describe a stepwise surgical technique for the fixed-bearing medial UKA.
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Affiliation(s)
- Tae Kyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea.
| | - Anurag Mittal
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Prashant Meshram
- Department of Orthopaedics, Johns Hopkins Medical Institute, 2360 West Joppa Road, Suite 306, Baltimore, MD, 21093, USA
| | - Woo Hyun Kim
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
| | - Sang Min Choi
- TK Orthopedic Institution, 55 Dongpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13535, Republic of Korea
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16
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Petterson SC, Blood TD, Plancher KD. Role of alignment in successful clinical outcomes following medial unicompartmental knee arthroplasty: current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Lin J, Yan S, Ye Z, Zhao X. A systematic review of MAKO-assisted unicompartmental knee arthroplasty. Int J Med Robot 2020; 16:1-7. [PMID: 32445224 DOI: 10.1002/rcs.2124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Unicompartmental knee arthroplasty (UKA), which has many potential advantages compared with total knee arthroplasty, was widely used across the world in recent years. The introduction of the robot systems greatly makes up for the defects of the conventional UKA surgery such as higher complication rates and revision rates. MAKO system, a new image-guided robot system relies on a preoperative computed tomography scan to assist in preoperative mapping and planning, offers an opportunity to improve the outcome of UKA surgeries. In order to have a more comprehensive and in-depth understanding of MAKO-assisted UKA, the studies on MAKO-assisted UKA were summarized. MAKO-assisted UKA is better than conventional UKA surgery on implant accuracy, soft tissue balance, patient function scores and satisfaction, complications rates, and learning curve in short-term outcome; however, the mid-term and long-term outcomes of MAKO-assisted UKA need to be further studied.
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Affiliation(s)
- Jiyan Lin
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xiang Zhao
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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18
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Zambianchi F, Franceschi G, Rivi E, Banchelli F, Marcovigi A, Khabbazè C, Catani F. Clinical results and short-term survivorship of robotic-arm-assisted medial and lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:1551-1559. [PMID: 31218389 DOI: 10.1007/s00167-019-05566-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/13/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of this multicentre, retrospective, observational study was to determine the incidence of revision and clinical results of a large cohort of robotic-arm-assisted medial and lateral UKAs at short-term follow-up. It was hypothesized that patients who receive robotic-arm-assisted UKA will have high survivorship rates and satisfactory clinical results. METHODS Between 2013 and 2016, 437 patients (470 knees) underwent robotic-arm-assisted medial and lateral UKAs at two centres. Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score 12 (FJS-12) and Short-Form Physical and Mental Health Summary Scales (SF-12) were administered to estimate patients' overall health status pre- and post-operatively. Results were dichotomized as 'excellent' and 'poor' if KOOS/FJS-12 were more than or equal to 90 and SF-12 was more or equal to 45. Associations between patients' demographic characteristics and clinical outcomes were investigated. Post-operative complications and pain persistence were recorded. RESULTS Following exclusions and losses to follow-up, 338 medial and 67 lateral robotic-arm-assisted UKAs were assessed at a mean follow-up of 33.5 and 36.3 months, respectively. Three medial UKAs were revised, resulting in a survivorship of 99.0%. No lateral implants underwent revision (survivorship 100%). On average, significant improvement in all clinical scores was reported in both medial and lateral UKA patients. In medial UKA patients, male gender was associated with higher probability of better scores in overall KOOS, FJS-12 and in specific KOOS subscales. No other associations were reported between biometric parameters and outcome for either medial or lateral UKA. CONCLUSIONS Robotic-assisted medial and lateral UKAs demonstrated satisfactory clinical outcomes and excellent survivorship at 3-year follow-up. Continued patient follow-up is needed to determine the long-term device performance and clinical satisfaction. LEVEL OF EVIDENCE Retrospective cohort study, Level IV.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio-Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
| | - Giorgio Franceschi
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, PD, Italy
| | - Elisa Rivi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio-Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Federico Banchelli
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio-Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Claudio Khabbazè
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, PD, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio-Emilia, Via del Pozzo, 71, 41124, Modena, Italy
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St Mart JP, de Steiger RN, Cuthbert A, Donnelly W. The three-year survivorship of robotically assisted versus non-robotically assisted unicompartmental knee arthroplasty. Bone Joint J 2020; 102-B:319-328. [PMID: 32114810 DOI: 10.1302/0301-620x.102b3.bjj-2019-0713.r1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM There has been a significant reduction in unicompartmental knee arthroplasty (UKA) procedures recorded in Australia. This follows several national joint registry studies documenting high UKA revision rates when compared to total knee arthroplasty (TKA). With the recent introduction of robotically assisted UKA procedures, it is hoped that outcomes improve. This study examines the cumulative revision rate of UKA procedures implanted with a newly introduced robotic system and compares the results to one of the best performing non-robotically assisted UKA prostheses, as well as all other non-robotically assisted UKA procedures. METHODS Data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR) for all UKA procedures performed for osteoarthritis (OA) between 2015 and 2018 were analyzed. Procedures using the Restoris MCK UKA prosthesis implanted using the Mako Robotic-Arm Assisted System were compared to non-robotically assisted Zimmer Unicompartmental High Flex Knee System (ZUK) UKA, a commonly used UKA with previously reported good outcomes and to all other non-robotically assisted UKA procedures using Cox proportional hazard ratios (HRs) and Kaplan-Meier estimates of survivorship. RESULTS There was no difference in the rate of revision when the Mako-assisted Restoris UKA was compared to the ZUK UKA (zero to nine months: HR 1.14 (95% CI 0.71 to 1.83; p = 0.596) vs nine months and over: HR 0.66 (95% CI 0.42 to 1.02; p = 0.058)). The Mako-assisted Restoris had a significantly lower overall revision rate compared to the other types of non-robotically assisted procedures (HR 0.58 (95% confidence interval (CI) 0.42 to 0.79); p < 0.001) at three years. Revision for aseptic loosening was lower for the Mako-assisted Restoris compared to all other non-robotically assisted UKA (entire period: HR 0.34 (95% CI 0.17 to 0.65); p = 0.001), but not the ZUK prosthesis. However, revision for infection was significantly higher for the Mako-assisted Restoris compared to the two comparator groups (ZUK: entire period: HR 2.91 (95% CI 1.22 to 6.98; p = 0.016); other non-robotically assisted UKA: zero to three months: HR 5.57 (95% CI 2.17 to 14.31; p < 0.001)). CONCLUSION This study reports comparable short-term survivorship for the Mako robotically assisted UKA compared to the ZUK UKA and improved survivorship compared to all other non-robotic UKA. These results justify the continued use and investigation of this procedure. However, the higher rate of early revision for infection for robotically assisted UKA requires further investigation. Cite this article: Bone Joint J 2020;102-B(3):319-328.
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Affiliation(s)
- Jean-Pierre St Mart
- St Vincent's Hospital Northside, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Victoria, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Alana Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - William Donnelly
- St Vincent's Hospital Northside, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
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20
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吴 东, 杨 敏, 曹 正, 孔 祥, 王 毅, 郭 人, 柴 伟. [Research progress in unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:145-150. [PMID: 32030942 PMCID: PMC8171978 DOI: 10.7507/1002-1892.201906085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 11/24/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical application and research progress in unicompartmental knee arthroplasty (UKA). METHODS The literature related to UKA in recent years was reviewed and the emerging indications, implant options, comparisons between other surgical techniques, and recent advances were summarized. RESULTS Clinical studies show that UKA has many advantages, such as less trauma, faster recovery, and fewer postoperative complications. At present, the operative indication has been expanded. The body mass index more than 25 kg/m 2, less than 60 years old, patellofemoral arthritis, and anterior cruciate ligament dysfunction are no longer considered as contraindications. The prosthesis type in UKA should be selected according to the patient's condition. In recent years, the robot-assisted UKA can effectively improve the effectiveness, improve patient satisfaction, and reduce postoperative complications. CONCLUSION With the development of surgical techniques, designs of prosthesis, and the robotic technology, UKA would be further applicated. As more long-term data on UKA become available, it will further guide clinicians in counseling patients on whether UKA should be performed.
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Affiliation(s)
- 东 吴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 敏之 杨
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院(天津 300071)Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 正 曹
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 南开大学医学院(天津 300071)Medicine School of Nankai University, Tianjin, 300071, P.R.China
| | - 祥朋 孔
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 毅 王
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 人文 郭
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 伟 柴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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Park KK, Han CD, Yang IH, Lee WS, Han JH, Kwon HM. Robot-assisted unicompartmental knee arthroplasty can reduce radiologic outliers compared to conventional techniques. PLoS One 2019; 14:e0225941. [PMID: 31794587 PMCID: PMC6890211 DOI: 10.1371/journal.pone.0225941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to compare the clinical and radiologic outcomes of robot-assisted unicompartmental knee arthroplasty (UKA) to those of conventional UKA in Asian patients. Methods Fifty-five patients underwent robot-assisted UKA and 57 patients underwent conventional UKA were assessed in this study. Preoperative and postoperative range of motion (ROM), American Knee Society (AKS) score, Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC), and patellofemoral (PF) score values were compared between the two groups. The mechanical femorotibial angle (mFTA) and Kennedy zone were also measured. Coronal alignments of the femoral and tibial components and posterior slopes of the tibial component were compared. Additionally, polyethylene (PE) liner thicknesses were compared. Results There was no significant difference between the two groups regarding postoperative ROM, AKS, WOMAC and PF score. Robot group showed fewer radiologic outliers in terms of mFTA and coronal alignment of tibial and femoral components (p = 0.022, 0.037, 0.003). The two groups showed significantly different PE liner thicknesses (8.4 ± 0.8 versus 8.8 ± 0.9, p = 0.035). Robot group was the only influencing factor for reducing radiologic outlier (postoperative mFTA) in multivariate model (odds ratio: 2.833, p = 0.037). Conclusion In this study, robot-assisted UKA had many advantages over conventional UKA, such as its ability to achieve precise implant insertion and reduce radiologic outliers. Although the clinical outcomes of robot-assisted UKA over a short-term follow-up period were not significantly different compared to those of conventional UKA, longer follow-up period is needed to determine whether the improved radiologic accuracy of the components in robotic-assisted UKA will lead to better clinical outcomes and improved long-term survival.
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Affiliation(s)
- Kwan Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ick-Hwan Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hyung Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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22
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Bush AN, Ziemba-Davis M, Deckard ER, Meneghini RM. An Experienced Surgeon Can Meet or Exceed Robotic Accuracy in Manual Unicompartmental Knee Arthroplasty. J Bone Joint Surg Am 2019; 101:1479-1484. [PMID: 31436656 DOI: 10.2106/jbjs.18.00906] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reports in the literature indicate that implant placement is more accurate with robotic-assisted unicompartmental knee arthroplasty (UKA); however, these studies have not always accounted for surgeon experience. The purpose of the present study was to compare the accuracy of tibial component alignment in UKA between an experienced high-volume surgeon and the published data on robotic-assisted surgery. METHODS The radiographs made before and after 128 consecutive medial UKAs performed manually by a single surgeon using a cemented fixed-bearing implant were reviewed. Native tibial and tibial implant slope and varus alignment of the tibial implant were measured on preoperative and postoperative lateral and anteroposterior radiographs, respectively. The percentages of knees in which the postoperative measurements were within preoperative targets and the root mean square (RMS) error rates between the planned and achieved targets were compared with published robotic-assisted-UKA data. RESULTS In the present study, the proportion of manual UKAs in which the tibial component alignment was within the preoperative target was 66% (85 of 128), which exceeded published values in a study comparing robotic (58%) with manual (41%) UKA. The RMS error for tibial component alignment in the present study (1.48°) was less than published RMS error rates for robotic UKAs (range, 1.8° to 5°). Fifty-eight percent (74) of the 128 study UKAs were within the surgeon's preoperative goal for tibial slope, which was closer to the published value of 80% for robotic UKAs than is the published rate of 22% for manual UKAs. The RMS error for tibial slope in the study UKAs (1.50°) was smaller than the published RMS error rates for tibial slope in robotic UKAs (range, 1.6° to 1.9°). CONCLUSIONS Accurate implant alignment is important in UKA. In this study, an experienced surgeon achieved or exceeded robotic accuracy of tibial implant alignment in UKA. However, the relationship between implant position and patient outcomes is unknown, and a consensus on ideal surgical targets for optimal implant survivorship has yet to be established. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ashleigh N Bush
- School of Medicine, Indiana University-Purdue University at Indianapolis, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- Indiana University Health Physicians Orthopedics at IU Health Saxony Hospital, Fishers, Indiana
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Fishers, Indiana
| | - R Michael Meneghini
- Indiana University Health Physicians Orthopedics at IU Health Saxony Hospital, Fishers, Indiana.,Department of Orthopaedic Surgery, Indiana University School of Medicine, Fishers, Indiana
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23
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Robinson PG, Clement ND, Hamilton D, Blyth MJG, Haddad FS, Patton JT. A systematic review of robotic-assisted unicompartmental knee arthroplasty: prosthesis design and type should be reported. Bone Joint J 2019; 101-B:838-847. [PMID: 31256672 DOI: 10.1302/0301-620x.101b7.bjj-2018-1317.r1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. MATERIALS AND METHODS A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "knee", and "surgery". The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies. RESULTS A total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001). CONCLUSION There is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838-847.
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Affiliation(s)
| | - N D Clement
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - D Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - M J G Blyth
- Glasgow Royal Infirmary Orthopaedic Research Unit, Glasgow, UK
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
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24
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Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1232-1240. [PMID: 30066017 DOI: 10.1007/s00167-018-5081-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this case-control study was to compare implant position and revision rate for UKA, performed with either a robotic-assisted system or with conventional technique. METHODS Eighty UKA (57 medial, 23 lateral) were performed with robotic assistance (BlueBelt Navio system) between 2013 and 2017. These patients were matched with 80 patients undergoing UKA using the same prosthesis, implanted using conventional technique. The sagittal and coronal component position was assessed on postoperative radiographs. The revision rate was reported at last follow-up. RESULTS The mean follow-up was 19.7 months ± 9 for the robotic-assisted group, and 24.2 months ± 16 for the control group. The rate of postoperative limb alignment outliers (± 2°) was significantly higher in the control group than in the robotic-assisted group for both lateral UKA (26% in robotic group versus 61% in control group; p = 0.018) and medial UKA (16% versus 32%, resp.; p = 0.038). The coronal and sagittal tibial baseplate position had significantly less outliers (± 3°) in the robotic-assisted group, than in the control group. Revision rates were: 5% (n = 4/80) for robotic assisted UKA and 9% (n = 7/80) for conventional UKA (n.s.). The reasons for revision were different between groups, with 86% of revisions in the control group occurring in association with component malposition or limb malalignment, compared with none in the robotic-assisted group. CONCLUSION Robotic-assisted UKA has a lower rate of postoperative limb alignment outliers, as well as a lower revision rate, compared to conventional technique. The accuracy of implant positioning is improved by this robotic-assisted system. LEVEL OF EVIDENCE Level of evidence III. Retrospective case-control study CLINICAL RELEVANCE: This is the first paper comparing implant position, clinical outcome, and revision rate for UKA performed using the Navio robotic system with a control group.
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Affiliation(s)
- Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France.
| | - Nathan White
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | | | - Philippe Neyret
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
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25
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Abstract
Medial unicompartmental knee arthroplasty (UKA) has several benefits over total knee arthroplasty for the surgical treatment of isolated medial compartmental arthritis in the knee, including reduced surgical risk and postoperative morbidity, rapid recovery, more normal kinematics, greater patient satisfaction, and shorter hospitalization. Nonetheless, there is substantial concern about the higher revision rates and lower survivorship in UKA compared to those in total knee arthroplasty. Robotic assistance has been advanced to improve the precision of bone preparation, component alignment, and quantified ligament balance in UKA, with the ultimate goal of improving kinematics and implant survivorship. Two currently available semiautonomous robotic platforms have demonstrated improved accuracy, and emerging short-term follow-up has demonstrated satisfactory functional outcomes. Further studies will be needed to determine if these technologies indeed have a meaningful impact on patient outcomes and survivorship in the mid- to long term.
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26
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Fu J, Wang Y, Li X, Yu B, Ni M, Chai W, Hao L, Chen J. Robot-assisted vs. conventional unicompartmental knee arthroplasty : Systematic review and meta-analysis. DER ORTHOPADE 2018; 47:1009-1017. [PMID: 30051277 DOI: 10.1007/s00132-018-3604-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Numerous advances have been made in prosthesis design, instrumentation and postoperative rehabilitation for unicompartmental knee arthroplasty; however, only 70-86% of patients are satisfied with the functional outcome and revision rates range between 10% and 20%. The primary outcome for this meta-analysis was implantation accuracy of component positioning and tibiofemoral component safe zone. A total of three randomized controlled trials (RCT), three quasi-RCTs and one prospective trial were included in this review. It was found that the use of robotic-assisted systems reduces implantation errors without an increase in adverse events. There are only a few reports about clinical outcome and long-term follow-up and whether the more accurate component positioning results in a better clinical effect or a better long-term survival of the implants is unknown.
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Affiliation(s)
- Jun Fu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Yuning Wang
- Clinical Department of Surgery, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Xiang Li
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Baozhan Yu
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Ming Ni
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Wei Chai
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Libo Hao
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China
| | - Jiying Chen
- Department of Orthopaedics, Chinese People's Liberation Army General Hospital (301 Hospital), 28 Fuxing Rd, 100853, Beijing, China.
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27
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Deese JM, Gratto-Cox G, Carter DA, Sasser TM, Brown KL. Patient reported and clinical outcomes of robotic-arm assisted unicondylar knee arthroplasty: Minimum two year follow-up. J Orthop 2018; 15:847-853. [PMID: 30140132 DOI: 10.1016/j.jor.2018.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background Unicompartmental knee arthroplasty (UKA) originated in the 1950's. There have been many enhancements to the implants and the technique, improving the precision and accuracy of this challenging operation. Specifically for Robotic Arm Interactive Orthopedic System (Rio; Mako Stryker, Fort Lauderdale, FL), there are many studies reporting clinical outcomes, but our search offered nothing regarding patient reported outcomes using validated surveys. Methods Patients with onlay tibial components presenting for routine follow-up of robotic-arm assisted UKA performed between May 2009 and September 2013 were invited to participate. Four joints had simultaneous patella femoral resurfacing. Knee Injury and Osteoarthritis Outcomes Score (KOOS) and the 2011 Knee Society Scores were collected. Radiographic evidence of osteoarthritis in the non-operative knee compartments was documented. Results Eighty-one patients presented for follow-up and consented to participate. Mean follow up was 54 months. Mean patient reported KOOS activities of daily living and pain scores were each 90. Knee Society 2011 mean objective score was 96 and mean function score 81. There was one revision to total knee at 40 months post-op for pain after injury. Seventy-seven percent reported their knee always felt "Normal", 20% sometimes, and only 3% reported that it never felt normal. Conclusion Literature on UKA failure rates suggests that UKA may be a less forgiving procedure than total knee arthroplasty. Robotic-arm assisted surgery is reported to improve the accuracy of implant placement. Based on our prospectively collected positive patient outcomes, the authors have achieved good results from performing robotic-arm assisted UKA on select patients.
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Affiliation(s)
- J Melvin Deese
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Gwen Gratto-Cox
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Denny A Carter
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Thomas M Sasser
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Karah L Brown
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
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Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B:930-937. [PMID: 29954217 PMCID: PMC6413767 DOI: 10.1302/0301-620x.100b7.bjj-2017-1449.r1] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims The objective of this study was to compare early postoperative
functional outcomes and time to hospital discharge between conventional
jig-based total knee arthroplasty (TKA) and robotic-arm assisted
TKA. Patients and Methods This prospective cohort study included 40 consecutive patients
undergoing conventional jig-based TKA followed by 40 consecutive
patients receiving robotic-arm assisted TKA. All surgical procedures
were performed by a single surgeon using the medial parapatellar
approach with identical implant designs and standardized postoperative inpatient
rehabilitation. Inpatient functional outcomes and time to hospital
discharge were collected in all study patients. Results There were no systematic differences in baseline characteristics
between the conventional jig-based TKA and robotic-arm assisted
TKA treatment groups with respect to age (p = 0.32), gender (p =
0.50), body mass index (p = 0.17), American Society of Anesthesiologists
score (p = 0.88), and preoperative haemoglobin level (p = 0.82). Robotic-arm
assisted TKA was associated with reduced postoperative pain (p <
0.001), decreased analgesia requirements (p < 0.001), decreased
reduction in postoperative haemoglobin levels (p < 0.001), shorter
time to straight leg raise (p < 0.001), decreased number of physiotherapy
sessions (p < 0.001) and improved maximum knee flexion at discharge
(p < 0.001) compared with conventional jig-based TKA. Median
time to hospital discharge in robotic-arm assisted TKA was 77 hours
(interquartile range (IQR) 74 to 81) compared with 105 hours (IQR
98 to 126) in conventional jig-based TKA (p < 0.001). Conclusion Robotic-arm assisted TKA was associated with decreased pain,
improved early functional recovery and reduced time to hospital
discharge compared with conventional jig-based TKA. Cite this article: Bone Joint J 2018;100-B:930–7.
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Affiliation(s)
- B Kayani
- University College London Hospitals and Princess Grace Hospital, London, UK
| | - S Konan
- University College London Hospitals and Princess Grace Hospital, London, UK
| | | | - J R T Pietrzak
- University College London Hospitals and Princess Grace Hospital, London, UK
| | - F S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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29
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Robotic-Assisted Unicompartmental Knee Arthroplasty: State-of-the Art and Review of the Literature. J Arthroplasty 2018; 33:1994-2001. [PMID: 29555499 DOI: 10.1016/j.arth.2018.01.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty is a successful treatment for unicompartmental knee osteoarthritis that has lower complication rates, faster recovery, and a more natural feeling knee compared to total knee arthroplasty. However, long-term survival has been a persistent concern. As more surgeon-controlled variables have been linked to survival, interest in robotic-assisted surgery has continued to grow. METHODS A review and synthesis of the literature on the subject of robotic-assisted unicompartmental knee arthroplasty was performed. RESULTS We present the driving factors behind the development of robotic-assisted techniques in unicompartmental knee arthroplasty and the current state-of-the art. The ability of surgeons to achieve intraoperative targets with robotic assistance and the outcomes of robotic-assisted surgery are also described. CONCLUSION Robotic-assisted surgery has become increasingly popular in unicompartmental knee arthroplasty, as it allows surgeons to more accurately and reproducibly plan and achieve operative targets during surgery. Cost remains a concern, and it remains to be seen whether robotic-assisted surgery will improve long-term survivorship after unicompartmental knee arthroplasty.
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30
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Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Midterm Survivorship and Patient Satisfaction of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2018; 33:1719-1726. [PMID: 29486909 DOI: 10.1016/j.arth.2018.01.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/02/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies have showed improved accuracy of lower leg alignment, precise component position, and soft-tissue balance with robotic-assisted unicompartmental knee arthroplasty (UKA). No studies, however, have assessed the effect on midterm survivorship. Therefore, the purpose of this prospective, multicenter study was to determine midtem survivorship, modes of failure, and satisfaction of robotic-assisted medial UKA. METHODS A total of 473 consecutive patients (528 knees) underwent robotic-arm-assisted medial UKA surgery at 4 separate institutions between March 2009 and December 2011. All patients received a fixed-bearing, metal-backed onlay tibial component. Each patient was contacted at minimum 5-year follow-up and asked a series of questions to determine survival and satisfaction. Kaplan-Meier method was used to determine survivorship. RESULTS Data were collected for 384 patients (432 knees) with a mean follow-up of 5.7 years (5.0-7.7). The follow-up rate was 81.2%. In total, 13 revisions were performed, of which 11 knees were converted to total knee arthroplasty and in 2 cases 1 UKA component was revised, resulting in 97% survivorship. The mean time to revision was 2.27 years. The most common failure mode was aseptic loosening (7/13). Fourteen reoperations were reported. Of all unrevised patients, 91% was either very satisfied or satisfied with their knee function. CONCLUSION Robotic-arm-assisted medial UKA showed high survivorship and satisfaction at midterm follow-up in this prospective, multicenter study. However, in spite of the robotic technique, early fixation failure remains the primary cause for revision with cemented implants. Comparative studies are necessary to confirm these findings and compare to conventional implanted UKA and total knee arthroplasty.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, OR
| | - Thomas M Coon
- Department of Orthopaedic Surgery, Coon Joint Replacement Institute, St. Helena, CA
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, FL
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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31
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Motesharei A, Rowe P, Blyth M, Jones B, Maclean A. A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA. Gait Posture 2018. [PMID: 29524796 DOI: 10.1016/j.gaitpost.2018.02.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little research has been conducted to ascertain if this results in a measureable improvement in knee function post operatively and a more normal gait. The kinematics of 70 OA knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Statistically significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There were no significant difference between the healthy group and the robotic assisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also some kinematic benefits to the user during gait.
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Affiliation(s)
- Arman Motesharei
- Biomedical Engineering Department, University of Strathclyde, 106 Rottenrow East, Glasgow, G4 0NW, UK
| | - Philip Rowe
- Biomedical Engineering Department, University of Strathclyde, 106 Rottenrow East, Glasgow, G4 0NW, UK.
| | - Mark Blyth
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Bryn Jones
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Angus Maclean
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
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32
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Enayati N, Ferrigno G, De Momi E. Performance metrics for guidance active constraints in surgical robotics. Int J Med Robot 2017; 14. [DOI: 10.1002/rcs.1873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nima Enayati
- Department of Electronics; Information and Bioengineering, Politecnico di Milano; Milan Italy
| | - Giancarlo Ferrigno
- Department of Electronics; Information and Bioengineering, Politecnico di Milano; Milan Italy
| | - Elena De Momi
- Department of Electronics; Information and Bioengineering, Politecnico di Milano; Milan Italy
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33
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Marcovigi A, Zambianchi F, Sandoni D, Rivi E, Catani F. Robotic-arm assisted partial knee arthroplasty: a single centre experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:54-59. [PMID: 28657565 DOI: 10.23750/abm.v88i2 -s.6514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK UKA has proven to be an effective surgical procedure, but its survivorship is still negatively affected by inaccuracy in component component positioning, implant and limb alignment. Robotic surgery has been introduced in order to minimize such technical errors. The aim of the present paper was to evaluate clinical and surgical outcomes after a 3 years' experience of robotic assisted UKA with the Mako Robotic Arm. METHODS Seventy-three patients undergoing UKA with robotic instrumentation (65 medial UKAs, 8 lateral UKAs) and with a clinical follow-up of 3 -37 months were included in the present study. A complete clinical evaluation with KOOS, FJS-12 and SF-12 was administered to all patients pre and post operatively. Post-operative HKA angle and surgical time were also recorded. RESULTS Mean post-operative KOOS score was 81.32 (SD 17.19), while the mean FJS-12 score was 75.51 (SD 30.12) and the mean SF-12 Physical Score 42.25 (SD 9.97). 91% to 88% of post-operative results were considered satisfactory. Only 1 UKA failure was reported (1.3%) caused by peri-prosthetic infection. In medial UKAs mean postoperative HKA angle in extension was 3.9° varus (SD 2.5°), with no case of overcorrection; in lateral UKAs mean postoperative HKA angle in extension was 1.9° valgus (SD 1.9°) with 1 case (13%) of overcorrection. Mean skin to skin surgical time decreased from 83.2 minutes (SD 13.0) to 70.0 minutes (SD 10.9) along the learning curve. CONCLUSIONS Robotic UKA has provided an improvement both in clinical and technical results, determining satisfactory clinical outcomes and a low risk of post-operative complications.
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34
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Jinnah AH, Multani A, Jinnah RH, Plate JF. Robotic unicondylar knee arthroplasty: a commentary on a recently published level 1 study. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:S40. [PMID: 27868008 DOI: 10.21037/atm.2016.10.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alexander H Jinnah
- Wake Forest School of Medicine, Department of Orthopaedic Surgery, Medical Center Blvd, Winston Salem, NC 27157, USA
| | - Ashley Multani
- Windsor University School of Medicine, St. Kitts, West Indies
| | - Riyaz H Jinnah
- Wake Forest School of Medicine, Department of Orthopaedic Surgery, Medical Center Blvd, Winston Salem, NC 27157, USA; ; Southeastern Regional Medical Center, Lumberton, NC, USA
| | - Johannes F Plate
- Wake Forest School of Medicine, Department of Orthopaedic Surgery, Medical Center Blvd, Winston Salem, NC 27157, USA
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Enayati N, De Momi E, Ferrigno G. Haptics in Robot-Assisted Surgery: Challenges and Benefits. IEEE Rev Biomed Eng 2016; 9:49-65. [DOI: 10.1109/rbme.2016.2538080] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Banerjee S, Cherian JJ, Elmallah RK, Jauregui JJ, Pierce TP, Mont MA. Robotic-assisted knee arthroplasty. Expert Rev Med Devices 2015; 12:727-35. [PMID: 26365088 DOI: 10.1586/17434440.2015.1086264] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robotics in total knee arthroplasty (TKA) has undergone vast improvements. Although some of the systems have fallen out of favor due to safety concerns, there has been recent increased interest for semi-active haptic robotic systems that provide intraoperative tactile feedback to the surgeon. The potential advantages include improvements in radiographic outcomes, reducing the incidence of mechanical axis malalignment of the lower extremity and better tissue balance. Proponents of robotic technology believe that these improvements may lead to superior functional outcomes and implant survivorship. We aim to discuss robotic technology development, outcomes of unicompartmental and total knee arthroplasty and the future outlook. Short-term follow-up studies on robotic-assisted knee arthroplasty suggest that, although some alignment objectives may have been achieved, more studies regarding functional outcomes are needed. Furthermore, studies evaluating the projected cost-benefit analyses of this new technology are needed before widespread adoption. Nevertheless, the short-term results warrant further evaluation.
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Affiliation(s)
- Samik Banerjee
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Jeffrey J Cherian
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Randa K Elmallah
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Julio J Jauregui
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
| | - Todd P Pierce
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore , Baltimore, Maryland, USA
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Koenig JH, Hepinstall MS. Available Robotic Platforms in Partial and Total Knee Arthroplasty. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.oto.2015.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tamam C, Poehling GG. Robotic-assisted Unicompartmental Knee Arthroplasty. Sports Med Arthrosc Rev 2014; 22:219-22. [DOI: 10.1097/jsa.0000000000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Modern total hip replacement is typically effective and durable, but early failures do occur. Component position influences functional outcome, durability, and risk of complications. Surgical robotics provides the detail-oriented surgeon with a robust tool to optimize the accuracy and precision of total hip arthroplasty, with the potential to minimize risk of mechanical failure. This article describes efficient workflows for using surgical robotics to optimize surgical precision without increasing surgical complexity.
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Affiliation(s)
- Matthew S Hepinstall
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075, USA; Department of Orthopaedic Surgery, Franklin Hospital, 900 Franklin Avenue, Valley Stream, NY 11580, USA.
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