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Bayoumi T, Ten Noever de Brauw GV, Ruderman LV, van der List JP, Kerkhoffs GMMJ, Pearle AD, Zuiderbaan HA. The phenotypic diversity of anteromedial osteoarthritis before and after treatment with medial unicompartmental knee arthroplasty: A radiographic analysis of 1000 knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:274-286. [PMID: 38226437 DOI: 10.1002/ksa.12043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This study aimed to assess phenotypic variation in the coronal plane of knees with anteromedial osteoarthritis using the functional knee phenotype classification, before and after treatment with medial unicompartmental knee arthroplasty (UKA). METHODS The study comprised 1000 knees of 835 patients (45% females, 55% males, 90% Caucasian) who underwent medial UKA for anteromedial osteoarthritis. Pre and postoperative alignment was evaluated through the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). Knees were classified according to the functional knee phenotype system which combines limb phenotype (HKA), and femoral and tibial knee phenotypes (FMA and TMA, respectively). Restoration of prearthritic coronal alignment following medial UKA was evaluated by phenotype. RESULTS Preoperatively, 76 distinct and 25 relevant (prevalence ≥1%) functional knee phenotypes were identified, of which VARHKA 6°VARFMA 3°NEUTMA 0° was the most common (9.4% of knees). The most prevalent limb phenotype, VARHKA 6°, comprised 15 distinct knee phenotypes (FMA and TMA combinations). Postoperatively, 58 distinct and 17 relevant functional knee phenotypes were observed, of which VARHKA 3°NEUFMA 0°NEUTMA 0° had the highest prevalence at 18.3%. Knees with combined tibial and femoral deformities were associated with a lower probability of restoration of prearthritic coronal alignment following medial UKA, compared to knees without extra-articular deformity, or knees with an isolated tibial or femoral deformity. CONCLUSION Phenotype analysis using the functional knee phenotype system demonstrated a wide diversity of coronal alignment phenotypes among knees with anteromedial osteoarthritis in a predominantly Caucasian population. Following medial UKA, a reduction from 25 preoperative to 17 postoperative relevant phenotypes was observed. Consideration of phenotypic variation can be of importance when aiming to restore prearthritic coronal alignment during medial UKA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey V Ruderman
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-Noord, The Netherlands
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Zambianchi F, Seracchioli S, Franceschi G, Cuoghi Costantini R, Malatesta A, Barbo G, Catani F. Image-based robotic-arm assisted unicompartmental knee arthroplasty provides high survival and good-to-excellent clinical outcomes at minimum 10 years follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:5477-5484. [PMID: 37814136 DOI: 10.1007/s00167-023-07599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The purpose of the present study was to determine the incidence of revision and report on clinical outcomes at a minimum of 10 years follow-up in patients who had received a medial unicompartmental knee arthroplasty (UKA) with an three-dimensional image-based robotic system. METHODS A total of 239 patients (247 knees), who underwent medial robotic-arm assisted (RA)-UKA at a single center between April 2011 and June 2013, were assessed. The mean age at surgery was 67.0 years (SD 8.4). Post-operatively, patients were administered the Forgotten Joint Score-12 (FJS-12) and asked about their satisfaction (from 1 to 5). Post-operative complications were recorded. Failure mechanisms, revisions and reoperations were collected. Kaplan-Meier survival curves were calculated, considering revision as the event of interest. RESULTS A total of 188 patients (196 knees) were assessed at a mean follow-up of 11.1 years (SD 0.5, range 10.0-11.9), resulting in a 79.4% follow-up rate. Seven RA-UKA underwent revision, resulting in a survivorship rate of 96.4% (CI 94.6%-99.2%). Causes of revision included aseptic loosening (2 cases), infection (1 case), post-traumatic (1 case), and unexplained pain (3 cases). The mean FJS-12 and satisfaction were 82.2 (SD 23.9) and 4.4 (SD 0.9), respectively. Majority of cases (174/196, 88.8%) attained the Patient Acceptable Symptoms State (PASS, FJS-12 > 40.63). Male subjects had a higher probability of attaining a "forgotten joint" (p < 0.001) and high satisfaction (equal to 5, p < 0.05), when compared to females. CONCLUSIONS Three-dimensional image-based RA-UKA demonstrated high implant survivorship and good-to-excellent clinical outcomes at minimum 10 years follow-up. Pain of unknown origin represented the most common reason for RA-UKA revision. LEVEL OF EVIDENCE III.
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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.
| | - Stefano Seracchioli
- 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
| | - Riccardo Cuoghi Costantini
- Department of Maternal, Child and Adult Medical and Surgical Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Alessandro Malatesta
- Department of Orthopaedic Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Giovanni Barbo
- Department of Orthopaedic Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Parratte S, Daxhelet J, Argenson JN, Batailler C. The Deep-MCL Line: A Reliable Anatomical Landmark to Optimize the Tibial Cut in UKA. J Pers Med 2023; 13:jpm13050855. [PMID: 37241025 DOI: 10.3390/jpm13050855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The extramedullary guides for the tibial resection during medial unicompartmental knee arthroplasty (UKA) are inaccurate, with an error risk in coronal and sagittal planes and cut thickness. It was our hypothesis that the use of anatomical landmarks for the tibial cut can help the surgeon to improve accuracy. The technique described in this paper is based on the use of a simple and reproducible anatomical landmark. This landmark is the line of insertion of the fibers of the deep medial collateral ligament (MCL) around the anterior half of the medial tibial plateau called the "Deep MCL insertion line". The used anatomical landmark determines the orientation (in the coronal and sagittal planes) and the thickness of the tibial cut. This landmark corresponds to the line of insertion of the fibers of the deep MCL around the anterior half of the medial tibial plateau. A consecutive series of patients who underwent primary medial UKA between 2019 and 2021 were retrospectively reviewed. A total of 50 UKA were included. The mean age at the time of surgery was 54.5 ± 6.6 years (44-79). The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements. The limb and implant alignments and the tibial positioning were satisfying, with a low rate of outliers and good restoration of the native anatomy. The landmark of the insertion of deep MCL constitutes a reliable and reproducible reference for the tibial cut axis and thickness during medial UKA, independent of the wear severity.
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Affiliation(s)
- Sébastien Parratte
- Department of Orthopaedic Surgery, International Knee and Joint Centre, Hazza Bin Zayed St., Abu Dhabi P.O. Box 46705, United Arab Emirates
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille University, Institute of Movement and Locomotion, 270 Bd de Sainte-Marguerite, 13009 Marseille, France
| | - Jeremy Daxhelet
- Department of Orthopaedic Surgery, Clinique Saint-Luc Bouge, Rue Saint-Luc 8, 5004 Namur, Belgium
| | - Jean-Noel Argenson
- Department of Orthopedics and Traumatology, St. Marguerite Hospital, Aix Marseille University, Institute of Movement and Locomotion, 270 Bd de Sainte-Marguerite, 13009 Marseille, France
| | - Cécile Batailler
- Department of Orthopaedics, Croix Rousse Hospital, University of Lyon 1, 69004 Lyon, France
- Claude Bernard Lyon 1 University, LBMC UMR_T9406, 69100 Lyon, France
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Bayoumi T, Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Prospective Multicenter Study. J Bone Joint Surg Am 2023:00004623-990000000-00793. [PMID: 37146125 DOI: 10.2106/jbjs.22.01104] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) has been shown to result in high short- and mid-term survivorship. However, it is not known whether these outcomes are maintained at long-term follow-up. This study aimed to evaluate long-term implant survivorship, modes of failure, and patient satisfaction following robotic-arm-assisted medial UKA. METHODS A prospective multicenter study of 474 consecutive patients (531 knees) undergoing robotic-arm-assisted medial UKA was conducted. A cemented, fixed-bearing system with a metal-backed onlay tibial implant was used in all cases. Patients were contacted at 10-year follow-up to determine implant survivorship and satisfaction. Survival was analyzed using Kaplan-Meier models. RESULTS Data were analyzed for 366 patients (411 knees) with a mean follow-up of 10.2 ± 0.4 years. A total of 29 revisions were reported, corresponding to a 10-year survivorship of 91.7% (95% confidence interval, 88.8% to 94.6%). Of all revisions, 26 UKAs were revised to total knee arthroplasty. Unexplained pain and aseptic loosening were the most commonly reported modes of failure, accounting for 38% and 35% of revisions, respectively. Of patients without revision, 91% were either satisfied or very satisfied with their overall knee function. CONCLUSIONS This prospective multicenter study found high 10-year survivorship and patient satisfaction following robotic-arm-assisted medial UKA. Pain and fixation failure remained common causes for revision following cemented fixed-bearing medial UKA, despite the use of a robotic-arm-assisted technique. Prospective comparative studies are needed to assess the clinical value of robotic assistance over conventional techniques in UKA. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarik Bayoumi
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, Oregon
| | - Thomas M Coon
- Coon Joint Replacement Institute, Department of Orthopaedic Surgery, St. Helena, California
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, Florida
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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UKA with a handheld robotic device results in greater surgeon physiological stress than conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 2023; 31:777-785. [PMID: 35188582 DOI: 10.1007/s00167-022-06908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Poor ergonomics and acute stress can impair surgical performance and cause work-related injuries. Robotic assistance may optimize these psychophysiological factors during UKA. This study compared surgeon physiologic stress and ergonomics during robotic-assisted UKA (rUKA) and conventional UKA (cUKA). METHODS Cardiorespiratory and postural data from a single surgeon were recorded during 30 UKAs, (15 rUKAs, 15 cUKAs). Heart rate (HR), HR variability, respiratory rate (RR), minute ventilation and calorie expenditure were used to measure surgical strain. Intraoperative ergonomics were assessed by measuring flexion/extension/rotation of the neck and lumbar spine, and shoulder abduction/adduction. RESULTS Mean operative time was 32.0 ± 7 min for cUKA and 45.9 ± 9 min for rUKA (p < 0.001). Mean neck flexion was - 23.4° ± 13° for rUKA and - 49.1° ± 18 for cUKA (p < 0.001), while mean lumbar flexion was - 20.3° ± 30° for rUKA and - 0.4° ± 68° for cUKA (p = 0.313). Mean lumbar flexion was similar; however, a significantly greater percentage of time was spent in lumbar flexion > 20° during cUKA. Bilateral shoulder abduction was significantly higher for rUKA. Mean calorie expenditure was 154 cal for rUKA and 89.1 cal for cUKA (p < 0.001). Mean HR was also higher for rUKA (88.7 vs. 84.7, p = 0.019). HR variability was slightly lower for rUKA (12.4) than for cUKA (13.4), although this did not reach statistical significance (p = 0.056). No difference in RR or minute ventilation was observed. CONCLUSION rUKA resulted in less neck flexion but increased shoulder abduction, heart rate, and energy expenditure. The theoretical ergonomic and physiologic advantages of robotic assistance using a handheld sculpting device were not realized in this study. LEVEL OF EVIDENCE II.
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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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Mojica ES, Hurley ET, Markus DH, Bloom DA, Mannino BJ, Stein SM, Jazrawi LM, Campbell KA. Female Gender Is Associated with Lower Satisfaction with Postoperative Telemedicine Visits in Sports Medicine. Telemed J E Health 2022; 28:1658-1663. [PMID: 35333658 DOI: 10.1089/tmj.2021.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine is a relatively new adjunct in orthopedic care but it has emerged from the periphery, driven in part by the COVID-19 pandemic. Although it has drastically increased in use, little is known of the factors that drive satisfaction with telemedicine. The purpose of the current study was to evaluate the patient's satisfaction with postoperative telemedicine visits in those undergoing knee or shoulder arthroscopy, and to analyze the factors associated with satisfaction with telemedicine. Methods: A prospective study was performed to evaluate satisfaction comparing postoperative telemedicine and in-office visits, in those undergoing shoulder and knee arthroscopy. Multiple factors were analyzed for correlation with satisfaction via multi-linear regression, including demographics such as gender, education, age, and race. Patients were also evaluated for preference for future visits with reference to the group in which they were placed. Results: Overall, 215 patients were included with a subgroup analysis of 93 patients receiving telemedicine visits. Patients reported overall similar satisfaction with telemedicine visits after shoulder and knee arthroscopy, with a high level of satisfaction seen in both. Female sex was found to be associated with decreasing satisfaction with telemedicine visits (p = 0.036). In addition, as a whole, the cohort was found to prefer future visits to be the same as the group they were placed in, but females statistically did not have this preference for their familiar group and were skewed toward the preference of in-person visits (p = 0.377). Conclusions: Our study found that female patients were less likely to be satisfied with postoperative telemedicine visits after knee or shoulder arthroscopy. Further, females were also less likely to indicate preference for future telemedicine visits. In contrast, education, history of prior surgery, age, and race were not associated with postoperative satisfaction.
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Affiliation(s)
- Edward S Mojica
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
- Department of Surgery, National University of Ireland Galway, Galway, Ireland
| | - Danielle H Markus
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - David A Bloom
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Brian J Mannino
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Spencer M Stein
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
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MacAskill M, Blickenstaff B, Caughran A, Bullock M. Revision Total Knee Arthroplasty Using Robotic Arm Technology. Arthroplast Today 2021; 13:35-42. [PMID: 34917719 PMCID: PMC8666608 DOI: 10.1016/j.artd.2021.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 01/19/2023] Open
Abstract
Total knee arthroplasty (TKA) is a highly successful operation for the treatment of end-stage osteoarthritis of the knee. Increasing use of computer-assisted and robotic-assisted total joint arthroplasty has been shown to improve component position, with short-term studies demonstrating improved survivability in unicompartmental knee arthroplasty. Robotic-assisted technology has been shown to be helpful in revising unicompartmental knee arthroplasty to TKA, as well as hip fusion to total hip arthroplasty, but few have described revision of a primary TKA. This case report describes the use of robotic-assisted technology in revision TKA. Robotic assistance during revision TKA may improve component alignment and increase prosthesis longevity. Future research is needed to investigate the effects on survivorship and cost.
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Affiliation(s)
- Micah MacAskill
- Marshall University, Joan C Edwards SOM, Department of Orthopaedics, Huntington, WV, USA
| | - Baylor Blickenstaff
- Marshall University, Joan C Edwards SOM, Department of Orthopaedics, Huntington, WV, USA
| | - Alexander Caughran
- Marshall University, Joan C Edwards SOM, Department of Orthopaedics, Huntington, WV, USA
| | - Matthew Bullock
- Marshall University, Joan C Edwards SOM, Department of Orthopaedics, Huntington, WV, USA
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Abstract
INTRODUCTION The Mako robotic arm knee arthroplasty system was initially indicated in unicompartmental knee arthroplasty followed by bicompartmental and total knee arthroplasty techniques. The system utilizes three elements: (1) Pre-op 3D CT based planning and image based intra-op navigation. (2) Pre-resection implant modifications with integrated alignment, implant position and gap data, and (3) A semi-constrained robotic arm assisted execution of bone resection with "haptic" boundaries, and cemented implants. MATERIALS AND METHODS This paper evaluates variable pre-op implant placement, and anatomic reference positioning; data entry with incorporation of alignment, implant congruency through range of motion, and gaps; bone resection with "haptic" boundaries, and final implant evaluation with kinetic sensors. RESULTS The Mako system allowed for improved implant placement utilizing CT guidance, bone resection accuracy, flexibility for functional implant placement with gap balancing. When combined with kinetic sensors, there was improved rotation and soft tissue balance. CONCLUSION The MAKO robotic system can assist the surgeon with anatomic landmarks, provides the flexibility for independent gap balance through implant and alignment refinement, and three-dimensional soft tissue balancing data to achieve functional stability. Registry data has shown improved outcome survivorship irrespective of the surgeons' volumes and learning curves.
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Zambianchi F, Daffara V, Negri A, Franceschi G, Schiavon G, Catani F. Preoperative Osteoarthritic Grade Affects Forgotten Joint Status and Patient Acceptable Symptom State After Robotic Arm-Assisted Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:3650-3655. [PMID: 34294481 DOI: 10.1016/j.arth.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This retrospective observational study was designed to investigate the association between radiographic Ahlbäck osteoarthritis (OA) grade and postoperative joint perception in a cohort of patients undergoing medial robotic arm-assisted unicompartmental knee arthroplasty (RA-UKA), using the Forgotten Joint Status and Patient Acceptable Symptom State (PASS) as outcomes. METHODS Between January 2014 and May 2019, 660 patients (719 knees) underwent medial RA-UKA at 2 centers. Ahlbäck OA grade was measured on preoperative knee radiographs. Postoperatively, patients were administered the Forgotten Joint Score-12 (FJS-12) and 5-level Likert scale to assess patients' satisfaction. Correlations were described among FJS-12, satisfaction, and Ahlbäck OA grade by means of logistic regression models. RESULTS A total of 547 patients (602 knees) were assessed at a mean follow-up of 3.5 years (standard deviation 1.4). A total of 293 cases were graded as Ahlbäck 1 (Group A) and 309 knees were graded as Ahlbäck>1 (Group B). Statistically significant difference was detected in mean FJS-12 (P < .001), but not in the postoperative satisfaction level (P = .06) between the 2 groups. Patients in Group B had a significantly higher probability of attaining a "forgotten knee" after the operation, compared to Group A (P < .05). Cases in Group A had a significantly lower probability of achieving the PASS (P < .01). CONCLUSION Patients with higher grades of OA (Ahlbäck>1) were more likely to attain a "forgotten knee," while patients with less severe OA (Ahlbäck 1) were less likely to achieve the PASS after RA-UKA. Although patients with less severe OA reported fairly good outcome, cases in which the results will be poorer are currently difficult to predict.
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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
| | - Alberto Negri
- 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
| | - Guglielmo Schiavon
- Department of Orthopaedics and Traumatology, EOC Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
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