1
|
Burgio C, Bosco F, Rovere G, Giustra F, Lo Bue G, Petillo A, Lucenti L, Palumbo G, Camarda L. Early and delayed periprosthetic joint infection in robot-assisted total knee arthroplasty: a multicenter study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04043-0. [PMID: 39026078 DOI: 10.1007/s00590-024-04043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (RA-TKA) has significantly improved knee surgery outcomes in the last few years. However, its association with the periprosthetic joint infection (PJI) rate remains debatable. This study investigates the incidence of early and delayed PJI in a multicentric cohort of patients who underwent RA-TKA, aiming to elucidate the risk associated with this procedure. METHODS This retrospective study analyzed data from a consecutive series of patients who underwent RA-TKA using the NAVIO Surgical System (Smith & Nephew, Memphis, USA) between 2020 and 2023. The inclusion criteria encompassed individuals over 18 years of age with a minimum follow-up period of three months. The primary outcome was the incidence of early and delayed PJI, defined according to the European Bone and Joint Infection Society (EBJIS) diagnostic criteria. Secondary outcomes included the evaluation of postoperative complications. RESULTS The study included patients who underwent RA-TKA with the NAVIO system, achieving an average follow-up of 9.1 ± 3.9 months. None of the patients met the EBJIS criteria for a likely or confirmed infection, indicating an absence of both early and delayed PJI cases. Two patients required subsequent surgical interventions due to patellar maltracking and prosthetic loosening, respectively. Additionally, three patients underwent passive manipulation under anesthesia (MUA). CONCLUSION The findings indicate no evidence of early or delayed PJI in patients undergoing RA-TKA within the study period. The low complication rate further supports the reliability and safety of this surgical technique in short-term follow-up. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Carmelo Burgio
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| | - Francesco Bosco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, Palermo, Italy.
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino-ASL Città di Torino, Turin, Italy
| | - Giorgia Lo Bue
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| | - Antonio Petillo
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| | - Ludovico Lucenti
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| | - Gaetano Palumbo
- Department of Orthopedic and Traumatology, Casa Di Cura Musumeci-GECAS, Catania, Italy
| | - Lawrence Camarda
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| |
Collapse
|
2
|
Rinehart DB, Stambough JB, Mears SC, Barnes CL, Stronach B. Robotic Total Knee Arthroplasty Surgeon Marketing: Do Claims Align With the Literature? Arthroplast Today 2024; 27:101357. [PMID: 38524152 PMCID: PMC10958061 DOI: 10.1016/j.artd.2024.101357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/26/2024] Open
Abstract
Background Robotic total knee arthroplasty (R-TKA) utilization and marketing continue to rise. We examined the marketing on surgeon websites regarding R-TKA benefits and sought to determine if the claims were supported by existing literature. Methods A Google search identified 10 physician websites from each of the 5 largest U.S. markets by population with the term "robotic total knee arthroplasty city, state." Claims on websites about R-TKA were categorized. Literature from 2012-2022 was reviewed for data "for" or "against" each claim. Level of evidence for each publication was collected. Results Fifty websites were captured that included 59 surgeons. A specific R-TKA platform was mentioned on 68% of websites. Website claims about robotics were placed into 8 major categories. Literature review supported the claims of more precise/accurate, reduced injury to tissue, and less pain with more literature "for" than "against" the claims. Conclusions Claims made on physician websites regarding the benefits of R-TKA are variable and not definitively supported by existing literature. Most available data can be categorized into levels of evidence III, IV, and V. There is a paucity of level I evidence to support the various marketing statements. Physicians should be cognizant of both the claims made on their websites and the literature that could be used to support or refute those specific claims.
Collapse
Affiliation(s)
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
3
|
Liu G, Liu Q, Tian R, Wang K, Yang P. Associations of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial. Int J Surg 2024; 110:2115-2121. [PMID: 38241323 PMCID: PMC11019982 DOI: 10.1097/js9.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND The association between postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) and nutrition status among elderly adults remained unclear. The authors aimed to evaluate these associations and provide a nutrition status reference for the surgical technique selection of TKA. METHODS In the present study, the authors used data from a multicenter, prospective, randomized controlled project, which recruited patients underwent TKA therapy. A total of 88 elderly adults (age ≥65 years old) were included in this study. Their preoperative and postoperative demographic data and radiographic parameters were collected. Clinical outcomes, including postoperative hip-knee-ankle (HKA) angle deviation, knee society score (KSS), 10 cm visual analog scale, and so on, were observed and compared between the RA-TKA group and the conventional TKA group. Logistic regression was performed to adjust several covariates. In addition, according to the results of restricted cubic splines analyses, all participants were categorized into two groups with GNRI≤100 and GNRI >100 for further subgroup analyses. RESULTS Our results showed despite having a lower postoperative HKA angle deviation, the RA-TKA group had a similar postoperative KSS score compared with the conventional TKA group in elderly adults. Among elderly patients with GNRI>100, RA-TKA group achieved significantly more accurate alignment (HKA deviation, P =0.039), but did not obtain more advanced postoperative KSS scores because of the compensatory effect of good nutrition status. However, among elderly patients with GNRI≤100, RA-TKA group had significantly higher postoperative KSS scores compared to the conventional TKA group ( P =0.025) and this association were not altered after adjustment for other covariates. CONCLUSION Considering the clinical outcomes of conventional TKA may be more susceptible to the impact of nutrition status, elderly patients with GNRI≤100 seem to be an applicable population for RA-TKA, which is more stable and would gain significantly more clinical benefits compared with conventional TKA.
Collapse
Affiliation(s)
- Guanzhi Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Qimeng Liu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| |
Collapse
|
4
|
Fontalis A, Hansjee S, Giebaly DE, Mancino F, Plastow R, Haddad FS. Troubleshooting Robotics During Total Hip and Knee Arthroplasty. Orthop Clin North Am 2024; 55:33-48. [PMID: 37980102 DOI: 10.1016/j.ocl.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
The introduction of new surgical technology highlights appreciable concerns; robotic arthroplasty is no exception. Acquiring comprehensive understanding of the robotic technology to avoid complications during surgery and devising troubleshooting strategies to overcome potential difficulties is of paramount importance. Troubleshooting algorithms depend on the stage of the procedure and problem encountered, such as loosening of the pins or array, registration or verification problems, or malfunctioning of the device, which is rare. This article aims to outline reproducible workflows and solutions for troubleshooting during robotic-arm assisted total hip arthroplasty and total knee arthroplasty.
Collapse
Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK.
| | - Shanil Hansjee
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
| |
Collapse
|
5
|
Fary C, Cholewa J, Ren AN, Abshagen S, Anderson MB, Tripuraneni K. Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation. ARTHROPLASTY 2023; 5:62. [PMID: 38044446 PMCID: PMC10694935 DOI: 10.1186/s42836-023-00216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Range of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR. METHODS A total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation. RESULTS Changes in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events. CONCLUSIONS Compared with mTKR, raTKR resulted in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation. TRIAL REGISTRATION Clinicaltrials.gov (NCT# 03737149).
Collapse
Affiliation(s)
- Camdon Fary
- Epworth Foundation, Richmond, VIC, 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne, 3011, Australia
| | | | | | | | | | | |
Collapse
|
6
|
Hoeffel D, Goldstein L, Intwala D, Kaindl L, Dineen A, Patel L, Mayle R. Systematic review and meta-analysis of economic and healthcare resource utilization outcomes for robotic versus manual total knee arthroplasty. J Robot Surg 2023; 17:2899-2910. [PMID: 37819597 PMCID: PMC10678833 DOI: 10.1007/s11701-023-01703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/19/2023] [Indexed: 10/13/2023]
Abstract
The introduction of robotics in orthopedic surgery has led to improved precision and standardization in total knee arthroplasty (TKA). Clinical benefits of robotic versus manual TKA have been well established; however, evidence for economic and healthcare resource utilization outcomes (HRU) is lacking. The primary objective of this study was to compare economic and HRU outcomes for robotic and manual TKA. The secondary objective was to explore comparative robotic and manual TKA pain and opioid consumption outcomes. Multi-database literature searches were performed to identify studies comparing robotic and manual TKA from 2016 to 2022 and meta-analyses were conducted. This review included 50 studies with meta-analyses conducted on 35. Compared with manual TKA, robotic TKA was associated with a: 14% reduction in hospital length of stay (P = 0.022); 74% greater likelihood to be discharged to home (P < 0.001); and 17% lower likelihood to experience a 90-day readmission (P = 0.043). Robotic TKA was associated with longer mean operating times (incision to closure definition: 9.27 min longer, P = 0.030; general operating time definition: 18.05 min longer, P = 0.006). No differences were observed for total procedure cost and 90-day emergency room visits. Most studies reported similar outcomes for robotic and manual TKA regarding pain and opioid use. Coupled with the clinical benefits of robotic TKA, the economic impact of using robotics may contribute to hospitals' quality improvement and financial sustainability. Further research and more randomized controlled trials are needed to effectively quantify the benefits of robotic relative to manual TKA.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Robert Mayle
- California Pacific Orthopaedics, San Francisco, CA, USA
| |
Collapse
|
7
|
Vandenberk J, Mievis J, Deferm J, Janssen D, Bollars P, Vandenneucker H. NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4798-4808. [PMID: 37555860 DOI: 10.1007/s00167-023-07524-7] [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: 04/13/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA. METHODS This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann-Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test. RESULTS There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p = .144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p = .044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p = .038 and 0.6% vs 4.3%, p = .001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend. CONCLUSIONS This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA. LEVEL OF EVIDENCE Level III (therapeutic retrospective cohort study).
Collapse
Affiliation(s)
- Jim Vandenberk
- Department of Biomedical Sciences (Development and Regeneration), KU Leuven-University of Leuven, Herestraat 49, Box 700, 3000, Louvain, Belgium.
- Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Jan Mievis
- Orthoteam Limburg, Dienst Orthopedische Heelkunde St. Trudo, Sint-Truiden, Belgium
| | - Jorien Deferm
- St. Elisabeth Krankenhaus Geilenkirchen, Geilenkirchen, Duitsland
| | - Daniël Janssen
- Orthoteam Limburg, Dienst Orthopedische Heelkunde St. Trudo, Sint-Truiden, Belgium
| | | | - Hilde Vandenneucker
- Department of Biomedical Sciences (Development and Regeneration), KU Leuven-University of Leuven, Herestraat 49, Box 700, 3000, Louvain, Belgium
- Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| |
Collapse
|
8
|
Carvajal Alba J, Constantinescu DS, Lopez JD, Lepkowsky ER, Hernandez VH, Jose J. Safe Zones and Trajectory of Femoral Pin Placement in Robotic Total Knee Arthroplasty. Arthroplast Today 2023; 23:101186. [PMID: 37745957 PMCID: PMC10517266 DOI: 10.1016/j.artd.2023.101186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 09/26/2023] Open
Abstract
Background Robotic-assisted total knee arthroplasty may result in array pin-related complications. Lack of knowledge on ideal pin placement results in varied insertion sites and trajectory, with unknown risks to surrounding neurovascular structures. Methods This study included 10 lower-extremity magnetic resonance images. Images were subdivided into 6 zones of study. Zones consisted of a correlating axial image with femoral pin placement replicated by drawing a line angled 45° from the anterior to posterior reference in the anteromedial to posterolateral femoral quadrants. The distances from the pin paths to the neurovascular structures were measured. Results Zone 2C demonstrated femoral pin trajectory an average of 14 mm from the femoral artery/vein. In Zone 2B, proximity increased to an average of 30 mm to the femoral artery and 29 mm to the femoral vein. At Zone 1A, the popliteal artery and vein were on average 22 mm from the femoral pin, while the common peroneal nerve was an average of 21 mm. Placing pins in Zone 1A poses a high risk of injury to the genicular arteries. Women demonstrated greater proximity to neurovascular structures than men in 66% of the sites (P < .05). Conclusions This classification system for safe zones and trajectory of femoral pin placement in robotic-assisted total knee arthroplasty demonstrates that proximally, the profunda femoris and femoral artery/vein are at risk of injury, while distally, the genicular arteries, common peroneal nerve, and popliteal artery/vein are at risk. Caution should be exercised if femoral pins are inserted with an angle less than 45°, especially in women.
Collapse
Affiliation(s)
| | | | - Juan D. Lopez
- Department of Orthopaedics, University of Miami, Miami, FL, USA
| | | | | | - Jean Jose
- Department of Radiology, University of Miami, Miami, FL, USA
| |
Collapse
|
9
|
Adamska O, Modzelewski K, Szymczak J, Świderek J, Maciąg B, Czuchaj P, Poniatowska M, Wnuk A. Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020236. [PMID: 36837438 PMCID: PMC9963242 DOI: 10.3390/medicina59020236] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023]
Abstract
Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger's method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA-NAVIO and mTKA-CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.
Collapse
Affiliation(s)
- Olga Adamska
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
- Correspondence:
| | - Krzysztof Modzelewski
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Jakub Szymczak
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Jakub Świderek
- Faculty of Medicine, Medical University of Bialystok, 1 Jana Kilińskiego St., 15-089 Bialystok, Poland
| | - Bartosz Maciąg
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Paweł Czuchaj
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | | | - Artur Wnuk
- Hospital in Ostrow Mazowiecka, 68 Dubois St., 07-300 Ostrów Mazowiecka, Poland
| |
Collapse
|
10
|
Nogalo C, Meena A, Abermann E, Fink C. Complications and downsides of the robotic total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:736-750. [PMID: 35716186 PMCID: PMC9958158 DOI: 10.1007/s00167-022-07031-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this systematic review is to describe the complications and downsides of robotic systems in total knee arthroplasty (TKA). METHODS A comprehensive search according to the PRISMA guidelines was performed across PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and Google Scholar from inception until December 2021. All articles of any study design directly reporting on complications and downsides of the robotic system in TKA were considered for inclusion. Risk of bias assessment was performed for all included studies using the Cochrane risk of bias and MINORS score. RESULTS A total of 21 studies were included, consisting of 4 randomized controlled trials, 7 prospective studies and 10 retrospective studies. Complications of the robotic system were pin-hole fracture, pin-related infection, iatrogenic soft tissue and bony injury, and excessive blood loss. While, downsides were longer operative duration, higher intraoperative cost, learning curve and aborting a robotic TKA due to different reasons. Iatrogenic injuries were more common in the active robotic system and abortion of the robotic TKA was reported only with active robotic TKA. CONCLUSION Robotic TKA is associated with certain advantages and disadvantages. Therefore, surgeons need to be familiar with the system to use it effectively. Widespread adoption of the robotic system should always be evidence-based. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Christian Nogalo
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria ,Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, UMIT - Private University for Health Sciences, Hall in Tirol, Austria
| | - Amit Meena
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria ,Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, UMIT - Private University for Health Sciences, Hall in Tirol, Austria
| | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020 Innsbruck, Austria ,Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, UMIT - Private University for Health Sciences, Hall in Tirol, Austria
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020, Innsbruck, Austria. .,Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, UMIT - Private University for Health Sciences, Hall in Tirol, Austria.
| |
Collapse
|
11
|
Thomas TL, Goh GS, Nguyen MK, Lonner JH. Pin-Related Complications in Computer Navigated and Robotic-Assisted Knee Arthroplasty: A Systematic Review. J Arthroplasty 2022; 37:2291-2307.e2. [PMID: 35537611 DOI: 10.1016/j.arth.2022.05.012] [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: 03/16/2022] [Revised: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Computer-assisted navigation (CAN) and robotic-assisted (RA) knee arthroplasty procedures carry unique risks of tracking pin-related complications. This systematic review aimed to quantitatively assess the incidence, timing, treatment, and clinical outcomes of all tracking pin-related complications following CAN and RA knee arthroplasty. METHODS A systematic review was performed using PubMed, Cochrane Central and Scopus databases. All clinical studies that documented pin-related complications associated with the use of CAN or RA for total or partial knee arthroplasty were included. Descriptive statistics were analyzed when data were available. RESULTS Thirty-six studies were included: 18 case reports (25 cases) and 18 randomized controlled trials, cohort studies and case series i.e., non-case reports (7,336 cases). The most common pin-related complication among case reports was fracture (n = 22; 81%). The overall rate of pin-related complications among non-case reports was 1.4%. The intraoperative and postoperative complication with the highest incidence were pin dislodgement (0.6%) and superficial pin site infections (0.6%), respectively. Most postoperative complications were related to the tibial site (69%). All complications were effectively treated and resolved at follow-up. CONCLUSION Pin-related complications following CAN and RA knee arthroplasty are relatively uncommon. While pin loosening, superficial infections and fractures have been most commonly documented, other complications such as vascular injury, myositis ossificans, and osteomyelitis can also occur. The potential for pin-related complications should be considered by arthroplasty surgeons, especially during early stages of adoption. Further studies investigating patient risk factors for pin-related complications are warranted.
Collapse
Affiliation(s)
- Terence L Thomas
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew K Nguyen
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
12
|
Mullaji AB, Khalifa AA. Is it prime time for robotic-assisted TKAs? A systematic review of current studies. J Orthop 2022; 34:31-39. [PMID: 35992614 PMCID: PMC9389136 DOI: 10.1016/j.jor.2022.07.016] [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: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/23/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Less-than-optimum positioning of femoral and tibial components and improper soft tissue tension, with abnormal loads and reduced range of motion, may cause lower patient satisfaction rates. To reduce surgeon-related variables during TKA, technology-assisted TKA was introduced, including computer navigation and robotic-assisted surgery (RATKA). Although several studies show promising short- and long-term functional and radiological outcomes of RATKA, there are still concerns related to its absolute superiority over conventional TKA. Methods This review aims to provide an updated insight into the most recent articles reporting on outcomes (functional, radiological, and complications) of RATKA through a systematic search of major databases. A comprehensive English literature search was performed by both authors through four databases (Embase, PubMed, Web of Science, and Scopus). The full text of the final eligible studies was evaluated for inclusion, resulting in 13 studies that are included in this review. Results There were 2112 knees in the 13 studies, with a follow-up ranging from three months to 13 years; only three were randomized controlled trials (RCTs), and nine directly compared the results of RATKA with CTKA technique. Seven studies reported the operative time ranging from 76.8 to 156 min; six reported a longer operative time with RATKA. Length of hospital stay (LOS) was reported in six studies which ranged from 0.48 to 2.1 days; in four studies the LOS was shorter with RATKA. In seven of the nine studies comparing RATKA with CTKA, no difference in functional outcomes was found. Four out of six studies reported that the overall alignment had mechanical alignment within ±3° of neutral alignment in all RATKA patients with an HKA ranging from -0.3 to 1.8°. Only one study reported better radiological outcomes in the RATKA group. In six comparative studies, no difference was found in the incidence of complications between RATKA and CTKA. Conclusion Although robotic-assisted total knee arthroplasty is a promising technology that provides better component alignment and superior early functional outcomes, the justification for its widespread adoption needs more robust evidence through well-designed and better long-term studies demonstrating superior, predictable, and durable clinical results compared to conventional total knee arthroplasty techniques.
Collapse
Affiliation(s)
| | - Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
| |
Collapse
|
13
|
Lim YY, Zaidi AMA, Miskon A. Composing On-Program Triggers and On-Demand Stimuli into Biosensor Drug Carriers in Drug Delivery Systems for Programmable Arthritis Therapy. Pharmaceuticals (Basel) 2022; 15:1330. [PMID: 36355502 PMCID: PMC9698912 DOI: 10.3390/ph15111330] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 08/31/2023] Open
Abstract
Medication in arthritis therapies is complex because the inflammatory progression of rheumatoid arthritis (RA) and osteoarthritis (OA) is intertwined and influenced by one another. To address this problem, drug delivery systems (DDS) are composed of four independent exogenous triggers and four dependent endogenous stimuli that are controlled on program and induced on demand, respectively. However, the relationships between the mechanisms of endogenous stimuli and exogenous triggers with pathological alterations remain unclear, which results in a major obstacle in terms of clinical translation. Thus, the rationale for designing a guidance system for these mechanisms via their key irritant biosensors is in high demand. Many approaches have been applied, although successful clinical translations are still rare. Through this review, the status quo in historical development is highlighted in order to discuss the unsolved clinical difficulties such as infiltration, efficacy, drug clearance, and target localisation. Herein, we summarise and discuss the rational compositions of exogenous triggers and endogenous stimuli for programmable therapy. This advanced active pharmaceutical ingredient (API) implanted dose allows for several releases by remote controls for endogenous stimuli during lesion infections. This solves the multiple implantation and local toxic accumulation problems by using these flexible desired releases at the specified sites for arthritis therapies.
Collapse
Affiliation(s)
- Yan Yik Lim
- Faculty of Defence Science and Technology, National Defence University of Malaysia, Sungai Besi Prime Camp, Kuala Lumpur 57000, Malaysia
| | - Ahmad Mujahid Ahmad Zaidi
- Faculty of Defence Science and Technology, National Defence University of Malaysia, Sungai Besi Prime Camp, Kuala Lumpur 57000, Malaysia
| | - Azizi Miskon
- Faculty of Engineering, National Defence University of Malaysia, Sungai Besi Prime Camp, Kuala Lumpur 57000, Malaysia
| |
Collapse
|
14
|
Mancino F, Rossi SMP, Sangaletti R, Lucenti L, Terragnoli F, Benazzo F. A new robotically assisted technique can improve outcomes of total knee arthroplasty comparing to an imageless navigation system. Arch Orthop Trauma Surg 2022; 143:2701-2711. [PMID: 35913518 DOI: 10.1007/s00402-022-04560-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/18/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Robotic assisted total knee arthroplasty (RTKA) has shown improved knee alignment and reduced radiographic outliers. However, there remains debate on functional outcomes and patient-reported outcomes (PROMs). This study compares the 1-year clinical outcomes of a new imageless robotically assisted technique (ROSA Knee System, Zimmer Biomet, Warsaw, IN) with an imageless navigated procedure (NTKA, iAssist Knee, Zimmer, Warsaw, IN). METHODS The study is a retrospective analysis of prospectively collected data that compared the functional outcomes and PROMs of 50 imageless RTKA with 47 imageless NTKA at 1-year follow-up. Baseline characteristics, intraoperative and postoperative information were collected including complications, revisions, Knee Society Score (KSS), Knee injury and Osteoarthritis Outcome Score (KOOS) score, and Forgotten Joint Score (FJS-12). Radiographic analysis of preoperative and postoperative images evaluating hip-knee-ankle (HKA) angle was performed. RESULTS There was no difference regarding baseline characteristics between the groups. Mean operative time was significantly longer in the RTKA group (122 min vs. 97 min; p < 0.0001). Significant differences were reported for the "Pain" (85 [RTKA] vs 79.1 [NTKA]; p = 0.0283) subsection of the KOOS score. In addition, RTKA was associated with higher maximum range of motion (119.4° vs. 107.1°; p < 0.0001) and better mean improvement of the arc of motion by 11.67° (23.02° vs. 11.36°; p < 0.0001). No significant differences were noted for other subsections of KOOS, KSS, FJS-12, complications, or limb alignment at 1-year follow-up. CONCLUSIONS Imageless RTKA was associated with longer surgical time, better pain perception and improved ROM at 12-month follow-up compared with NTKA. No significant differences were reported on other PROMs, complication rates and radiographic outcomes. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Fabio Mancino
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,Unità di Ortopedia e Traumatologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Ludovico Lucenti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Flavio Terragnoli
- U.O.C. Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
| |
Collapse
|
15
|
Navigated and Robot-Assisted Technology in Total Knee Arthroplasty: Do Outcome Differences Achieve Minimal Clinically Important Difference? J Arthroplasty 2022; 37:1562-1569. [PMID: 35367335 DOI: 10.1016/j.arth.2022.03.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In total knee arthroplasty (TKA), computer-assisted navigation (N-TKA) and robotic-assisted methods (RA-TKA) are intended to increase precision of mechanical and component alignment. However, the clinical significance of published patient-reported outcome measure (PROM) differences in comparison to conventional TKA (C-TKA) is unknown. METHODS A systematic review was performed to identify all studies reporting perioperative PROMs for either primary N-TKA or RA-TKA with a C-TKA comparison cohort with a minimum 1-year follow-up. Relative improvements in PROMs for the two cohorts were compared to published minimal clinically important difference (MCID) values. RESULTS After systematic review, 21 studies (N = 3,214) reporting on N-TKA and eight studies (N = 1,529) reporting on RA-TKA met inclusion criteria. Eighteen of 20 studies (90%) reported improved radiographic outcomes with N-TKA relative to C-TKA; five of five studies reported improved radiographic outcomes with RA-TKA relative to C-TKA. Five of 21 studies (24%) reported statistically significant greater improvements in clinical PROMs for N-TKA relative to C-TKA, whereas only two (10%) achieved clinical significance relative to MCID on a secondary analysis. One of 8 studies (13%) reported statistically significant greater improvements in PROMs for RA-TKA relative to C-TKA, whereas none achieved clinical significance relative to MCID on a secondary analysis. No studies reported a significant difference in revision rates. CONCLUSION While most studies comparing RA-TKA and N-TKA with C-TKA demonstrate improved radiographic alignment outcomes, a minority of studies reported PROM differences that achieve clinical significance. Future studies should report data and be interpreted in the context of clinical significance to establish patient and surgeon expectations for emerging technologies.
Collapse
|
16
|
Wang Z, Ji Y, Bao H, Hou J, Cheng YX. Patellar retraction versus eversion on functional outcomes in total knee replacement: a randomized controlled study protocol. J Orthop Surg Res 2021; 16:381. [PMID: 34127018 PMCID: PMC8204409 DOI: 10.1186/s13018-021-02518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background Patellar mobilization technique during total knee replacement (TKR) has been debated, with some suggesting that lateral retraction, rather than eversion, of the patella may be beneficial. This randomized controlled trial was to investigate the effects of patellar eversion on functional outcomes in TKR. Methods and analysis This single-center, prospective, randomized controlled test will be conducted in Jingjiang People's Hospital. Primary end-stage osteoarthritis patients that prepared for unilateral TKR were randomized to one of two patellar exposure techniques during the primary total knee arthroplasty: lateral retraction or eversion. The informed consent will be acquired in each patient. The primary outcome was operation time, length of hospital stay, and straight leg raising time. Second outcomes including Insall-Salvati ratio; range of motion at 1 month, 3 months, and 1 year following TKR; visual analog scale (VAS) at 1 month, 3 months; and Knee Society Score (KSS) score at 1 year following TKR. The significance level was defaulted as P < .05. Results Results will be published in relevant peer-reviewed journals. Conclusion Our study aims to systematically assess the functional outcomes of patellar eversion for TKR patients, which will provide clinical guidance for TKR patients.
Collapse
Affiliation(s)
- Zhao Wang
- Department of Orthopaedics, Jingjiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China
| | - Yong Ji
- Department of General Surgery, Jingjiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China.
| | - Hongwei Bao
- Department of Orthopaedics, Jingjiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China
| | - Jingzhao Hou
- Department of Orthopaedics, Jingjiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China
| | - Yan-Xiao Cheng
- Department of Orthopaedics, Jingjiang People's Hospital, No. 28, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China
| |
Collapse
|