Insufficient evidence to confirm benefits of custom partial knee arthroplasty: a systematic review

Robot-assisted partial knee replacement versus standard total knee replacement (RoboKnees): a protocol for a pilot randomized controlled trial

BACKGROUND

Total knee arthroplasty is a common surgery for end-stage knee osteoarthritis. Partial knee arthroplasty is also a treatment option for patients with arthritis present in only one or two knee compartments. Partial knee arthroplasty can preserve the natural knee biomechanics, but these replacements may not last as long as total knee replacements. Robotic-assisted orthopedic techniques can help facilitate partial knee replacements, increasing accuracy and precision. This trial will investigate the feasibility and assess clinical outcomes for a larger definitive trial.

METHODS

This is a protocol for an ongoing parallel randomized pilot trial of 64 patients with uni- or bicompartmental knee arthritis. Patients are randomized to either receive robot-assisted partial knee arthroplasty or manual total knee arthroplasty. The primary outcome of this pilot is investigating the feasibility of a larger trial. Secondary (clinical) outcomes include joint awareness, return to activities, knee function, patient global impression of change, persistent post-surgical pain, re-operations, resource utilization and cost-effectiveness, health-related quality of life, radiographic alignment, knee kinematics during walking gait, and complications up to 24 months post-surgery.

DISCUSSION

The RoboKnees pilot study is the first step in determining the outcome of robot-assisted partial knee replacements. Conclusions from this study will be used to design future large-scale trials. This study will inform surgeons about the potential benefits of robot-assisted partial knee replacements.

TRIAL REGISTRATION

This study was prospectively registered on clinicaltrials.gov (identifier: NCT04378049) on 4 May 2020, before the first patient was randomized.

Is sequential bilateral robotic total knee arthroplasty a safe procedure? A matched comparative pilot study

INTRODUCTION

To our knowledge, no papers have reported the results of robotic-assisted surgery for sequential bilateral Total Knee Arthroplasty (TKA). Indeed, sequential bilateral TKA present several benefits, as one single anesthesia, surgical episode, hospitalization, and rehabilitation. The purpose of our study was to evaluate peri-operative outcomes and compare the complication rates, clinical outcomes, and implant positioning of sequential bilateral TKA performed with a robotic-assisted system versus a conventional technique.

MATERIALS AND METHODS

All patients who underwent a sequential bilateral robotic-assisted primary TKA (raTKA) in our institution between November 2019 and February 2021 were included. Twenty patients met the inclusion criteria and were matched with 20 sequential bilateral TKA performed with a conventional technique. The two groups were comparable for the demographic data and the preoperative parameters, including preoperative anticoagulation and ASA score. The minimum follow-up was 6 months.

RESULTS

The operative time was significantly longer in the robotic group (< 0.0001), with a mean additional time of 29 min. There was no significant difference between both groups for postoperative blood loss, rate of blood transfusion, or postoperative pain. The average length of stay was 5 days. There was one early complication in the robotic group due to the tibial trackers. The functional outcomes were similar between both groups, except for the functional KSS score, which was better at 6 months in the robotic group (p < 0.0001). The restoration of the knee alignment and the distal femoral anatomy were significantly better in the robotic group than in the conventional group.

CONCLUSIONS

Despite a longer operative time, the peri-operative parameters of sequential bilateral TKA were similar between robotic and conventional techniques. Further, sequential bilateral raTKA was at least as safe as a conventional technique, without additional risk of medical complications.

Patient Specific Instruments and Patient Individual Implants—A Narrative Review

Joint arthroplasties are one of the most frequently performed standard operations worldwide. Patient individual instruments and patient individual implants represent an innovation that must prove its usefulness in further studies. However, promising results are emerging. Those implants seem to be a benefit especially in revision situations. Most experience is available in the field of knee and hip arthroplasty. Patient-specific instruments for the shoulder and upper ankle are much less common. Patient individual implants combine individual cutting blocks and implants, while patient individual instruments solely use individual cutting blocks in combination with off-the-shelf implants. This review summarizes the current data regarding the implantation of individual implants and the use of individual instruments.

Quadriceps strength is an early indicator of return to competitive sports 1 year after anterior cruciate ligament reconstruction in adult amateur athletes

BACKGROUND

Return to sports is one of the important reasons why athletes with an anterior cruciate ligament (ACL) injury undergo surgery. There are few reports on return to sports among adult amateur athletes (individuals older than the college age who participate in competitive sports). This study aimed to investigate the return of adult amateur athletes to competitive sports 1 year after ACL reconstruction and to identify the indicators for return to competitive sports.

METHODS

Between January 2015 and December 2017, adult amateur athletes who underwent primary ACL reconstruction were retrospectively investigated. The rate of return to competitive sports 1 year after surgery was evaluated. The patients were categorized into two groups: return to sports group (R group) and non-return to sports group (N group). Pre- and postoperative range of motion, pivot-shift test, anteroposterior laxity, quadriceps strength, Lysholm score, and the International Knee Documentation Committee score were compared between the groups.

RESULTS

This study included 78 patients (48 men, 30 women; age range, 22-53 years). Five months after ACL reconstruction, quadriceps strength was significantly lower in the N group than in the R group, denoting muscle weakness in the N group at that time. No significant differences were found in the other items between the groups preoperatively and 1 year after surgery.

CONCLUSION

In this study, the rate of return to competitive sports of adult amateur athletes 1 year after ACL reconstruction was 76.9%. Quadriceps strength may be an early indicator of return to competitive sports 1 year after reconstruction.

Image-based robot assisted bicompartmental knee arthroplasty versus total knee arthroplasty

OBJECTIVE

To evaluate the short-term clinical outcomes of image-based robot-assisted bicruciate retaining bicompartmental knee arthroplasty and compare it to robot-assisted total knee arthroplasty in the Indian population.

METHODS

Between December 2018 and November 2019, five patients (six knees) underwent robot-assisted bicompartmental knee arthroplasty (BCKA). These patients were demographically matched with five patients (six knees) who underwent robot-assisted total knee arthroplasty (TKA) during the same period. Clinical outcomes of these twelve knees were assessed in the form of knee society score (KSS) score, Oxford knee score (OKS), and forgotten joint score (FJS) after a minimum follow-up period of 25 months. The data between the two cohorts were compared and analyzed.

RESULTS

Scores obtained from both cohorts were subjected to statistical analysis. SPSS software was utilized and the Mann Whitney U-test was utilized to compare the two groups. There was no statistically significant difference found between the two groups in terms of functional outcome.

CONCLUSION

Image-based robot-assisted BCKA is a bone stock preserving and more physiological procedure which can be a promising alternative to patients presenting with isolated arthritis of only two compartments of the knee. Although long-term, larger trials are warranted to establish it as an alternative, our pilot study shows an equally favorable outcome as TKA, making it an exciting new avenue in the field of arthroplasty.