Moving beyond radiographic alignment: applying the Wald Principles in the adoption of robotic total knee arthroplasty

Problems and Opportunities of a Smartphone-Based Care Management Platform: Application of the Wald Principles to a Survey-Based Analysis of Patients' Perception in a Pilot Center

(1) Background: Mobile health (mHealth) solutions can become a means of improving functional recovery and reducing the peri-operative burden and costs associated with arthroplasty procedures. The aim of this study is to explore the objectives, functionalities, and outcomes of a platform designed to provide personalized surgical experiences to qualified patients, along with the associated problems and opportunities. (2) Methods: A survey-based analysis was conducted on patients who were prescribed the use of a specific care management platform and underwent primary robotic total knee arthroplasty (rTKA) between January 2021 and February 2023. (3) Results: Patients registered on the platform who have undergone primary robotic TKA (rTKA) were considered. The mean age of registered patients is 68.6 years. The male (M)/female (F) ratio is 45.1%/54.9%. The patients interviewed were at an average distance of 485 days from the intervention, with a standard deviation of 187.5. The survey highlighted appreciation for the app and its features, but also limitations in its use and in its perception by the patients. All these data were evaluated according to the Wald principles and strategies to improve patient recruitment, enhance adherence, and create a comprehensive patient journey for optimized surgical experiences. (4) Conclusions: This patient care platform may have the potential to impact surgical experiences by increasing patient engagement, facilitating remote monitoring, and providing personalized care. There is a need to emphasize the importance of integrating the recruiting process, improving adherence strategies, and creating a comprehensive patient journey within the platform.

Initial Learning Curve for Robot-Assisted Total Knee Arthroplasty in a Dedicated Orthopedics Center

Background and objectives: Our study aimed to assess the learning curve for robot-assisted (RA) total knee arthroplasty (TKA) in our hospital, compare operative times between RA-TKAs and manual TKAs, and assess the early complications rate between the two approaches. Methods: We included 39 patients who underwent RA-TKA and 45 control patients subjected to manual TKA in the same period and operated on by the same surgical staff. We collected demographic and patient-related data to assess potential differences between the two groups. Results: No statistical differences were recorded in regard to age, BMI, sex, Kellgren-Lawrence classification, or limb alignment between patients undergoing RA-TKA and manual TKA, respectively. Three surgeons transitioned from the learning to the proficiency phase in our study after a number of 6, 4, and 3 cases, respectively. The overall operative time for the learning phase was 111.54 ± 20.45 min, significantly longer compared to the average of 86.43 ± 19.09 min in the proficiency phase (p = 0.0154) and 80.56 ± 17.03 min for manual TKAs (p < 0.0001). No statistically significant difference was recorded between the global operative time for the proficiency phase TKAs versus the controls. No major complications were recorded in either RA-TKA or manual TKA groups. Conclusions: Our results suggest that experienced surgeons may adopt RA-TKA using this platform and quickly adapt without significant complications.

Robotic-Assisted Total Knee Arthroplasty Has Similar Rates of Prosthetic Noise Generation as Conventional Total Knee Arthroplasty

Background

Noise has been reported to occur with relatively high frequency after conventional total knee arthroplasty (C-TKA), and this may impact the incidence of patient satisfaction and function. The purpose of this study was to compare the rate of patient-reported prosthetic noise generation after robotically-assisted TKA (RA-TKA) and C-TKA.

Methods

A retrospective study was conducted of unilateral primary RA-TKAs and C-TKAs performed between 2018 and 2021. Patients completed a survey consisting of 4 Likert scale questions related to prosthetic noise generation and Knee Injury and Osteoarthritis Score Joint Replacement and Forgotten Joint Score were assessed prospectively preoperatively and at a minimum of 1-year of clinical follow-up. Statistical analysis was done utilizing T-tests and chi-square tests, with statistical significance defined as a P-value < .05.

Results

One hundred sixty-two RA-TKAs and 320 C-TKAs with similar baseline characteristics and functions were included. There were no significant differences in hearing or feeling grinding, popping, clicking, or clunking (40.7% vs 38.1%; P = .647) between groups. Most RA-TKAs and C-TKAs were not dissatisfied regarding noise generation (70.4% vs 73.1%; P = .596). In both cohorts, patients who reported noise generation had lower average Forgotten Joint Scores (45.5 vs 66.1; P < .001) and lower postoperative Knee Injury and Osteoarthritis Score Joint Replacement scores (72.0 vs 81.4; P < .001) than those who did not experience noise generation.

Conclusions

While RA-TKA may facilitate soft tissue balancing, there were no differences in prosthetic noise generation between RA-TKA and C-TKA. However, those who experience implant-generated noise have lower functional outcome scores.

What are the perceived benefits and barriers to the use of robot-assisted total knee arthroplasty? A survey of members of the European Knee Society

PURPOSE

Members of the European Knee Society (EKS) recently took part in an online questionnaire on robot-assisted TKA. The purpose of this study was to report and analyse the questionnaire results on the demographics of users versus non-users, the drivers for users of the technology, and the barriers or limitations that hinder the uptake of robot-assisted TKA.

METHODS

The questionnaire was composed of 16 questions covering surgeon demographics and drivers for or barriers to the use of robotics. Responses on four- or five-point Likert scales were trichotomised depending on the type of question ("not important" - "moderately important" - "important/very important" or "fully disagree/disagree" - "neutral" - "agree/fully agree"). Consensus on a statement was defined as at least 75% agreement.

RESULTS

There was a 67% response rate. Forty-five surgeons performed conventional TKA, of which 78% aimed for systematic alignment, while 22 performed robot-assisted TKA, of which 82% aimed for individualised alignment, and 16 performed technology-assisted TKA, of which 56% aimed for systematic alignment. Respondents agreed that robotics significantly impact accuracy of bone cuts (51/62, 82%), intra-operative feedback on ligament balancing (56/62, 90%) as well as bone cut orientation and implant positioning (57/ 62, 92%), and assistance to customise alignment (56/62, 90%). Respondents agreed that associated costs (14/18, 78%) are an important aspect for not using or to stop using robotics.

CONCLUSION

The majority of respondents still perform conventional TKA (54%), while only a small portion perform robot-assisted TKA (27%) or other technology-assisted TKA (19%). Most robot users aim for individualised lower limb alignment, whereas most other surgeons aimed for systematic lower limb alignment. There is consensus that robotic assistance has a positive impact on accuracy of bone cuts and alignment, but no consensus on its impact on other peri- or post-operative outcomes. Finally, the associated cost of robot-assisted TKA remains the main barrier to its uptake.

LEVEL OF EVIDENCE

V.