1
|
Cochrane NH, Kim BI, Leal J, Hallows RK, Seyler TM. Comparing a robotic imageless second-generation system to traditional instrumentation in total knee arthroplasty: A matched cohort analysis. J Orthop 2024; 57:1-7. [PMID: 38881681 PMCID: PMC11179564 DOI: 10.1016/j.jor.2024.05.022] [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: 04/18/2024] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Robotic-assisted total knee arthroplasty (rTKA) has gained interest from patients and surgeons alike. Robotic systems assist with gap balancing and bone cut accuracy, which can theoretically minimize post-operative pain by decreasing soft tissue damage. This study compared perioperative results, 30- and 90-day complications, patient-reported outcomes (PROs), and survivorship to all-cause revisions between patients undergoing traditional versus rTKA. Methods A total of 430 TKAs (215 rTKA, 215 traditional) by two fellowship trained arthroplasty surgeons were retrospectively reviewed from 2017 to 2022. All rTKAs were performed using the CORI Surgical System (Smith & Nephew, Memphis, Tennessee). Cohorts were propensity score matched by age, sex, body mass index, and American Society of Anesthesiologist classification. Blood loss, surgical times, length of stays, 30- and 90-day complications, pain scores and PROs were compared with univariable analyses. Cox regression analyses evaluated survival to all-cause revisions. Results Patients undergoing rTKA had a higher incidence of discharge home (86.5 %-60.0 %) (p < 0.01). There was no difference in blood loss or surgical time. rTKA pain scores were lower in-hospital mean 2 (range, 0 to 9) vs 3 (range, 0 to 9) (p = 0.02) as well as at one-year post-operatively, mean 1 (range, 0 to 7) vs 2 (range, 0 to 10) (p = 0.02). Cox hazard ratio demonstrated no difference in survival to all-cause revisions (HR 1.3; CI 0.5 to 3.7) (p = 0.64). Conclusion This matched cohort analysis demonstrated potential short-term benefits associated with imageless second generation rTKA including improved early post-operative pain, without compromising survivorship to all-cause revisions.
Collapse
Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Justin Leal
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Rhett K Hallows
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
2
|
Graefe SB, Kirchner GJ, Pahapill NK, Nam HH, Dunleavy ML, Haines N. Adverse events associated with robotic-assistance in total hip arthroplasty: an analysis based on the FDA MAUDE database. Hip Int 2024:11207000241263315. [PMID: 39099264 DOI: 10.1177/11207000241263315] [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] [Indexed: 08/06/2024]
Abstract
BACKGROUND The Food and Drug Administration (FDA) maintains the Manufacturer and User Facility Device Experience (MAUDE) database for reporting adverse events associated with medical devices, including emerging technologies, such as robotic-assisted total hip arthroplasty (THA). Aim of this study was to evaluate the variation of adverse events associated with robotics in THA. METHODS Medical device reports (MDRs) within the MAUDE database were identified between 2017 and 2021. For MDR identification the product class "orthopaedic stereotaxic equipment" and terms associated with THA were used. Individual adverse events were identified and organised by type and consequences, such as patient injury, surgical delay, or conversion to the manual technique. RESULTS 521 MDRs constituting 546 discrete events were found. The most common reported complication was intraoperative hardware failure (304/546, 55.7%), among which the most common failure was a broken impaction handle/platform (110, 20.1%). Inaccurate cup placement was the second most common reported complication (63, 11.5%). Abandoning the robot occurred in 13.0% (71/521) of reports. A surgical delay was noted in 28% (146/521) of reports, with an average delay of 17.9 (range 1-60) minutes. CONCLUSIONS Identifying complications that may occur with robotics in THA is an important first step in preventing adverse events and surgical delays. Database analysis provide an overview of the range of complications.
Collapse
Affiliation(s)
- S Bradley Graefe
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Gregory J Kirchner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Natalie K Pahapill
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Hannah H Nam
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Mark L Dunleavy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Nikkole Haines
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|
3
|
Cochrane NH, Kim BI, Stauffer TP, Hallows RK, Urish KL, Carvajal Alba JA, Seyler TM. Revision Total Knee Arthroplasty With an Imageless, Second-Generation Robotic System. J Arthroplasty 2024; 39:S280-S284. [PMID: 38355066 DOI: 10.1016/j.arth.2024.02.018] [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: 09/29/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty is increasingly used in revision total knee arthroplasty (rTKA), with imageless systems recently receiving Food and Drug Administration (FDA) approval. However, there remains a paucity of literature on the use of robotic assistance in revision total knee arthroplasty (TKA). This paper describes the imageless surgical technique for robotic revision TKA using a second-generation robotic system and details both intraoperative and 90-day outcomes. METHODS This was a retrospective review of 115 robotic revision TKAs from March 2021 to May 2023 at 3 tertiary academic centers. Patient demographics, perioperative surgical data, and 90-day outcomes were collected. Pain and Patient-Reported Outcomes Measurement Information System scores preoperatively and postoperatively were recorded. All-cause reoperations at the final follow-up were detailed. The mean patient age was 65 years (range, 43 to 88), and 58% were women. The mean follow-up time was 13 months (range, 3 to 51). RESULTS The most common indications for rTKA were instability (n = 37, 32%) and aseptic loosening (n = 42, 37%). There were 83 rTKAs to a posterior-stabilized liner, 22 to a varus-valgus constrained liner, and 5 to a hinged construct. The median polyethylene size was 11 (interquartile range, 10 to 13), and 93% of patients had their joint line restored within 5 millimeters of the native contralateral knee. Within the 90-day postoperative window, there were 8 emergency department visits and 2 readmissions. At the final follow-up, there were 5 reoperations and 2 manipulations under anesthesia. There were 4 patients who required irrigation and debridement after superficial wound dehiscence, and one had an arthrotomy disruption after a fall. CONCLUSIONS This review demonstrates favorable intraoperative and 90-day outcomes and suggests that imageless robotic surgery is a promising modality in rTKA. Further studies comparing the longitudinal outcomes after robotic and conventional rTKA are warranted.
Collapse
Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Taylor P Stauffer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rhett K Hallows
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaime A Carvajal Alba
- Department of Orthopaedic Surgery, University of Miami Health System, Miami, Florida
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
4
|
Inabathula A, Semerdzhiev DI, Srinivasan A, Amirouche F, Puri L, Piponov H. Robots on the Stage: A Snapshot of the American Robotic Total Knee Arthroplasty Market. JB JS Open Access 2024; 9:e24.00063. [PMID: 39238881 PMCID: PMC11368221 DOI: 10.2106/jbjs.oa.24.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
» Computer-assisted robots aid orthopaedic surgeons in implant positioning and bony resection. Surgeons selecting a robot for their practice are faced with numerous options. This study aims to make the choice less daunting by reviewing the most commonly used Food and Drug Administration-approved robotic total knee arthroplasty platforms in the American arthroplasty market.» Modern total knee arthroplasty (TKA) robots use computer guidance to create a virtual knee model that serves as the surgeon's canvas for resection planning.» Most available robotic TKA (rTKA) systems are closed semiactive systems that restrict implant use to those of the manufacturer.» Each system has distinct imaging requirements, safety features, resection methods, and operating room footprints that will affect a surgeon's technique and practice.» Robots carry different purchase, maintenance, and equipment costs that will influence patient access across different socioeconomic groups.» Some studies show improved early patient-reported outcomes with rTKA, but long-term studies have yet to show clinical superiority over manual TKA.
Collapse
Affiliation(s)
| | | | | | | | - Lalit Puri
- Northshore University Health System, Evanston, Illinois
| | | |
Collapse
|
5
|
Koucheki R, Wolfstadt JI, Chang JS, Backstein DJ, Lex JR. Total Knee Arthroplasty With Robotic and Augmented Reality Guidance: A Hierarchical Task Analysis. Arthroplast Today 2024; 27:101389. [PMID: 39071834 PMCID: PMC11282423 DOI: 10.1016/j.artd.2024.101389] [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: 09/03/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 07/30/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility. The objective of this study was to develop and validate HTAs for conventional, robotic-assisted, and AR-navigated TKA. Methods The development of HTAs for conventional TKA involved an iterative review process that incorporated the input of 4 experienced arthroplasty surgeons. The HTAs were then adapted for robotic-assisted and AR-navigated TKA by incorporating specific steps associated with the use of these systems. The accuracy and completeness of the HTAs were validated by observing 10 conventional and 10 robotic-assisted TKA procedures. Results HTAs for conventional, robotic-assisted, and AR-navigated TKA were developed and validated. The resulting HTAs provide a comprehensive and standardized plan for each procedure and can aid in the identification of potential areas of inefficiency and risk. Robotic-assisted and AR-navigated approaches require additional steps, and there are an increased number of instances where complications may occur. Conclusions The HTAs developed in this study can provide valuable insights into the potential pitfalls of robotic-assisted and AR-navigated TKA procedures. As AR-navigation systems are developed, they should be optimized by critical analysis using the developed HTAs to ensure maximum efficiency, reliability, accessibility, reduction of human error, and costs.
Collapse
Affiliation(s)
- Robert Koucheki
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jesse I. Wolfstadt
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Justin S. Chang
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Humber River Hospital, Toronto, ON, Canada
| | - David J. Backstein
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Johnathan R. Lex
- Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
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
|
7
|
Pinci MV, Torres-Lugo NJ, Deliz-Jimenez DE, Salem-Hernandez J, Claudio-Marcano A, Ramírez N, Otero-López A. Patient Perception of Robotic-Assisted Total Joint Arthroplasty in a Hispanic Population. Arthroplast Today 2024; 25:101286. [PMID: 38292146 PMCID: PMC10826131 DOI: 10.1016/j.artd.2023.101286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 02/01/2024] Open
Abstract
Background Robotic-assisted orthopaedic surgery has become popular and widely available, mainly for total joint arthroplasty. However, there has been a persistent concern regarding access to robotic-assisted surgery and the utilization rate of total joint arthroplasty among minority groups. As an imperative effort to close the gap regarding health inequalities, we assessed the knowledge and perspective of Hispanics regarding robotic-assisted orthopaedic surgery. Methods A 28-item questionnaire was established to evaluate Hispanics' perceptions of robotic-assisted orthopaedic surgery. Participants answered questions about demographic features, knowledge about robotic-assisted orthopaedic surgery, and preferences regarding manual vs robotic-assisted procedures. Results A total of 580 questionnaires were analyzed in our study, with an average age of participants of 49.1 years. Only 44.2% of the participants were familiar with robotic-assisted orthopaedic surgery. Fifty-three percent of the respondents preferred robotic-assisted surgery over conventional procedures, with many participants believing that robotic-assisted surgery leads to better outcomes (54.7%) and faster recovery (53.1%). Conclusions Knowledge about specific factors such as clinical outcomes and costs may influence the perception and preference of Hispanics toward robotic-assisted orthopaedic surgery. Therefore, patient education may play a crucial role in the informed decision-making process in Hispanics when opting between robotic-assisted or traditional orthopaedic surgery.
Collapse
Affiliation(s)
- Marcantonio V. Pinci
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J. Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - David E. Deliz-Jimenez
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | - Alexandra Claudio-Marcano
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico
| | - Antonio Otero-López
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| |
Collapse
|
8
|
Rajgor HD, Mayne A, Munasinghe C, Pagkalos J, Agrawal Y, Davis ET, Sharma AD. Mako versus ROSA: comparing surgical accuracy in robotic total knee arthroplasty. J Robot Surg 2024; 18:33. [PMID: 38231299 DOI: 10.1007/s11701-023-01786-6] [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: 09/17/2023] [Accepted: 10/14/2023] [Indexed: 01/18/2024]
Abstract
There is increasing adoption of robotic surgical technology in Total Knee Arthroplasty. The ROSA® knee system can be used in either image-based mode (using pre-operative calibrated radiographs) or imageless modes (using intra-operative bony registration). The Mako knee system is an image-based system (using a pre-operative CT scan). This study aimed to compare surgical accuracy between the ROSA and Mako systems with specific reference to joint line height, patella height, posterior condylar offset and tibial slope. This was a retrospective review of a prospectively collected data of the initial 50 consecutive ROSA TKAs and the initial 50 consecutive Mako TKAs performed by two high-volume surgeons. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to joint line height (JLH), patella height (PH), tibial slope (TS) and posterior condylar offset (PCO). Mean difference between pre- and post-operative radiographs using the ROSA knee system of joint line height was 0.47 mm (SD 0.95) posterior condylar offset 0.16 mm (SD 0.76), tibial slope 0.9 degrees (SD 1.6) and patella height 0.01 (SD 0.05). Mean difference using the MAKO knee system of joint line height was 0.26 (SD 1.08), posterior condylar offset -0.26 mm (SD 0.78), tibial slope 1.8 degrees and patella height 0.03. No significant difference was demonstrated between the accuracy of component positioning of the ROSA or MAKO knee systems. Our study is the first study to compare the accuracy of the ROSA and MAKO knee systems in total knee arthroplasty. Both systems are highly accurate in restoring native posterior condylar offset, joint line height, tibial slope and patella height in TKA with no significant difference demonstrated between the two groups.
Collapse
Affiliation(s)
- Harshadkumar D Rajgor
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK.
| | - Alistair Mayne
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | | | - Joseph Pagkalos
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | - Yuvraj Agrawal
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| | - Edward T Davis
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Akash D Sharma
- Royal Orthopaedic Hospital, Bristol Rd S, The Woodlands, Northfield, Birmingham, B31 2AP, UK
| |
Collapse
|
9
|
Borsinger TM, Chandi SK, Puri S, Debbi EM, Blevins JL, Chalmers BP. Total Hip Arthroplasty: An Update on Navigation, Robotics, and Contemporary Advancements. HSS J 2023; 19:478-485. [PMID: 37937097 PMCID: PMC10626925 DOI: 10.1177/15563316231193704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates. Similarly, navigation and robotic technology has proven to more reproducibly achieve intraoperative component positioning, which has demonstrated clinical benefit with decreased risk of dislocation in a number of studies. Given the projected increase in THA over the coming decades, continued investigation of effective incorporation of technology, soft tissue-sparing approaches, and durable implants is imperative to continued pursuit of improved outcomes in THA.
Collapse
Affiliation(s)
- Tracy M Borsinger
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Sonia K Chandi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eytan M Debbi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jason L Blevins
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
10
|
Tarwala R, Mercuri JJ, Iorio R, Karkare N. Ethical Considerations in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:1001-1008. [PMID: 37561941 DOI: 10.5435/jaaos-d-22-00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Hip and knee arthroplasty surgeries have excellent outcomes and notably improve quality of life. However, ethical issues permeate the practice of adult reconstruction, and as economics and technology evolve, these issues have become increasingly important. This article will review the currently published literature on ethical issues including industry influences, implants and instrumentations, surgical innovation, new technology adoptions, and healthcare policy-relevant issues, including patient cost sharing and bundled care programs. In addition, the direct marketing of implants from the manufacturer to the general public may falsely raise patient expectations concerning the long-term clinical outcome and performance of newer devices in the absence of long-term studies. This article will also focus on relevant contemporary ethical issues that do not necessarily have preexisting published literature or guidelines but, nonetheless, are crucial for adult reconstruction surgeons to address. These issues include access to care and challenges with orthopaedic resident and fellow education. Surgeons must understand the ethical issues that can arise in their clinical practice and how those issues affect patients. Clinicians are tasked with making the best-reasoned judgment possible to optimize their patients' outcomes. Still, the ability to standardize treatment while optimizing individual outcomes for unique patients remains a challenge.
Collapse
Affiliation(s)
- Rupesh Tarwala
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY (Tarwala), the Division of Adult Hip and Knee Reconstruction, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Scranton, PA (Mercuri), the Harvard Medical School, Brigham and Women's Hospital, Boston, MA (Iorio), and Lenox Hill Hospital, New York, NY (Karkare)
| | | | | | | |
Collapse
|
11
|
Wininger AE, Lambert BS, Sullivan TC, Brown TS, Incavo SJ, Park KJ. Robotic-Assisted Total Knee Arthroplasty Can Increase Frequency of Achieving Target Limb Alignment in Primary Total Knee Arthroplasty for Preoperative Valgus Deformity. Arthroplast Today 2023; 23:101196. [PMID: 37745954 PMCID: PMC10517281 DOI: 10.1016/j.artd.2023.101196] [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: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Background Robotic-assisted total knee arthroplasty (rTKA) has been shown to reduce the number of alignment outliers and to improve component positioning compared to manual TKA (mTKA). The primary purpose of this investigation was to compare the frequency of achieving target postoperative limb alignment and component positioning for rTKA vs mTKA. Methods A retrospective comparative study was performed on 250 patients undergoing primary TKA by 2 fellowship-trained arthroplasty surgeons. Surgeon A performed predominantly rTKA (103 cases) with the ROSA system (Zimmer Biomet, Warsaw, IN) and less frequently mTKA (44 cases) with conventional instrumentation. Surgeon B performed only mTKA (103 cases). Target limb alignment for surgeon A was 0° for all cases and for surgeon B was 2° varus for varus knees and 0° for valgus knees. Radiographic measurements were determined by 2 reviewers. Target zone was set at ± 2 degrees from the predefined target. Results When comparing rTKA to mTKA performed by different surgeons, there were no differences in the percentage within the target zone (57.28% vs 53.40%, P = .575), but rTKA did result in a greater percentage for cases with preoperative valgus (71.42% vs 44.12%, P = .031). Patient-reported Outcomes Measurement Information System Global-10 physical scores were statistically higher at both 3 (P = .016) and 6 months (P = .001) postoperatively for rTKA compared to mTKA performed by different surgeons. Conclusions Although experienced surgeons can achieve target limb alignment correction with similar frequency when comparing rTKA to mTKA for all cases, rTKA may achieve target limb alignment with more accuracy for preoperative valgus deformity. Level of Evidence Retrospective Cohort Study, Level III.
Collapse
Affiliation(s)
- Austin E. Wininger
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Bradley S. Lambert
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Thomas C. Sullivan
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Timothy S. Brown
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Stephen J. Incavo
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Kwan J. Park
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| |
Collapse
|
12
|
Sweet MC, Miladore N, Bovid KM, Kenter K. Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey. J Am Acad Orthop Surg 2023; 31:1033-1039. [PMID: 37467400 DOI: 10.5435/jaaos-d-23-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION The adoption of technology-assisted total joint arthroplasty (TA-TJA) is increasing; however, the extent to which TA-TJA is used among orthopaedic trainees is unknown. The purpose of this study was to assess the current use of TA total knee arthroplasty (TKA) and total hip arthroplasty (THA) by orthopaedic residents and to evaluate resident perceptions toward TA-TJA in their surgical training. METHODS In this cross-sectional study, an anonymous electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency program coordinators to distribute to their PGY-2 to PGY-5 residents. The survey consisted of 24 questions, including resident demographics, utilization of TA-TJA in their training, and perceptions regarding TA-TJA. RESULTS A total of 103 orthopaedic residents completed the survey, of whom 68.0% reported using TA-TJA at their institution. Of the residents using TA-TJA, 28.6% used TA for total TKA only, 71.4% used TA for both TKA and THA, and none used TA solely for THA. One-third of residents (33.3%) use TA for more than half of all TKAs conducted, whereas 57.0% use TA for <10% of all THAs conducted. Approximately half of all residents (49.5%) thought that training in TA-TJA should be required during residency, with no significant differences between junior and senior level residents ( P = 0.24). Most (82.0%) thought that trainees should be required to learn conventional TJA before learning TA-TJA. 63.0% thought that technology had a positive effect on their primary TJA training experience; however, 26.0% reported concern that their training conducting conventional TJA may be inadequate. DISCUSSION This study demonstrates that most orthopaedic residents currently conduct TA-TJA and highlights notable differences in TJA training experiences. These results provide a platform for future work aimed at further optimizing TJA training in residency, particularly as technology continues to rapidly evolve and utilization of TA-TJA is projected to grow exponentially. LEVEL OF EVIDENCE N/A, survey-based study.
Collapse
Affiliation(s)
- Matthew C Sweet
- From the Department of Orthopaedic Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | | | | | | |
Collapse
|
13
|
Gao J, Xing D, Li J, Li T, Huang C, Wang W. Is robotic assistance more eye-catching than computer navigation in joint arthroplasty? A Google trends analysis from the point of public interest. J Robot Surg 2023; 17:2167-2176. [PMID: 37270445 PMCID: PMC10239277 DOI: 10.1007/s11701-023-01630-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: 02/27/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
Computer-assisted navigation system (CAS) and robotic assisted surgery (RAS) have been widely used in joint arthroplasty, but few studies focused on public interest. We aimed to evaluate current trend and seasonality of public interest in CAS and RAS arthroplasty over the past 10 years, and forecast the future development. All data related to CAS or RAS arthroplasty from January 2012 to December 2021 were collected through Google Trends. Public interest was described by relative search volume (RSV). Pre-existing trend was evaluated by linear and exponential models. Time series analysis and ARIMA model were utilized to analyze the seasonality and future trend. R software 3.5.0 was for statistics analysis. Public interest in RAS arthroplasty has been continuously increasing (P < 0.001) and exponential model (R2 = 0.83, MAE = 7.35, MAPE = 34%, RSME = 9.58) fitted better than linear one (R2 = 0.78, MAE = 8.44, MAPE = 42%, RSME = 10.67). CAS arthroplasty showed a downtrend (P < 0.01) with equivalent R2 (0.04) and accuracy measures (MAE = 3.92, MAPE = 31%, RSME = 4.95). The greatest popularity of RAS was observed in July and October, while the lowest was in March and December. For CAS, a rise of public interest was in May and October, but lower values were observed in January and November. Based on ARIMA models, the popularity of RAS might continuously increase and nearly double in 2030, along with a stability with slight downtrend for CAS. Public interest in RAS arthroplasty has been continuously increasing and seems to maintain this uptrend in the next 10 years, whereas popularity of CAS arthroplasty will likely remain stable.
Collapse
Affiliation(s)
- Jiaxiang Gao
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No.2 Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China
| | - Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Jiaojiao Li
- Kolling Institute, University of Sydney, Sydney, NSW, 2006, Australia
| | - Tong Li
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No.2 Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No.2 Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, No.2 Yinghuayuan East Street, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
14
|
Boddu SP, Moore ML, Rodgers BM, Brinkman JC, Verhey JT, Bingham JS. A Bibliometric Analysis of the Top 100 Most Influential Studies on Robotic Arthroplasty. Arthroplast Today 2023; 22:101153. [PMID: 37342364 PMCID: PMC10277458 DOI: 10.1016/j.artd.2023.101153] [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: 06/30/2022] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 06/22/2023] Open
Abstract
Background The use of robotics in arthroplasty surgery has increased substantially in recent years. The purpose of this study was to objectively identify the 100 most influential studies in the robotic arthroplasty literature and to conduct a bibliometric analysis of these studies to describe their key characteristics. Methods The Clarivate Analytics Web of Knowledge database was used to gather data and metrics for robotic arthroplasty research using Boolean queries. The search list was sorted in descending order by the number of citations, and articles were included or excluded based on clinical relevance to robotic arthroplasty. Results The top 100 studies were cited a total of 5770 times from 1997 to 2021, with rapid growth in both citation generation and the number of articles published occurring in the past 5 years. The top 100 robotic arthroplasty articles originated from 12 countries, with the United States being responsible for almost half of the top 100. The most common study types were comparative studies (36) followed by case series (20), and the most common levels of evidence were III (23) and IV (33). Conclusions Research on robotic arthroplasty is rapidly growing and originates from a wide variety of countries, academic institutions, and with significant industry influence. This article serves as a reference to direct orthopaedic practitioners to the 100 most influential studies in robotic arthroplasty. We hope that these 100 studies and the analysis we provide aid healthcare professionals in efficiently assessing consensus, trends, and needs within the field.
Collapse
Affiliation(s)
- Sayi P. Boddu
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | | | - Jens T. Verhey
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
| | | |
Collapse
|
15
|
Morgan P. What's New in Hip Replacement. J Bone Joint Surg Am 2022; 104:1599-1604. [PMID: 35980042 DOI: 10.2106/jbjs.22.00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Patrick Morgan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
16
|
Moore ML, Brinkman JC, Pollock JR, Deckey DG, Makovicka JL, Bingham JS. Patients are Most Interested in Which Hip Arthroplasty Approach? A 15-year Google Trends Analysis. Arthroplast Today 2022; 17:192-197. [PMID: 36254208 PMCID: PMC9568677 DOI: 10.1016/j.artd.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ USA
| | - Joseph C. Brinkman
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
- Corresponding author. Mayo Clinic Department of Orthopedic Surgery, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA. Tel.: +1 480 301 9506.
| | | | - David G. Deckey
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, AZ, USA
| | | | | |
Collapse
|
17
|
Iyengar KP, Zaw Pe E, Jalli J, Shashidhara MK, Jain VK, Vaish A, Vaishya R. Industry 5.0 technology capabilities in Trauma and Orthopaedics. J Orthop 2022; 32:125-132. [DOI: 10.1016/j.jor.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022] Open
|