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Itou J, Kuwashima U, Itoh M, Okazaki K. Robotic-assisted total knee arthroplasty is not associated with increased risk of postoperative deep vein thrombosis. J Exp Orthop 2023; 10:65. [PMID: 37382867 DOI: 10.1186/s40634-023-00628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/11/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE Prolongation of operation time due to registration and pin insertion has been reported with robotic-assisted total knee arthroplasty (RATKA), and there has been concern about an increase in the postoperative incidence of deep vein thrombosis (DVT). In this study, we compared the incidence of DVT after RATKA with that after conventional manual TKA (mTKA). METHODS This consecutive retrospective series included 141 knees that underwent primary TKA using the Journey II system. The CORI robot was used. There were 60 RATKAs and 81 mTKAs. Doppler ultrasound was performed in all patients on postoperative day 7 to determine whether DVT was present. RESULTS The operation time was longer in the RATKA cohort (99.5 min vs 78.0 min, p < 0.001). The overall incidence of DTV was 43.9% (62/141 knees), all of which were asymptomatic. There was no significant difference in incidence of DVT between RATKA and mTKA (50.0% vs 39.5%, p = 0.23). Use of the robot did not affect the incidence of DVT following TKA (odds ratio 1.02, 95% confidence interval 0.40-2.60; p = 0.96). CONCLUSION The incidence of DVT was not significantly different between RA-TKA and mTKA. Multiple logistic regression indicated that RATKA is not associated with increased risk of postoperative DVT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
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Riantho A, Butarbutar JCP, Fidiasrianto K, Elson E, Irvan I, Haryono H, Prasetio JN. Radiographic Outcomes of Robot-Assisted Versus Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. JB JS Open Access 2023; 8:JBJSOA-D-23-00010. [PMID: 37197698 PMCID: PMC10184987 DOI: 10.2106/jbjs.oa.23.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis. Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robot-assisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA. Methods We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models. Results A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, -0.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups. Conclusions Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles. Level of Evidence Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Albert Riantho
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - John Christian Parsaoran Butarbutar
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
- Email for corresponding author:
| | - Kevin Fidiasrianto
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Elson Elson
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Irvan Irvan
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Handy Haryono
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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RUANGSOMBOON P, RUANGSOMBOON O, PORNRATTANAMANEEWONG C, NARKBUNNAM R, CHAREANCHOLVANICH K. Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Acta Orthop 2023; 94:60-79. [PMID: 36805771 PMCID: PMC9941983 DOI: 10.2340/17453674.2023.9411] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND PURPOSE Robotic-assisted total knee arthroplasty (RATKA) is an alternative surgical treatment method to conventional total knee arthroplasty (COTKA) that may deliver better surgical accuracy. However, its impact on patient outcomes is uncertain. The aim of this systematic review of randomized controlled trials (RCTs) is to evaluate whether RATKA could improve functional and radiological outcomes compared with COTKA in adult patients with primary osteoarthritis of the knee. METHODS We searched Ovid MEDLINE, EMBASE, Scopus, and the Cochrane Library to identify published RCTs comparing RATKA with COTKA. 2 reviewers independently screened eligible studies, reviewed the full texts, assessed risk of bias using the Risk of Bias 2.0 tool, and extracted data. Outcomes were patient-reported outcomes, range of motion, and mechanical alignment (MA) deviation and outliers, and complications. RESULTS We included 12 RCTs involving 2,200 patients. RATKA probably results in little to no effect on patient-reported outcomes (mean difference (MD) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of -0.35 (95% confidence interval [CI] -0.78 to 0.07) and range of motion (MD -0.73°; CI -7.5° to 6.0°) compared with COTKA. However, RATKA likely results in a lower degree of MA outliers (risk ratio 0.43; CI 0.27 to 0.67) and less deviation from neutral MA (MD -0.94°; CI -1.1° to -0.73°). There were no differences in revision rate or major adverse effects associated with RATKA. CONCLUSION Although RATKA likely results in higher radiologic accuracy than COTKA, this may not be clinically meaningful. Also, there is probably no clinically important difference in clinical outcomes between RATKA and COTKA, while it is as yet inconclusive regarding the revision and complication rates due to insufficient evidence.
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Affiliation(s)
- Pakpoom RUANGSOMBOON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Onlak RUANGSOMBOON
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada,Department of Emergency Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | | | - Rapeepat NARKBUNNAM
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Keerati CHAREANCHOLVANICH
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
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Abstract
Modern and innovative technologies are rapidly penetrating the clinical practices of Orthopaedic Surgeons. The ones that have proved successful for clinical use are Additive Manufacturing/3D printing, Artificial Intelligence, Robotics, Smart sensors, and Orthobiologics. Industry 5.0 revolution has helped provide personalised treatment by integrating machines and human beings. In this special issue, we present a collection of excellent articles on these technologies.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics & Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, 110076, India
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Mancino F, Jones CW, Benazzo F, Singlitico A, Giuliani A, De Martino I. Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives. Orthop Res Rev 2022; 14:339-349. [PMID: 36274930 PMCID: PMC9586165 DOI: 10.2147/orr.s294369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
Robotic-assisted total knee arthroplasty (rTKA) has been developed to improve knee kinematics and functional outcomes, expedite recovery, and improve implants long-term survivorship. Robotic devices are classified into active, semi-active, and passive, based on their degree of freedom. Their capacity to provide increased accuracy in implants positioning with reduced radiographic outliers has been widely proved. However, these early advantages are yet to be associated with long-term survivorship. Moreover, multiple drawbacks are still encountered including a variable learning curve, increased setup and maintenance costs, and potential complications related to the surgical technique. Despite recent technologies applied to TKA have failed to prove substantial improvements, robotic-assisted surgery seems to be here to stay and revolutionize the field of TKA. To support its consistent usage on a daily basis, long-term results are still awaited, and further improvements are necessary to reduce the expenses related to it.
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Affiliation(s)
- Fabio Mancino
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Christopher W Jones
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia,Curtin University, Perth, Western Australia, Australia
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico, Unità di Traumatologia dello Sport, Fondazione Poliambulanza, Brescia, Italy,IUSS, Istituto di Studi Superiori, Pavia, Italy
| | | | | | - Ivan De Martino
- Università Cattolica del Sacro Cuore, Roma, Italy,Unità di Ortopedia e Traumatologia, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy,Correspondence: Ivan De Martino, Unità di Ortopedia e Traumatologia, Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, Roma, 00168, Italy, Tel +39 3512412491, Email ;
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