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Goh GS, Haffar A, Tarabichi S, Courtney PM, Krueger CA, Lonner JH. Robotic-Assisted Versus Manual Unicompartmental Knee Arthroplasty: A Time-Driven Activity-Based Cost Analysis. J Arthroplasty 2022; 37:1023-1028. [PMID: 35172186 DOI: 10.1016/j.arth.2022.02.029] [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: 01/11/2022] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The cost-effectiveness of robotic-assisted unicompartmental knee arthroplasty (RA-UKA) remains unclear. Time-driven activity-based costing (TDABC) has been shown to accurately reflect true resource utilization. This study aimed to compare true facility costs between RA-UKA and conventional UKA. METHODS We identified 265 consecutive UKAs (133 RA, 132 conventional) performed at a specialty hospital in 2016-2020. Itemized facility costs were calculated using TDABC. Separate analyses including and excluding implant costs were performed. Multiple regression was performed to determine the independent effect of robotic assistance on facility costs. RESULTS Due to longer operative time, RA-UKA patients had higher personnel costs and total facility costs ($2,270 vs $1,854, P < .001). Controlling for demographics and comorbidities, robotic assistance was associated with an increase in personnel costs of $399.25 (95% confidence interval [CI] $343.75-$454.74, P < .001), reduction in supply costs of $55.03 (95% CI $0.56-$109.50, P = .048), and increase in total facility costs of $344.27 (95% CI $265.24-$423.31, P < .001) per case. However, after factoring in implant costs, robotic assistance was associated with a reduction in total facility costs of $235.87 (95% CI $40.88-$430.85, P < .001) per case. CONCLUSION Using TDABC, overall facility costs were lower in RA-UKA despite a longer operative time. To facilitate wider adoption of this technology, implant manufacturers may negotiate lower implant costs based on volume commitments when robotic assistance is used. These supply cost savings appear to offset a portion of the increased costs. Nonetheless, further research is needed to determine if RA-UKA can improve clinical outcomes and create value in arthroplasty.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Amer Haffar
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Saad Tarabichi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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2
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Du G, Li Z, Lao S, Urish K. [Biomechanical analysis of sitting-up movement of knee joint after robot-assisted unicompartmental knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1259-1264. [PMID: 34651478 DOI: 10.7507/1002-1892.202101061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of Navio robot-assisted unicompartmental knee arthroplasty (UKA) on the biomechanics of knee joint during sitting-up movement, and to determine whether UKA can maintain the biomechanical characteristics of knee joint. Methods The clinical data of 8 patients with medial compartment osteoarthritis treated with medial fixed platform of Navio robot-assisted UKA between January 2018 and January 2019 and had the complete follow-up data were retrospectively analyzed. There were 4 males and 4 females; the age ranged from 58 to 67 years, with an average of 62.3 years. The disease duration was 6-18 months, with an average of 13 months. The varus deformity ranged from 4° to 6°, with an average of 5°; the knee flexion range of motion was 0°-130°, with an average of 110°. All patients had no extension limitation. The imaging data of bilateral knees during sitting-up movement were collected by biplane C-arm X-ray machine at 3 weeks before operation and 7 months after operation. The three-dimensional models of femur and tibia were established by dual-energy CT scanning, and the three-dimensional models of femur and tibia were matched and synchronized with the femur and tibia in X-ray film by automatic matching tracer software. The biomechanical parameters of femur and tibia were measured, including internal rotation/external rotation, varus/valgus, forward/backward displacement of medial and lateral tibia contact center, and lateral compartment joint space. Results Eight patients were followed up 5-7 months, with an average of 6.4 months. In the comparison of the affected side before and after operation, except for the difference of varus/valgus which was significant ( t=4.959, P=0.002), the differences in other indicators was not significant ( P>0.05). There were significant differences in varus/valgus and internal rotation/external rotation between healthy and affected sides at 3 weeks before operation ( P<0.05), and the differences in other indicators was not significant ( P>0.05). At 7 months after operation, the difference in the forward and backward displacement of medial tibia contact center was significant ( t=3.798, P=0.007), and the differences in other indicators was not significant ( P>0.05). Conclusion UKA can effectively correct the varus and valgus of the knee joint, and restore the rotational biomechanical characteristics of the affected knee joint. It does not affect the establishment of the lateral compartment joint space, but the medial and lateral tibia contact center still changes.
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Affiliation(s)
- Gang Du
- Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China.,Department of Orthopedics, UPMC Magee Hospital, University of Pittsburgh, Pittsburgh, 15217, USA
| | - Zhengtian Li
- Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - Shan Lao
- Department of Bone and Joint Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - Ken Urish
- Department of Orthopedics, UPMC Magee Hospital, University of Pittsburgh, Pittsburgh, 15217, USA
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Vijayan RC, Han R, Wu P, Sheth NM, Ketcha MD, Vagdargi P, Vogt S, Kleinszig G, Osgood GM, Siewerdsen JH, Uneri A. Development of a fluoroscopically guided robotic assistant for instrument placement in pelvic trauma surgery. J Med Imaging (Bellingham) 2021; 8:035001. [PMID: 34124283 PMCID: PMC8189698 DOI: 10.1117/1.jmi.8.3.035001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: A method for fluoroscopic guidance of a robotic assistant is presented for instrument placement in pelvic trauma surgery. The solution uses fluoroscopic images acquired in standard clinical workflow and helps avoid repeat fluoroscopy commonly performed during implant guidance. Approach: Images acquired from a mobile C-arm are used to perform 3D-2D registration of both the patient (via patient CT) and the robot (via CAD model of a surgical instrument attached to its end effector, e.g; a drill guide), guiding the robot to target trajectories defined in the patient CT. The proposed approach avoids C-arm gantry motion, instead manipulating the robot to acquire disparate views of the instrument. Phantom and cadaver studies were performed to determine operating parameters and assess the accuracy of the proposed approach in aligning a standard drill guide instrument. Results: The proposed approach achieved average drill guide tip placement accuracy of 1.57 ± 0.47 mm and angular alignment of 0.35 ± 0.32 deg in phantom studies. The errors remained within 2 mm and 1 deg in cadaver experiments, comparable to the margins of errors provided by surgical trackers (but operating without the need for external tracking). Conclusions: By operating at a fixed fluoroscopic perspective and eliminating the need for encoded C-arm gantry movement, the proposed approach simplifies and expedites the registration of image-guided robotic assistants and can be used with simple, non-calibrated, non-encoded, and non-isocentric C-arm systems to accurately guide a robotic device in a manner that is compatible with the surgical workflow.
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Affiliation(s)
- Rohan C. Vijayan
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Runze Han
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Pengwei Wu
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Niral M. Sheth
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Michael D. Ketcha
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Prasad Vagdargi
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | | | | | - Greg M. Osgood
- Johns Hopkins Medicine, Department of Orthopaedic Surgery, Baltimore, Maryland, United States
| | - Jeffrey H. Siewerdsen
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Ali Uneri
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
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4
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Thilak J, Thadi M, Mane PP, Sharma A, Mohan V, Babu BC. Accuracy of tibial component positioning in the robotic arm assisted versus conventional unicompartmental knee arthroplasty. J Orthop 2020; 22:367-371. [PMID: 32952328 PMCID: PMC7486415 DOI: 10.1016/j.jor.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our study aims to determine the planned accuracy of the tibial component placement in robotic arm assisted unicompartmental knee arthroplasty (UKA) versus the conventional jig based UKA of the initial cases done in India for the first time with this particular robotic system.Materials & Methods: Study group 1 consisted of patients who underwent robotic arm (MAKO, Stryker, USA) assisted UKA. Group 2 consists of patients who underwent a standard conventional jig based (Oxford knee, Biomet, UK). Post-operative radiographs were taken to determine the Tibial Implant position and orientation which were compared to their preoperative plan respectively by two independent observers. The mean error value was obtained for both study groups respectively and compared to determine the accuracy of the post-operative tibial implant placement. RESULTS In the Robotic arm assisted UKA, the deviation of post-operative varus angle from preoperative planned angle was about 0.43° and post-operative Tibial slope alignment differed from preoperative plan was 0.41°. In the Conventional UKA group post-operative varus angle differed from preoperative planned angle by about 2.12° and post-operative Tibial slope alignment deviation from preoperative plan was 2.47°. CONCLUSIONS Robotic arm assisted system was more accurate compared to the conventional jig-based technique in achieving the planned orientation and alignment of the tibial implant in the initial learning phase of this particular Robotic System used for the first time in India. MESH TERMS partial knee replacement, robotic assisted surgery.
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Affiliation(s)
- Jai Thilak
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Mohan Thadi
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Anubhav Sharma
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vipin Mohan
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu C. Babu
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Picard F, Deakin AH, Riches PE, Deep K, Baines J. Computer assisted orthopaedic surgery: Past, present and future. Med Eng Phys 2020; 72:55-65. [PMID: 31554577 DOI: 10.1016/j.medengphy.2019.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022]
Abstract
Computer technology is ubiquitous and relied upon in virtually all professional activities including neurosurgery, which is why it is surprising that it is not the case for orthopaedic surgery with fewer than 5% of surgeons using available computer technology in their procedures. In this review, we explore the evolution and background of Computer Assisted Orthopaedic Surgery (CAOS), delving into the basic principles behind the technology and the changes in the discussion on the subject throughout the years and the impact these discussions had on the field. We found evidence that industry had an important role in driving the discussion at least in knee arthroplasty-a leading field of CAOS-with the ratio between patents and publications increased from approximately 1:10 in 2004 to almost 1:3 in 2014. The adoption of CAOS is largely restrained by economics and ergonomics with sceptics challenging the accuracy and precision of navigation during the early years of CAOS moving to patient functional improvements and long term survivorship. Nevertheless, the future of CAOS remains positive with the prospect of new technologies such as improvements in image-guided surgery, enhanced navigation systems, robotics and artificial intelligence.
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Affiliation(s)
- Frederic Picard
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK; Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, UK.
| | | | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, UK
| | - Kamal Deep
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Joseph Baines
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
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Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-Assisted Technologies in Arthroplasty: Navigating Your Way Today. JBJS Rev 2020; 8:e0157. [PMID: 32224641 DOI: 10.2106/jbjs.rvw.19.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Computer-assisted technologies that are used in arthroplasty include navigation, image-derived instrumentation (IDI), and robotics. Computer-assisted navigation improves accuracy and allows for real-time assessment of component positioning and soft-tissue tension. It is not clear whether the implementation of these technologies improves the clinical outcome of surgery. High cost and time demands have prevented the global implementation of computer-assisted technologies.
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Affiliation(s)
- Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia.,Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Sarah G Brereton
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Constantin E Dlaska
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mackay Hospital and Health Services, Mackay, Queensland, Australia
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7
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Park KK, Han CD, Yang IH, Lee WS, Han JH, Kwon HM. Robot-assisted unicompartmental knee arthroplasty can reduce radiologic outliers compared to conventional techniques. PLoS One 2019; 14:e0225941. [PMID: 31794587 PMCID: PMC6890211 DOI: 10.1371/journal.pone.0225941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to compare the clinical and radiologic outcomes of robot-assisted unicompartmental knee arthroplasty (UKA) to those of conventional UKA in Asian patients. Methods Fifty-five patients underwent robot-assisted UKA and 57 patients underwent conventional UKA were assessed in this study. Preoperative and postoperative range of motion (ROM), American Knee Society (AKS) score, Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC), and patellofemoral (PF) score values were compared between the two groups. The mechanical femorotibial angle (mFTA) and Kennedy zone were also measured. Coronal alignments of the femoral and tibial components and posterior slopes of the tibial component were compared. Additionally, polyethylene (PE) liner thicknesses were compared. Results There was no significant difference between the two groups regarding postoperative ROM, AKS, WOMAC and PF score. Robot group showed fewer radiologic outliers in terms of mFTA and coronal alignment of tibial and femoral components (p = 0.022, 0.037, 0.003). The two groups showed significantly different PE liner thicknesses (8.4 ± 0.8 versus 8.8 ± 0.9, p = 0.035). Robot group was the only influencing factor for reducing radiologic outlier (postoperative mFTA) in multivariate model (odds ratio: 2.833, p = 0.037). Conclusion In this study, robot-assisted UKA had many advantages over conventional UKA, such as its ability to achieve precise implant insertion and reduce radiologic outliers. Although the clinical outcomes of robot-assisted UKA over a short-term follow-up period were not significantly different compared to those of conventional UKA, longer follow-up period is needed to determine whether the improved radiologic accuracy of the components in robotic-assisted UKA will lead to better clinical outcomes and improved long-term survival.
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Affiliation(s)
- Kwan Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Dong Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ick-Hwan Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hyung Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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8
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Casper M, Mitra R, Khare R, Jaramaz B, Hamlin B, McGinley B, Mayman D, Headrick J, Urish K, Gittins M, Incavo S, Neginhal V. Accuracy assessment of a novel image-free handheld robot for Total Knee Arthroplasty in a cadaveric study. Comput Assist Surg (Abingdon) 2019; 23:14-20. [PMID: 30307763 DOI: 10.1080/24699322.2018.1519038] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Surgical navigation has been shown to improve the accuracy of bone preparation and limb alignment in total knee arthroplasty (TKA). Previous work has shown the effectiveness of various types of navigation systems. Here, for the first time, we assessed the accuracy of a novel imageless semiautonomous handheld robotic sculpting system in performing bone resection and preparation in TKA using cadaveric specimens. In this study, we compared the planned and final implant placement in 18 cadaveric specimens undergoing TKA using the new tool. Eight surgeons carried out the procedures using three types of implant designs. A quantitative analysis was performed to determine the translational, angular, and rotational differences between the planned and achieved positions of the implants. The mean femoral flexion, varus/valgus, and rotational error was -2.0°, -0.1°, and -0.5°, respectively. The mean tibial posterior slope, and varus/valgus error was -0.2°, and -0.2°, respectively. We obtained higher flexion errors for the femoral implant when using cut-guides as compared to using a bur for cutting the bones. The image-free robotic sculpting tool achieved accurate implementation of the surgical plan with small errors in implant placement. Future studies will focus on determining how well the accurate implant placement translates into a clinical and functional benefit for the patient.
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Affiliation(s)
| | | | - Rahul Khare
- a Smith & Nephew Inc. , Pittsburgh , PA , USA
| | | | - Brian Hamlin
- b Department of Orthopaedic Surgery , The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Brian McGinley
- c John T. Mather Memorial hospital , Port Jefferson , NY , USA
| | - David Mayman
- d Orthopaedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Jeff Headrick
- e Orthopedic Surgeon , The Center for Orthopedic Surgery , Lubbock , TX , USA
| | - Kenneth Urish
- f Arthritis and Arthroplasty Design Group , The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center , Pittsburgh , PA , USA.,g Department of Orthopaedic Surgery, Department of Bioengineering, and Clinical and Translational Science Institute , University of Pittsburgh , Pittsburgh , PA , USA.,h Department of Biomedical Engineering , Carnegie Mellon University, University of Pittsburgh , Pittsburgh , PA , USA
| | | | - Stephen Incavo
- j Adult Reconstructive Surgery , Houston Methodist Hospital Center for Orthopaedic Surgery , Houston , TX , USA.,k Houston Methodist Hospital , Houston , TX , USA
| | - Vivek Neginhal
- l Orthopedic Surgeon, Scott Orthopedic Center , Huntington , WV , USA
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Lonner JH, Kerr GJ. Low rate of iatrogenic complications during unicompartmental knee arthroplasty with two semiautonomous robotic systems. Knee 2019; 26:745-749. [PMID: 30902518 DOI: 10.1016/j.knee.2019.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/02/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intraoperative complications due to utilization of robotic assistance during unicompartmental knee arthroplasty have not been reported. While inadvertent soft tissue injury has been reported during total knee and hip arthroplasty with autonomous style robotic systems, the incidence of these problems with semiautonomous (i.e. surgeon-driven) systems is unknown. METHODS We report on a series of 1064 consecutive unicompartmental knee arthroplasties performed by one surgeon with either one of two commercially available semiautonomous robotic systems. RESULTS There were no soft tissue, bone injuries or other complications related to the use of the robotic bone preparation method. Six complications related to the use of standard computer navigation pins occurred (0.6%) - one pseudoaneurysm of a branch of the tibialis anterior artery, one tibial metaphyseal stress fracture, and four areas of pin site irritation/superficial infection that resolved with a short course of oral antibiotics. CONCLUSION Current semiautonomous robotic methods are safe, with few complications using meticulous surgical techniques.
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Affiliation(s)
- Jess H Lonner
- Rothman Orthopaedic Institute, Sidney Kimmel Medical College at Thomas Jefferson University, 925 Chestnut St., Philadelphia, PA 19107, United States of America.
| | - Glenn J Kerr
- OrthoVirginia, St. Francis Medical Center, Bon Secours, 13710 St. Francis Blvd, Midlothian, VA 23114, United States of America
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10
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Abstract
Medial unicompartmental knee arthroplasty (UKA) has several benefits over total knee arthroplasty for the surgical treatment of isolated medial compartmental arthritis in the knee, including reduced surgical risk and postoperative morbidity, rapid recovery, more normal kinematics, greater patient satisfaction, and shorter hospitalization. Nonetheless, there is substantial concern about the higher revision rates and lower survivorship in UKA compared to those in total knee arthroplasty. Robotic assistance has been advanced to improve the precision of bone preparation, component alignment, and quantified ligament balance in UKA, with the ultimate goal of improving kinematics and implant survivorship. Two currently available semiautonomous robotic platforms have demonstrated improved accuracy, and emerging short-term follow-up has demonstrated satisfactory functional outcomes. Further studies will be needed to determine if these technologies indeed have a meaningful impact on patient outcomes and survivorship in the mid- to long term.
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11
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Battenberg AK, Netravali NA, Lonner JH. A novel handheld robotic-assisted system for unicompartmental knee arthroplasty: surgical technique and early survivorship. J Robot Surg 2019; 14:55-60. [PMID: 30762173 PMCID: PMC7000507 DOI: 10.1007/s11701-018-00907-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/02/2018] [Indexed: 11/24/2022]
Abstract
Technology, including robotics, has been developed for use in unicompartmental knee arthroplasty (UKA) to improve accuracy and precision of bone preparation, implant positioning, and soft tissue balance. The NAVIO™ System (Smith and Nephew, Pittsburgh, PA, United States) is a handheld robotic system that assists surgeons in planning implant positioning based on an individual patient’s anatomy and then preparing the bone surface to accurately achieve the plan. The surgical technique is presented herein. In addition, initial results are presented for 128 patients (mean age 64.7 years; 57.8% male) undergoing UKA with NAVIO. After a mean of follow-up period of 2.3 years, overall survivorship of the knee implant was 99.2% (95% confidence interval 94.6–99.9%). There was one revision encountered during the study, which was due to persistent soft tissue pain, without evidence of loosening, subsidence, malposition or infection. These initial results suggest a greater survivorship than achieved in the same follow-up time intervals in national registries and cohort studies, though further follow-up is needed to confirm whether this difference is maintained at longer durations.
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Affiliation(s)
- Andrew K Battenberg
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA
| | | | - Jess H Lonner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA
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12
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Moccia S, Foti S, Routray A, Prudente F, Perin A, Sekula RF, Mattos LS, Balzer JR, Fellows-Mayle W, De Momi E, Riviere CN. Toward Improving Safety in Neurosurgery with an Active Handheld Instrument. Ann Biomed Eng 2018; 46:1450-1464. [PMID: 30014286 PMCID: PMC6150797 DOI: 10.1007/s10439-018-2091-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Microsurgical procedures, such as petroclival meningioma resection, require careful surgical actions in order to remove tumor tissue, while avoiding brain and vessel damaging. Such procedures are currently performed under microscope magnification. Robotic tools are emerging in order to filter surgeons' unintended movements and prevent tools from entering forbidden regions such as vascular structures. The present work investigates the use of a handheld robotic tool (Micron) to automate vessel avoidance in microsurgery. In particular, we focused on vessel segmentation, implementing a deep-learning-based segmentation strategy in microscopy images, and its integration with a feature-based passive 3D reconstruction algorithm to obtain accurate and robust vessel position. We then implemented a virtual-fixture-based strategy to control the handheld robotic tool and perform vessel avoidance. Clay vascular phantoms, lying on a background obtained from microscopy images recorded during petroclival meningioma surgery, were used for testing the segmentation and control algorithms. When testing the segmentation algorithm on 100 different phantom images, a median Dice similarity coefficient equal to 0.96 was achieved. A set of 25 Micron trials of 80 s in duration, each involving the interaction of Micron with a different vascular phantom, were recorded, with a safety distance equal to 2 mm, which was comparable to the median vessel diameter. Micron's tip entered the forbidden region 24% of the time when the control algorithm was active. However, the median penetration depth was 16.9 μm, which was two orders of magnitude lower than median vessel diameter. Results suggest the system can assist surgeons in performing safe vessel avoidance during neurosurgical procedures.
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Affiliation(s)
- Sara Moccia
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Simone Foti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Arpita Routray
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | - Francesca Prudente
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Perin
- Besta NeuroSim Center, IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Jeffrey R Balzer
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Wendy Fellows-Mayle
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Lonner JH, Fillingham YA. Pros and Cons: A Balanced View of Robotics in Knee Arthroplasty. J Arthroplasty 2018; 33:2007-2013. [PMID: 29680583 DOI: 10.1016/j.arth.2018.03.056] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 02/01/2023] Open
Abstract
In both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), compared with conventional techniques robotic technology has been shown to optimize the precision of bone preparation and component alignment, reducing outliers and increasing the percentage of components aligned within 2° or 3° of the target goal. In addition, soft tissue balance can be quantified through a range of motion in UKA and TKA using the various robotic technologies available. Although the presumption has been that the improved alignment associated with robotics will improve function and implant durability, there are limited data to support that notion. Based on recent and emerging data, it may be unreasonable to presume that robotics is necessary for both UKA and TKA. In fact, despite improvements in various proxy measures, the precision of robotics may be more important for UKA than TKA, although if system costs and surgical efficiencies continue to improve, streamlining perioperative processes, reducing instrument inventory, and achieving comparable outcomes in TKA may be a reasonable goal of robotic surgery.
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Affiliation(s)
- Jess H Lonner
- Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Yale A Fillingham
- Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Intelligent HMI in Orthopedic Navigation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:207-224. [DOI: 10.1007/978-981-13-1396-7_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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