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Karasavvidis T, Pagan CA, Debbi EM, Mayman DJ, Jerabek SA, Vigdorchik JM. No Difference in Limb Alignment Between Kinematic and Mechanical Alignment Robotic-Assisted Total Knee Arthroplasty. J Arthroplasty 2024; 39:S200-S205. [PMID: 38548234 DOI: 10.1016/j.arth.2024.03.050] [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: 11/20/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Individualized alignment techniques have gained major interest in an effort to increase satisfaction among total knee arthroplasty patients. This study aimed to compare postoperative alignment between kinematic alignment (KA) and mechanical alignment (MA) and assess whether KA significantly deviates from the principle of aligning the limb as close to neutral alignment as possible. METHODS There were 234 patients who underwent robotic-assisted total knee arthroplasty using an unrestricted KA and a strict MA technique (KA: 145, MA: 89). The lateral distal femoral angle, medial proximal tibia angle, and the resultant arithmetic hip-knee-ankle angle (aHKA) were measured. The aHKA < 0 indicated varus alignment, while the aHKA > 0 indicated valgus knee alignment. The primary outcome was the frequency of cases that resulted in an aHKA of ± 4° of neutral (0°), as assessed on full-leg standing radiographs obtained at 6 weeks postoperatively. The secondary outcome was the change in coronal plane alignment of the knee classification type from preoperative to postoperative between the MA and KA groups. RESULTS The mean preoperative aHKA was similar between the 2 groups (P = .19). The KA group had a mean postoperative aHKA of -1.4 ± 2.4°, while the MA group had a mean postoperative aHKA of -0.5 ± 2.1°. No significant difference in limb alignment was identified between KA and MA cases that resulted in hip-knee-ankle angle of ± 4° being neutral (91.7 versus 96.6%, P = .14). There were 97.2% of cases in the KA group that fell within the ± 5° range. The MA group was associated with a significantly higher rate of coronal plane alignment of the knee classification type change from preoperatively to postoperatively (P < .001). CONCLUSIONS Kinematic alignment achieved similar postoperative aHKA compared to MA, and thus did not significantly deviate from the principle of aligning the limb as close to neutral alignment as possible. Surgeons should feel comfortable starting to introduce individualized alignment techniques. Without being restricted by boundaries, postoperative alignment will be within 5 degrees of neutral 97% of the time.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Chen JB, Borsinger TM, Chalmers BP, Debbi EM. Joint Replacement Technology in the Ambulatory Surgery Center: Current and Future Applications. HSS J 2024; 20:18-21. [PMID: 38356759 PMCID: PMC10863591 DOI: 10.1177/15563316231209500] [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: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 02/16/2024]
Abstract
Total joint replacement (TJR) surgery in the ambulatory surgery centers (ASCs) has grown significantly over the past several years, along with the ability to improve the value of care. Standardization of high-quality, perioperative care is pivotal to the success of a TJR ASC program. As surgeons are experiencing increasing overhead with decreasing reimbursement, technology integration can provide major advantages. In this article, we will therefore highlight several examples of technologies that are changing the field and improving care in the preoperative, intraoperative, and postoperative settings.
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Affiliation(s)
- James B Chen
- Mission Orthopedic Institute, Providence Mission Hospital, Mission Viejo, CA, USA
| | - Tracy M Borsinger
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Kafelov M, Batailler C, Shatrov J, Al-Jufaili J, Farhat J, Servien E, Lustig S. Functional positioning principles for image-based robotic-assisted TKA achieved a higher Forgotten Joint Score at 1 year compared to conventional TKA with restricted kinematic alignment. Knee Surg Sports Traumatol Arthrosc 2023; 31:5591-5602. [PMID: 37851026 DOI: 10.1007/s00167-023-07609-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Few comparative studies assessed the current concept of individualised alignment for total knee arthroplasty (TKA) and their outcomes at mid-term. This study aimed to evaluate the functional outcomes at 1 year of primary TKA performed with a functional positioning technique based on an image-based robotic-assisted system, compared to conventional TKA performed with a restricted kinematic alignment technique. METHODS This retrospective comparative study included 100 primary TKAs performed with functional positioning principles using an image-based robotic-assisted system. A control group included 100 primary TKAs with the same posterior-stabilised implant as the robotic group but performed with manual instrumentation and restricted kinematic alignment technique. In the robotic group, the mean age was 69.2 years old ± 7.9; the mean body mass index was 29.7 kg/m2 ± 4.6. The demographic characteristics were similar between both groups. Kujala score, Forgotten Joint Score (FJS), Knee Society Score (KSS) knee and KSS function were collected 12 months postoperatively. Normally distributed continuous variables were compared using the Student t test. For non-normally distributed continuous variables, the Mann-Whitney test was used. RESULTS FJS was significantly higher in the robotic group (76.3 ± 13 vs. 68.6 ± 16.9 in the conventional group; p = 0.026). At a 1-year follow-up, there was no significant difference in the KSS knee and KSS function scores and the Kujala score between both groups. The mean KSS knee score was 90.8 ± 11.4 in the robotic group versus 89.4 ± 9.6 in the conventional group (p = 0.082). The mean KSS function score was 91.4 ± 12.3 versus 91.3 ± 12.6, respectively (p = 0.778). CONCLUSION Functional positioning principles using an image-based robotic-assisted system achieved a higher Forgotten Joint Score 1 year after TKA compared to restricted kinematic alignment. Personalised alignment and implant positioning are interesting paths to improve the functional outcomes after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Moussa Kafelov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
- University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France.
| | - Jobe Shatrov
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia
| | - Jihad Al-Jufaili
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Jawhara Farhat
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
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Zak SG, Cieremans D, Tang A, Schwarzkopf R, Rozell JC. Intraoperative technology increases operating room times in primary total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:2113-2119. [PMID: 35551447 DOI: 10.1007/s00402-022-04468-4] [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: 11/26/2021] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Optimization of patient outcomes and identification of factors to improve the surgical workflow are increasingly important. Operating room time is one modifiable factor that leads to greater hospital efficiency as well as improved outcomes such as shorter length of stay and fewer infections and readmissions. The aim of this study was to identify factors associated with operative time disparities in total knee arthroplasty (TKA). METHODS A retrospective review of 7659 consecutive primary TKA cases was conducted. Patient demographic data, discrete operating room (OR) times, use of technology (i.e. robotic-assisted surgery, computer navigation), surgeon experience and the level of training of the first assistant were collected. Multivariate regression analysis was used to determine the effect of hospital characteristics on operative times. Operative times of five minutes or greater were considered to be clinically significant. RESULTS While the use of technology (182.64 ± 39.85 vs 158.70 ± 37.45 min; B = 26.09; p < 0.0001) and greater surgeon experience (162.14 ± 39.87 vs 158.69 ± 33.18 min, B = 3.15, p = 0.002) were found to increase OR times, level of training of the first assist (161.65 vs 156.4 min; Β = - 0.264; p = 0.487) did not. Of the discrete OR times examined, incision time and total time under anesthesia were negatively impacted by the use of technology. CONCLUSION Use of technology was the only study variable found to significantly increase OR times. With increased operative times and limited evidence that technology improves long-term patient outcomes, surgeons should carefully consider the benefits and cost of technology in TKA.
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Affiliation(s)
- Stephen G Zak
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - David Cieremans
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Alex Tang
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
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Mullaji AB, Khalifa AA. Is it prime time for robotic-assisted TKAs? A systematic review of current studies. J Orthop 2022; 34:31-39. [PMID: 35992614 PMCID: PMC9389136 DOI: 10.1016/j.jor.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/23/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Less-than-optimum positioning of femoral and tibial components and improper soft tissue tension, with abnormal loads and reduced range of motion, may cause lower patient satisfaction rates. To reduce surgeon-related variables during TKA, technology-assisted TKA was introduced, including computer navigation and robotic-assisted surgery (RATKA). Although several studies show promising short- and long-term functional and radiological outcomes of RATKA, there are still concerns related to its absolute superiority over conventional TKA. Methods This review aims to provide an updated insight into the most recent articles reporting on outcomes (functional, radiological, and complications) of RATKA through a systematic search of major databases. A comprehensive English literature search was performed by both authors through four databases (Embase, PubMed, Web of Science, and Scopus). The full text of the final eligible studies was evaluated for inclusion, resulting in 13 studies that are included in this review. Results There were 2112 knees in the 13 studies, with a follow-up ranging from three months to 13 years; only three were randomized controlled trials (RCTs), and nine directly compared the results of RATKA with CTKA technique. Seven studies reported the operative time ranging from 76.8 to 156 min; six reported a longer operative time with RATKA. Length of hospital stay (LOS) was reported in six studies which ranged from 0.48 to 2.1 days; in four studies the LOS was shorter with RATKA. In seven of the nine studies comparing RATKA with CTKA, no difference in functional outcomes was found. Four out of six studies reported that the overall alignment had mechanical alignment within ±3° of neutral alignment in all RATKA patients with an HKA ranging from -0.3 to 1.8°. Only one study reported better radiological outcomes in the RATKA group. In six comparative studies, no difference was found in the incidence of complications between RATKA and CTKA. Conclusion Although robotic-assisted total knee arthroplasty is a promising technology that provides better component alignment and superior early functional outcomes, the justification for its widespread adoption needs more robust evidence through well-designed and better long-term studies demonstrating superior, predictable, and durable clinical results compared to conventional total knee arthroplasty techniques.
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Affiliation(s)
| | - Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt
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