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Jiao X, Du M, Li Q, Huang C, Ding R, Wang W. Does patient-specific instrument or robot improve imaging and functional outcomes in unicompartmental knee arthroplasty? A bayesian analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05569-y. [PMID: 39294530 DOI: 10.1007/s00402-024-05569-y] [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: 05/09/2024] [Accepted: 09/09/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION This study conducted a Bayesian network meta-analysis (NMA) to compare the imaging and functional outcomes of patient-specific instrument-assisted unicompartmental knee arthroplasty (P-UKA), robot-assisted unicompartmental knee arthroplasty (R-UKA), and conventional unicompartmental knee arthroplasty (C-UKA). MATERIALS AND METHODS A comprehensive search was performed on five electronic databases and major orthopedic journals as of September 24, 2023. We included randomized controlled studies featuring at least two interventions of P-UKA, R-UKA, or C-UKA. Primary outcomes encompassed the deviation angle of hip-knee-ankle angle, as well as the coronal and sagittal plane alignment of femoral and tibial components. Secondary outcomes included patient-reported outcome measures (PROM), surgery time, revision rate, and complication rate. Bayesian framework was employed for risk ratio (RR) or mean deviation (MD) analysis, and treatment hierarchy was established based on rank probabilities. RESULTS This NMA included 871 knees from 12 selected studies. In sagittal plane, R-UKA exhibited a significantly reduced deviation angle of femoral component compared to P-UKA (MD: 4.16, 95% CI: 0.21, 8.07), and of tibial component in comparison to C-UKA (MD: -2.45, 95% CI: -4.20, -0.68). Notably, the surgery time was significantly longer in R-UKA than in C-UKA (MD: 15.98, 95% CI: 3.11, 28.88). However, no significant differences were observed in other outcomes. CONCLUSION Compared with P-UKA or C-UKA, R-UKA significantly improves the femoral and tibial component alignment in the sagittal plane, although this does not translate into discernible differences in functional outcomes. Comprehensive considerations of economic and learning costs are imperative for the judicious selection of the appropriate procedure.
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Affiliation(s)
- Xufeng Jiao
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Mincong Du
- Department of Orthopaedic Surgery, Xuanwu Hospital Capital Medical University, Beijing, P.R. China
| | - Qi Li
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
- Medical Research and Biometrics Center, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Beijing, P.R. China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Ran Ding
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, P.R. China.
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Twomey-Kozak J, Hurley E, Levin J, Anakwenze O, Klifto C. Technological innovations in shoulder replacement: current concepts and the future of robotics in total shoulder arthroplasty. J Shoulder Elbow Surg 2023; 32:2161-2171. [PMID: 37263482 DOI: 10.1016/j.jse.2023.04.022] [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: 02/22/2023] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) has been rapidly evolving over the last several decades, with innovative technological strategies being investigated and developed in order to achieve optimal component precision and joint alignment and stability, preserve implant longevity, and improve patient outcomes. Future advancements such as robotic-assisted surgeries, augmented reality, artificial intelligence, patient-specific instrumentation (PSI) and other peri- and preoperative planning tools will continue to revolutionize TSA. Robotic-assisted arthroplasty is a novel and increasingly popular alternative to the conventional arthroplasty procedure in the hip and knee but has not yet been investigated in the shoulder. Therefore, the purpose of this study was to conduct a narrative review of the literature on the evolution and projected trends of technological advances and robotic assistance in total shoulder arthroplasty. METHODS A narrative synthesis method was employed for this review, rather than a meta-analysis or systematic review of the literature. This decision was based on 2 primary factors: (1) the lack of eligible, peer-reviewed studies with high-quality level of evidence available for review on robotic-assisted shoulder arthroplasty, and (2) a narrative review allows for a broader scope of content analysis, including a comprehensive review of all technological advances-including robotics-within the field of TSA. A general literature search was performed using PubMed, Embase, and Cochrane Library databases. These databases were queried by 2 independent reviewers from database inception through November 11, 2022, for all articles investigating the role of robotics and technology assistance in total shoulder arthroplasty. Inclusion criteria included studies describing "shoulder arthroplasty" and "robotics." RESULTS After exclusion criteria were applied, 4 studies on robotic-assisted TSA were described in the review. Given the novelty of this technology and limited data on robotics in TSA, these studies consisted of a literature review, nonvalidated experimental biomechanical studies in sawbones models, and preclinical proof-of-concept cadaveric studies using prototype robotic technology primarily in conjunction with PSI. The remaining studies described the technological advancements in TSA, including PSI, computer-assisted navigation, artificial intelligence, machine learning, and virtual, augmented, and mixed reality. Although not yet commercially available, robotic-assisted TSA confers the theoretical advantages of precise humeral head cuts for restoration of proximal humerus anatomy, more accurate glenoid preparation, and improved soft-tissue assessment in limited early studies. CONCLUSION The evidence for the use of robotics in total hip arthroplasty and total knee arthroplasty demonstrates improved component accuracy, more precise radiographic measurements, and improved early/mid-term patient-reported and functional outcomes. Although no such data currently exist for shoulder arthroplasty given that the technology has not yet been commercialized, the lessons learned from robotic hip and knee surgery in conjunction with its rapid adoption suggests robotic-assisted TSA is on the horizon of innovation. By achieving a better understanding of the past, present, and future innovations in TSA through this narrative review, orthopedic surgeons can be better prepared for future applications.
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Affiliation(s)
- Jack Twomey-Kozak
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Eoghan Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees. INTERNATIONAL ORTHOPAEDICS 2023; 47:533-541. [PMID: 36434294 DOI: 10.1007/s00264-022-05640-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Implant malpositioning, joint line (JL) lowering, and malalignment have been identified as risk factors for implant failure in unicompartmental knee arthroplasty (UKA). The aims of this study were to compare the accuracy of implant positioning in robotic-assisted UKA versus conventional UKA in a large cohort and examine the correlation with implant survival at mid-term follow-up. METHODS This retrospective study included 356 medial UKAs from 2011 to 2019. The radiological measurements performed were coronal positioning of tibial implant according to Cartier angle (Δ Cartier), posterior tibial slope (PTS), residual hip-knee-ankle (HKA), and JL restoration. Outliers were defined as follows: post-operative HKA < 175° or > 180°, Δ Cartier > 3° or < - 3°, JL change ≥ 2 mm, and PTS < 2° or > 8°. The survival probability was reported at the last follow-up. RESULTS Out of the 356 knees included, 159 underwent conventional UKA (44.5%) and 197 (55.5%) robotic-assisted UKA. The mean follow-up was 61.3 months ± 24.0. Robotic UKA was associated with better accuracy compared to conventional UKA in relation to HKA (67% vs 56%, p = 0.023), JL restoration (70% vs 44%, p < 0.0001), PTS (83% vs 55%, p < 0.0001), and tibial varus restoration (65% vs 55%, p = 0.049). Implant survival in the robotic group was found to be superior at the last follow-up (96.4% versus 87.3% at 9 years, p = 0.004). CONCLUSION Robotic assistance in patients undergoing medial UKA was associated with better accuracy compared to conventional UKA with respect to tibial implant positioning, post-operative limb alignment, and JL restoration. This was translated in improved survival at mid-term follow-up favouring the robotic group.
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Image-based robotic unicompartmental knee arthroplasty allowed to match the rotation of the tibial implant with the native kinematic knee alignment. INTERNATIONAL ORTHOPAEDICS 2023; 47:519-526. [PMID: 36422703 DOI: 10.1007/s00264-022-05637-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Image-based robotic tools improve the accuracy of unicompartmental knee arthroplasty (UKA) positioning, but few studies have examined its effect on axial alignment. The aim of this study was to compare the characteristics of tibial and femoral implant positioning, mainly the tibial rotation, during medial or lateral UKA, performed with an image-based robotic assisted system. METHODS A total of 71 UKA performed between September 2021 and June 2022 (53 medial and 18 lateral) were analyzed. All data regarding implant positioning (rotation, coronal and sagittal alignment) for tibial and femoral components were obtained using MAKO® software (Stryker®, Mahwah, USA) intra-operatively. RESULTS The lateral UKA had a mean internal tibial rotation of 15.4 ± 3°, a mean external femoral rotation of 0.96 ± 2.4°, and a mean tibial slope of 4.7 ± 1.3°. The medial UKA had a mean internal tibial rotation of 0.18 ± 2.7°, a mean internal femoral rotation of 0.35 ± 2.2°, and a mean tibial slope of 5.4 ± 1.3°. The tibial rotations, femoral valgus, tibial varus and tibial size significantly differed between medial and lateral UKA (p < 0.05). There was no significant difference in femoral rotation, flexion, femoral size, slope, and polyethylene thickness between medial and lateral UKA. CONCLUSION Medial and lateral UKA had significantly different implantation characteristics related to the biomechanics of the knee compartments. Image-based robotic UKA allowed precise femorotibial positioning per-operatively to match native kinematic alignment.
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Zambianchi F, Franceschi G, Banchelli F, Marcovigi A, Ensini A, Catani F. Robotic Arm-Assisted Lateral Unicompartmental Knee Arthroplasty: How Are Components Aligned? J Knee Surg 2022; 35:1214-1222. [PMID: 33511590 DOI: 10.1055/s-0040-1722346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this multicenter, retrospective, observational study was to investigate the association between intraoperative component positioning and soft tissue balancing, as reported by robotic technology for a cohort of patients who received robotic arm-assisted lateral unicompartmental knee arthroplasty (UKA) as well as short-term clinical follow-up of these patients. Between 2013 and 2016, 78 patients (79 knees) underwent robotic arm-assisted lateral UKAs at two centers. Pre- and postoperatively, patients were administered the Knee Injury and Osteoarthritis Score (KOOS) and the Forgotten Joint Score-12 (FJS-12). Clinical results were dichotomized based upon KOOS and FJS-12 scores into either excellent or fair outcome, considering excellent KOOS and FJS-12 to be greater than or equal to 90. Intraoperative, postimplantation robotic data relative to computed tomography-based components placement were collected and classified. Following exclusions and loss to follow-up, a total of 74 subjects (75 knees) who received robotic arm-assisted lateral UKAs were taken into account with an average follow-up of 36.3 months (range: 25.0-54.2 months) postoperative. Of these, 66 patients (67 knees) were included in the clinical outcome analysis. All postoperative clinical scores showed significant improvement compared with the preoperative evaluation. No association was reported between three-dimensional component positioning and soft tissue balancing throughout knee range of motion with overall KOOS, KOOS subscales, and FJS-12 scores. Lateral UKA three-dimensional placement does not seem to affect short-term clinical performance. However, precise boundaries for lateral UKA positioning and balancing should be taken into account. Robotic assistance allows surgeons to acquire real-time information regarding implant alignment and soft tissue balancing.
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Affiliation(s)
- Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
| | - Giorgio Franceschi
- Department of Knee Surgery, Policlinico Abano Terme, Piazza Cristoforo Colombo, Abano Terme (PD), Italy
| | - Federico Banchelli
- Department of Diagnostics, Statistic Unit, Clinical and Public Health Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
| | - Andrea Ensini
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia - Via del Pozzo, Modena, Italy
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Wang Z, Deng W, Shao H, Zhou Y, Yang D, Li H. Predictors of a forgotten joint after medial fixed-bearing unicompartmental knee arthroplasty. Knee 2022; 37:103-111. [PMID: 35753203 DOI: 10.1016/j.knee.2022.06.004] [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: 03/27/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A forgotten joint is considered the ultimate goal of joint replacement. We aim to explore the predictive factors of a forgotten joint after fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS This retrospective cohort study used prospectively collected data from 302 cases of medial-compartment UKA with a minimum of 2-year follow-up. The primary outcome was the achievement of a forgotten joint after UKA, according to the Forgotten Joint Score (FJS-12) at the last follow-up. Patients with FJS-12 > 84 were considered to have forgotten UKA. Univariate and multivariate logistic regression analyses were conducted with preoperative patient characteristics and surgery-related factors as potential predictors. RESULTS Of patients, 94 (31.1%) achieved a forgotten joint post-surgery. Multivariate logistic regression analysis revealed that preoperative hip-knee-ankle angle (HKAA), anatomic lateral distal femoral angle (aLDFA), and postoperative HKAA and HKAA changes were independent predictors of a forgotten joint. The probability of achieving a forgotten joint increased by 29% (OR = 1.29, 95% CI: 1.12-1.51) with a 1° increase in aLDFA. Preoperative HKAA, postoperative HKAA, HKAA changes (ΔHKAA), and outcomes exhibited a non-linear relationship. The probability of achieving a forgotten joint was the highest with preoperative HKAA > 172.0°, postoperative HKAA of 176.0-178.5°, and ΔHKAA < 5.5°. CONCLUSION To achieve the forgotten joint state, the ideal HKAA range after medial fixed-bearing UKA is 176.0-178.5° and ΔHKAA should be <5.5°. Patients with smaller preoperative aLDFA and HKAA have a lower probability of achieving a forgotten joint after UKA.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hua Li
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing 100853, China; National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, No. 28 Fuxing Road, Beijing 100853, China
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Alruwaili SH, Park KK, Yang IH, Lee WS, Cho BW, Kwon HM. Difference between medial and lateral tibia plateau in the coronal plane: importance of preoperative evaluation for medial unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2022; 23:342. [PMID: 35397513 PMCID: PMC8994383 DOI: 10.1186/s12891-022-05298-6] [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] [Received: 08/24/2021] [Accepted: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Setting bone cutting levels for different joint line orientations of the medial and lateral tibia plateaus in individual patients is not clear. We aimed to evaluate the difference between joint line orientation of the medial and lateral tibia plateaus relative to the horizontal line of mechanical axis of tibia as tibial plateau difference (TPD) for an optimal tibial bone cut in medial unicompartmental knee arthroplasty (UKA) and determine which factors could influence TPD. We aimed to investigate the effect of preoperative TPD on polyethylene liner size in medial UKA. Methods TPD in the coronal plane were measured in 181 female patients (181 knees). To determine the morphology of proximal tibia according to the severity of osteoarthritis, the patients were classified into three groups based on diagnosis and treatment: 80 who underwent robot-assisted medial UKA, 45 who underwent total knee arthroplasty (TKA), and 56 with early-stage osteoarthritis (OA) who had conservative management. Also, we divided the medial UKA group into two groups according to TPD (greater than or less than 5 mm) and compared polyethylene liner sizes. Results No significant difference was observed in TPD (p = 0.662), difference between the medial and lateral femoral condyle levels (p = 0.54), medial proximal tibial angle (p = 0.169), or posterior tibial slope (p = 0.466) among the three groups. Increased TPD was significantly associated with increased mechanical femorotibial angle(mFTA) (p < 0.01). The medial UKA group was divided into two groups according to TPD greater or less than 5 mm. Thicker polyethylene liners were used for groups with TPD greater than 5 mm (8.5 ± 0.7 mm versus 8.2 ± 0.3 mm, p = 0.01). Additionally, the proportion of patients using the thinnest polyethylene (8 mm) in each TPD group (greater or less than 5 mm) was higher in patients with TPD less than 5 mm (82.4% versus 58.7%, p = 0.038). Conclusions Preoperative measurement of TPD is important to help surgeons predict the most appropriate bone cutting level in the coronal plane in primary medial UKA. Tibial bone resection would be likely to be thicker than needed in patients with increased TPD in medial UKA.
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Affiliation(s)
- Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
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Asokan A, Baawa-Ameyaw J, Kayani B, Radhakrishnan GT, Magan AA, Haddad FS. Nursing considerations for patients undergoing robotic-arm assisted joint replacements. ACTA ACUST UNITED AC 2021; 30:580-587. [PMID: 34037453 DOI: 10.12968/bjon.2021.30.10.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Robotic-arm assisted arthroplasty (RAA) has gained popularity over the past decade because of its ability to provide more accurate implant positioning with less surgical trauma than conventional manual arthroplasty. It has shown better early functional outcomes, less postoperative pain and shorter inpatient stays. A multidisciplinary approach is crucial in improving overall outcomes and ensuring this technology is implemented efficiently and safely, but there is limited published literature on the nursing considerations for managing patients undergoing RAA. This article aims to provide a pragmatic approach for nursing care in the pre-, intra-, and postoperative phases of RAA.
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Affiliation(s)
- Ajay Asokan
- Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Joanna Baawa-Ameyaw
- Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Babar Kayani
- PhD Candidate, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Ganan T Radhakrishnan
- Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Ahmed A Magan
- Senior Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Fares S Haddad
- Professor of Orthopaedics, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
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Mittal A, Meshram P, Kim TK. What is the evidence for clinical use of advanced technology in unicompartmental knee arthroplasty? Int J Med Robot 2021; 17:e2302. [PMID: 34196097 DOI: 10.1002/rcs.2302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND With an aim of improving prosthesis survivorship of unicompartmental knee arthroplasty (UKA), use of computer-assisted technologies (CATs) such as robotics, has been on the rise to reduce intraoperative errors in surgical technique. In light of recent influx of CATs in the UKA, a review of these innovations will help providers to understand their clinical utility. METHOD A systematic literature search was performed following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. RESULTS Among 19 studies comparing robot-assisted UKA with conventional UKA, only 32% were randomized control trials, 47% reported minimum mean follow-up of 2 years, and 21% evaluated prosthesis survival. Similar results were obtained for navigation-assisted UKA and UKA performed with patient-specific instrumentation. CONCLUSION While CATs seem to reduce the surgical errors in UKA, the evidence on the efficacy of any of the studied CATs to improve survivorship remains limited and there are issues related to cost-effectiveness, learning curve, and increase in operating time.
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Affiliation(s)
- Anurag Mittal
- Department of Orthopedics, Max Super Speciality Hospital, Dehradun, Uttarakhand, India
| | - Prashant Meshram
- Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tae Kyun Kim
- TK Orthopaedic Institution, Seongnam, Bundang, South Korea
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Batailler C, Bordes M, Lording T, Nigues A, Servien E, Calliess T, Lustig S. Improved sizing with image-based robotic-assisted system compared to image-free and conventional techniques in medial unicompartmental knee arthroplasty. Bone Joint J 2021; 103-B:610-618. [PMID: 33789484 DOI: 10.1302/0301-620x.103b4.bjj-2020-1453.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Ideal component sizing may be difficult to achieve in unicompartmental knee arthroplasty (UKA). Anatomical variants, incremental implant size, and a reduced surgical exposure may lead to over- or under-sizing of the components. The purpose of this study was to compare the accuracy of UKA sizing with robotic-assisted techniques versus a conventional surgical technique. METHODS Three groups of 93 medial UKAs were assessed. The first group was performed by a conventional technique, the second group with an image-free robotic-assisted system (Image-Free group), and the last group with an image-based robotic arm-assisted system, using a preoperative CT scan (Image-Based group). There were no demographic differences between groups. We compared six parameters on postoperative radiographs to assess UKA sizing. Incorrect sizing was defined by an over- or under-sizing greater than 3 mm. RESULTS There was a higher rate of tibial under-sizing posteriorly in the conventional group compared to robotic-assisted groups (47.3% (n = 44) in conventional group, 29% (n = 27) in Image-Free group, 6.5% (n = 6) in Image-Based group; p < 0.001), as well as a higher rate of femoral under-sizing posteriorly (30.1% (n = 28) in conventional group, 7.5% (n = 7) in Image-Free group, 12.9% (n = 12) in Image-Based group; p < 0.001). The posterior femoral offset was more often increased in the conventional group, especially in comparison to the Image-Based group (43% (n = 40) in conventional group, 30.1% (n = 28) in Image-Free group, 8.6% (n = 8) in Image-Based group; p < 0.001). There was no significant overhang of the femoral or tibial implant in any groups. CONCLUSION Robotic-assisted surgical techniques for medial UKA decrease the risk of tibial and femoral under-sizing, particularly with an image-based system using a preoperative CT scan. Cite this article: Bone Joint J 2021;103-B(4):610-618.
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Affiliation(s)
- Cecile Batailler
- Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Maxence Bordes
- Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | | | - Ana Nigues
- Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Tilman Calliess
- Articon The Specialists for Joint Surgery, Salem-Spital, Bern, Switzerland
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.,Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Fontalis A, Epinette JA, Thaler M, Zagra L, Khanduja V, Haddad FS. Advances and innovations in total hip arthroplasty. SICOT J 2021; 7:26. [PMID: 33843582 PMCID: PMC8040589 DOI: 10.1051/sicotj/2021025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) has been quoted as one of the most successful and cost-effective procedures in Orthopaedics. The last decade has seen an exponential rise in the number of THAs performed globally and a sharp increase in the percentage of young patients hoping to improve their quality of life and return to physically demanding activities. Hence, it is imperative to review the various applications of technology in total hip arthroplasty for improving outcomes. The development of state-of-the-art robotic technology has enabled more reproducible and accurate acetabular positioning, while long-term data are needed to assess its cost-effectiveness. This opinion piece aims to outline and present the advances and innovations in total hip arthroplasty, from virtual reality and three-dimensional printing to patient-specific instrumentation and dual mobility bearings. This illustrates and reflects the debate that will be at the centre of hip surgery for the next decade.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | | | - Martin Thaler
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan 20161, Italy
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Box 37, Addenbrookes Hospital, Cambridge CB2 0QQ, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
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Khow YZ, Liow MHL, Lee M, Chen JY, Lo NN, Yeo SJ. Coronal Alignment of Fixed-Bearing Unicompartmental Knee Arthroplasty Femoral Component May Affect Long-Term Clinical Outcomes. J Arthroplasty 2021; 36:478-487. [PMID: 32828619 DOI: 10.1016/j.arth.2020.07.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aims to investigate the clinical effects of femoral component coronal alignment in a cohort of fixed-bearing unicompartmental knee arthroplasty with clinical and radiological follow-up of 10 years. METHODS Prospectively collected registry data of 264 consecutive, cemented, primary fixed-bearing medial unicompartmental knee arthroplasties performed at a single institution from 2004 to 2007 were reviewed. Femoral component coronal angle (FCCA), tibial component coronal angle, and hip-knee-ankle angle were measured on postoperative radiographs. Patients were grouped into acceptable (AG ≤ 3°) and outlier (OG > 3°) groups according to absolute FCCA. Clinical assessment at 6-month, 2-year, and 10-year follow-up was performed using Knee Society Knee and Function Scores, Oxford Knee Score (OKS), and Short Form-36. Fulfillment of expectations, satisfaction, and implant survivorship was recorded. RESULTS There was no significant difference in demographics, tibial component coronal angle, hip-knee-ankle angle, and sagittal parameters in both groups. The OG had poorer OKS at 10 years and a larger deterioration from 2 to 10 years compared to AG (P = .02). Increase in FCCA was associated with deterioration in 2-year OKS (adjusted ß = 0.23, P = .01), 10-year OKS (adjusted ß = 0.26, P = .03), and 2-year Short Form-36 physical component score (adjusted ß = -0.44, P = .01). Expectation fulfillment at 2 years was lower in the OG vs the AG (88% vs 100%, P = .03). Both groups had similar 10-year survivorship (99% vs 98%, P = .65). CONCLUSIONS FCCA may affect long-term clinical outcomes, but not short-term clinical outcomes nor 10-year survivorship. Given similar limb alignment, coronal and sagittal component positioning, a larger FCCA was associated with poorer outcomes at 10-year follow-up.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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14
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Haddad FS. Wishing everyone a happy and healthy 2021. Bone Joint J 2021; 103-B:1-2. [PMID: 33380186 DOI: 10.1302/0301-620x.103b1.bjj-2020-2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
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15
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Klasan A, Carter M, Holland S, Young SW. Low femoral component prominence negatively influences early revision rate in robotic unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:3906-3911. [PMID: 32030503 DOI: 10.1007/s00167-020-05886-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The revision rate of unicompartmental knee arthroplasty (UKA) is higher than in total knee arthroplasty (TKA), and implant positioning may play a role. In combination with a pre-operative CT, robotic UKA may provide the ability to position the implants more precisely. The aim of this study was to investigate the influence of component prominence relative to the native joint surface on early outcomes and revisions. The hypothesis was that aiming for restoration of joint space to 0.5-1.5 mm will improve outcomes. METHODS Retrospective analysis of prospectively collected data of 94 patients undergoing robotic-assisted UKA (Mako, Stryker) was performed. The 'prominence' of the implant surface relative to the native bony surface in sagittal plane, hip-knee-ankle (HKA) correction in coronal plane was documented intraoperatively. The mean achieved gap between two components under valgus stress captured in at least 5 different flexion angles was calculated. These were then analysed for impact on early revision rate and outcomes, stratified by gender. RESULTS Median HKA correction was 3.5° (range 0°-9.5°). Median femoral prominence was 1.5 mm (range - 0.6 to 4 mm) and median tibial prominence was 4.3 mm (2-7 mm). The median achieved gap was 1.0 mm (- 1.2 to 2.8 mm). There was no difference in achieved correction between men and women (p = n.s.) but men had a higher achieved combined prominence than women (p < 0.001). PROMs did not correlate with the average gap (p = n.s.) nor with combined prominence (p = n.s.). Two patients underwent an early revision. Lower femoral prominence was a significant predictor of revision (p = 0.045; OR = 0.21; 95% CI 0.000-0.918). CONCLUSION Female patients need less component prominence to achieve the same average gap balance through a range of motion, without correlation with patient's height. Intraoperatively low femoral prominence could be a reason for early revision. LEVEL OF EVIDENCE IV.
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16
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Wang Z, Deng W, Shao H, Zhou Y, Li H. Forgotten Joint Score Thresholds for Forgotten Joint Status and Patient Satisfaction after Unicompartmental Knee Arthroplasty in Chinese Patients. J Arthroplasty 2020; 35:2825-2829. [PMID: 32482475 DOI: 10.1016/j.arth.2020.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/19/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Patient Acceptable Symptom State (PASS) and "forgotten joint" represent 2 treatment goals that arthroplasty surgeons often pursue. However, the actual Forgotten Joint Score (FJS-12) that corresponds to the PASS and forgotten joint in unicompartmental knee arthroplasty (UKA) patients remains unknown. METHODS One hundred ninety-three patients who underwent a medial UKA for knee osteoarthritis with a minimum of 1-year follow-up were included. Patients were asked to complete the FJS-12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. We used patient-reported satisfaction and the Patient's Joint Perception questions as anchors to determine the achievement of PASS and the forgotten joint, respectively. FJS-12 thresholds for PASS and the forgotten joint were calculated using the anchor-based receiver operating characteristic curve analysis. The ability of the FJS-12 and WOMAC scores to detect the PASS and forgotten joint was compared with DeLong's test. RESULTS Based on the answers to the anchor questions, 176 (91.2%) of the 193 total patients achieved the PASS and 34 (17.6%) patients achieved a forgotten joint after UKA. The FJS-12 outperformed the WOMAC with respect to detecting a forgotten joint (P = .008), but they performed equally well in terms of detecting PASS (P = .950). The FJS-12 threshold for PASS was 40.63 (sensitivity: 84.1%, specificity: 76.5%) and for the forgotten joint was 84.38 (sensitivity: 97.1%, specificity: 88.1%). CONCLUSION For UKA patients, the FJS-12 score has a superior ability to detect a forgotten joint when compared to the WOMAC. The FJS-12 threshold for the PASS is 40.63, while a score above 84.38 can be interpreted as having achieved a forgotten joint.
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Affiliation(s)
- Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hua Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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17
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Zhang P, Xu K, Zhang J, Chen P, Fang Y, Wang J. Comparison of robotic-assisted versus conventional unicompartmental knee arthroplasty for the treatment of single compartment knee osteoarthritis: A meta-analysis. Int J Med Robot 2020; 17:1-11. [PMID: 32946635 DOI: 10.1002/rcs.2170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/11/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The robotic-assisted unicompartmental knee arthroplasty (UKA) is proposed to improve the accuracy of component positioning. METHODS We conducted a literature search in Medline, Embase, Web of Science and the Cochrane Library until April 2020. RESULTS Our meta-analysis included 10 articles, involving 1231 knees. Our meta-analysis demonstrated that the robotic group had significantly better results in outliers of limb alignment (p < 0.001) and outliers of tibial alignment (p < 0.001). No statistical differences were found in the American Knee Society Score (p = 0.63), range of motion (p = 0.93), pain (p = 0.27), rate of revisions (p = 0.73) and rate of complications (p = 0.67). CONCLUSIONS Robotic-assisted UKA has better component position accuracy compared with conventional UKA. But there was no significant difference in clinical results. In order to further evaluate the utility of robotic-assisted UKA, long-term follow-up randomized controlled trials (RCTs) are needed, as well as studies to evaluate the correlation between postoperative alignment and long-term clinical results.
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Affiliation(s)
- Pei Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Keteng Xu
- Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jiale Zhang
- Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Pengtao Chen
- Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yongchao Fang
- Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jingcheng Wang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Department of Orthopedics, Clinical Medical College, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, China
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18
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Clement ND, Bell A, Simpson P, Macpherson G, Patton JT, Hamilton DF. Robotic-assisted unicompartmental knee arthroplasty has a greater early functional outcome when compared to manual total knee arthroplasty for isolated medial compartment arthritis. Bone Joint Res 2020; 9:15-22. [PMID: 32435451 PMCID: PMC7229306 DOI: 10.1302/2046-3758.91.bjr-2019-0147.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA. Methods A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment arthritis. Patients were matched for age, sex, body mass index (BMI), and preoperative function. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were collected preoperatively and six months postoperatively. The Forgotten Joint Score (FJS) and patient satisfaction were collected six months postoperatively. Length of hospital stay was also recorded. Results There were no significant differences in the preoperative demographics (p ⩾ 0.150) or function (p ⩾ 0.230) between the groups. The six-month OKS was significantly greater in the rUKA group when compared with the mTKA group (difference 7.7, p < 0.001). There was also a greater six-month postoperative EQ-5D (difference 0.148, p = 0.002) and FJS (difference 24.2, p < 0.001) for the rUKA when compared to the mTKA. No patient was dissatisfied in the rUKA group and five (6%) were dissatisfied in the mTKA, but this was not significant (p = 0.210). Length of stay was significantly (p < 0.001) shorter in the rUKA group (median two days, interquartile range (IQR) 1 to 3) compared to the mTKA (median four days, IQR 3 to 5). Conclusion Patients with isolated medial compartment arthritis had a greater knee-specific functional outcome and generic health with a shorter length of hospital stay after rUKA when compared to mTKA. Cite this article: Bone Joint Res 2019;9(1):15–22.
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Affiliation(s)
- N D Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Bell
- Spire Murrayfield Hospital, Edinburgh, UK
| | - P Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - G Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK. Spire Murrayfield Hospital, Edinburgh, UK
| | - D F Hamilton
- Department of Orthopaedics, University of Edinburgh, University of Edinburgh, Edinburgh, UK
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19
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Affiliation(s)
- Justin S. Chang
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
| | - Fares S. Haddad
- The Bone & Joint Journal, UK; Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, London, UK
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20
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St Mart JP, de Steiger RN, Cuthbert A, Donnelly W. The three-year survivorship of robotically assisted versus non-robotically assisted unicompartmental knee arthroplasty. Bone Joint J 2020; 102-B:319-328. [PMID: 32114810 DOI: 10.1302/0301-620x.102b3.bjj-2019-0713.r1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM There has been a significant reduction in unicompartmental knee arthroplasty (UKA) procedures recorded in Australia. This follows several national joint registry studies documenting high UKA revision rates when compared to total knee arthroplasty (TKA). With the recent introduction of robotically assisted UKA procedures, it is hoped that outcomes improve. This study examines the cumulative revision rate of UKA procedures implanted with a newly introduced robotic system and compares the results to one of the best performing non-robotically assisted UKA prostheses, as well as all other non-robotically assisted UKA procedures. METHODS Data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR) for all UKA procedures performed for osteoarthritis (OA) between 2015 and 2018 were analyzed. Procedures using the Restoris MCK UKA prosthesis implanted using the Mako Robotic-Arm Assisted System were compared to non-robotically assisted Zimmer Unicompartmental High Flex Knee System (ZUK) UKA, a commonly used UKA with previously reported good outcomes and to all other non-robotically assisted UKA procedures using Cox proportional hazard ratios (HRs) and Kaplan-Meier estimates of survivorship. RESULTS There was no difference in the rate of revision when the Mako-assisted Restoris UKA was compared to the ZUK UKA (zero to nine months: HR 1.14 (95% CI 0.71 to 1.83; p = 0.596) vs nine months and over: HR 0.66 (95% CI 0.42 to 1.02; p = 0.058)). The Mako-assisted Restoris had a significantly lower overall revision rate compared to the other types of non-robotically assisted procedures (HR 0.58 (95% confidence interval (CI) 0.42 to 0.79); p < 0.001) at three years. Revision for aseptic loosening was lower for the Mako-assisted Restoris compared to all other non-robotically assisted UKA (entire period: HR 0.34 (95% CI 0.17 to 0.65); p = 0.001), but not the ZUK prosthesis. However, revision for infection was significantly higher for the Mako-assisted Restoris compared to the two comparator groups (ZUK: entire period: HR 2.91 (95% CI 1.22 to 6.98; p = 0.016); other non-robotically assisted UKA: zero to three months: HR 5.57 (95% CI 2.17 to 14.31; p < 0.001)). CONCLUSION This study reports comparable short-term survivorship for the Mako robotically assisted UKA compared to the ZUK UKA and improved survivorship compared to all other non-robotic UKA. These results justify the continued use and investigation of this procedure. However, the higher rate of early revision for infection for robotically assisted UKA requires further investigation. Cite this article: Bone Joint J 2020;102-B(3):319-328.
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Affiliation(s)
- Jean-Pierre St Mart
- St Vincent's Hospital Northside, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Victoria, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Alana Cuthbert
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - William Donnelly
- St Vincent's Hospital Northside, Brisbane, Queensland, Australia.,The Prince Charles Hospital, Brisbane, Queensland, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
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21
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Manning W, Ghosh M, Wilson I, Hide G, Longstaff L, Deehan D. Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique. Knee Surg Sports Traumatol Arthrosc 2020; 28:2835-2845. [PMID: 31352497 PMCID: PMC7471111 DOI: 10.1007/s00167-019-05631-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Robot-assisted total knee arthroplasty (rTKA) remains in its infancy, is expensive but offers the promise of improved kinematic performance through precise bone cuts, with minimal soft tissue disruption, based on pre-resection soft tissue behaviour. This cadaveric study examined load transfer, soft tissue performance and radiographic indices for conventional (sTKA) versus rTKA. The null hypothesis was there would be no difference between the two modes of implantation. METHODS Whole (ten) cadaveric limbs were randomised to receive either robotic (rTKA, N = 5) or conventional measured resection (sTKA, N = 5) knee arthroplasty. Laxity patterns were established using validated fixed sensors (Verasense) with manual maximum displacement for six degrees of freedom. Tibiofemoral load and contact points were determined dynamically using remote sensor technology for medial and lateral compartments through a functional arc of motion (0-110 degrees of motion). Final component position was assessed using pre- and post-implantation CT. RESULTS No significant intergroup differences for laxity were found (n.s.). The rTKA group exhibited consistently balanced mediolateral load throughout the full arc with significantly reduced overall total load across the joint (for distinct points of measurement, p < 0.05). Despite using flexion-extension and mediolateral gap balancing with measured resection, the sTKA group failed to achieve balance in at least three points of the flexion arc. Post-operative CT confirmed satisfactory component alignment with no significant differences for positioning between the two groups. CONCLUSION This work found improved load sharing for rTKA when compared to conventional surgery for same donor knees. Laxity and CT determined final component positioning was not significantly different. The work supports the contention that robot-assisted TKA delivers improved tibiofemoral load sharing in time zero studies under defined conditions but such offers the promise of improved clinical performance and reduced implant wear.
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Affiliation(s)
- William Manning
- Newcastle Surgical Training Centre Research Unit Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK ,Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Milton Ghosh
- Newcastle Surgical Training Centre Research Unit Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK ,Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Ian Wilson
- Institute of Genetic Medicine, Newcastle University International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ UK
| | - Geoff Hide
- Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Lee Longstaff
- University Hospital of North Durham, Durham, DH1 5TW England, UK
| | - David Deehan
- Newcastle Surgical Training Centre Research Unit Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK. .,Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
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22
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Haddad FS. International perspectives are important. Bone Joint J 2019; 101-B:353-354. [PMID: 30929486 DOI: 10.1302/0301-620x.101b4.bjj-2019-0244] [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: 11/05/2022]
Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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