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Mancino F, Fontalis A, Kayani B, Magan A, Plastow R, Haddad FS. The current role of CT in total knee arthroplasty. Bone Joint J 2024; 106-B:892-897. [PMID: 39216858 DOI: 10.1302/0301-620x.106b9.bjj-2023-1303.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Advanced 3D imaging and CT-based navigation have emerged as valuable tools to use in total knee arthroplasty (TKA), for both preoperative planning and the intraoperative execution of different philosophies of alignment. Preoperative planning using CT-based 3D imaging enables more accurate prediction of the size of components, enhancing surgical workflow and optimizing the precision of the positioning of components. Surgeons can assess alignment, osteophytes, and arthritic changes better. These scans provide improved insights into the patellofemoral joint and facilitate tibial sizing and the evaluation of implant-bone contact area in cementless TKA. Preoperative CT imaging is also required for the development of patient-specific instrumentation cutting guides, aiming to reduce intraoperative blood loss and improve the surgical technique in complex cases. Intraoperative CT-based navigation and haptic guidance facilitates precise execution of the preoperative plan, aiming for optimal positioning of the components and accurate alignment, as determined by the surgeon's philosophy. It also helps reduce iatrogenic injury to the periarticular soft-tissue structures with subsequent reduction in the local and systemic inflammatory response, enhancing early outcomes. Despite the increased costs and radiation exposure associated with CT-based navigation, these many benefits have facilitated the adoption of imaged based robotic surgery into routine practice. Further research on ultra-low-dose CT scans and exploration of the possible translation of the use of 3D imaging into improved clinical outcomes are required to justify its broader implementation.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Weaver DJ, Deshmukh S, Bashyal R, Bagaria V. Complications and Learning Curve Associated with an Imageless Burr-Based (CORI) Robotic-Assisted Total Knee Arthroplasty System: Results from First 500 Cases. Indian J Orthop 2024; 58:1109-1117. [PMID: 39087033 PMCID: PMC11286604 DOI: 10.1007/s43465-024-01200-9] [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: 03/12/2024] [Accepted: 05/31/2024] [Indexed: 08/02/2024]
Abstract
Background The use of robotic-assisted total knee arthroplasty (RA-TKA) is gaining traction. There is evidence to suggest that RA-TKA can help to optimize the precision and accuracy of implant positioning and that there may be protective effects on surrounding bony and soft tissues. Yet, there are important differences between the various RA-TKA systems currently on the market. One such newly introduced RA-TKA system uses imageless technology and performs bony cuts with the use of a burr-based device. The learning curve and complications unique to this system have yet to be assessed. Methods We evaluated 500 consecutive RA-TKA cases using a newly developed burr-based and imageless system which were done by a single surgeon between the months of October 2021 and February 2023. Operative times were recorded and compared to the previous 150 conventional TKA cases allowing for the learning curve to be calculated using the CUSUM method. Intraoperative and postoperative complications were categorically profiled. Results The learning curve of this RA-TKA system was found to be 6 cases. Intraoperative complications included unintended bony over resection (n = 3), soft tissue injury (n = 2), and robotic system hardware (n = 2) or software (n = 2) malfunction. Postoperative complications consisted of superficial pin site infection (n = 1) and periprosthetic fracture near the pin sites (n = 1). There were no identified cases of prosthetic joint infection, instability events, or wound complications. Conclusions The learning curve and the complication profile of a newly introduced imageless and burr-based RA-TKA system were described. This information serves to guide surgeons in adopting this technology and can counsel them regarding the potential pitfalls and challenges associated with its integration into practice. The work sheds light on the complexity and learning curve of the recently released imageless burr-based RA-TKA system. This important information is intended to help surgeons accept this cutting-edge technology by providing advice on any errors and difficulties that can occur when integrating it into clinical practice. This information can help surgeons navigate the complexities of integrating this new burr-based robotic technology into knee replacement procedures, enabling them to make well-informed decisions and receive guidance.
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Affiliation(s)
- Douglas J. Weaver
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, USA
| | - Shobit Deshmukh
- Department of Orthopaedic Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Mumbai, 400004 India
| | - Ravi Bashyal
- North Shore University Health System Orthopaedic and Spine Institute, Evanston, USA
| | - Vaibhav Bagaria
- Department of Orthopaedic Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Mumbai, 400004 India
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Maman D, Laver L, Becker R, Takrori LA, Mahamid A, Finkel B, Gan-Or H, Yonai Y, Berkovich Y. Trends and epidemiology in robotic-assisted total knee arthroplasty: Reduced complications and shorter hospital stays. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39016343 DOI: 10.1002/ksa.12353] [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: 05/22/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION This study provides an in-depth analysis of the immediate postoperative outcomes and implications or robotic-assisted total knee arthroplasty (RA-TKA) compared with conventional TKA (C-TKA), particularly with regard to mortality, complications, hospital stay and costs, drawing from a comprehensive nationwide data set. METHODS The Nationwide Inpatient Sample (NIS) database, the largest all-payer inpatient healthcare database in the United States, was used to identify all patients who underwent RA-TKA or C-TKA from 2016 to 2019. A total of 527,376 cases, representing 2,638,679 patients who underwent elective TKA were identified, of which 88,415 had RA-TKA. To mitigate potential variations and selection bias in baseline characteristics between the two groups, a propensity score-matched analysis was employed to further balance and refine our data set, resulting in 176,830 patients evenly distributed between the groups. Analysis was performed according to demographics, immediate post-operative complications, and economic data, including payor class, length of stay and total charges. RESULTS There was a marked shift towards RA-TKA, from an initial 0.70% in 2016 to a notable 7.30% by 2019. Patients who underwent RA-TKA were slightly younger (66.2 ± SD years), compared to the C-TKA group (66.7 ± SD years). Hospital stay was 1.89 days and 2.29 days for RA-TKA and C-TKA, respectively. Charges metrics revealed slightly higher charges for RA-TKA. Less postoperative complications were found in the RA-TKA group, such as blood loss, anaemia, acute kidney injury, venous thromboembolism, pulmonary embolism, pneumonia and surgical wound complication. Even following the propensity score matching, these findings remained consistent and statistically significant. CONCLUSIONS RA-TKA use in the United States has grown substantially in the last few years and has been associated with significantly reduced immediate post-operative complications and length of hospital stay compared to C-TKA, offering safer surgical management for TKA patients. Further studies on the short- and long-term outcomes of RA-TKA would improve the understanding of the full potential of this technology. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- David Maman
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
| | - Lior Laver
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
- Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Roland Becker
- Department of Orthopedics and Traumatology, University Hospital Brandenburg, Berlin, Germany
| | | | - Assil Mahamid
- Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Binyamin Finkel
- Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Hadar Gan-Or
- Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Yonai
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
| | - Yaron Berkovich
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
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Maman D, Laver L, Becker R, Mahamid A, Berkovich Y. Robotic-assisted total knee arthroplasty reduces postoperative complications and length of stay without increased cost compared to navigation-guided techniques: A national analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38953206 DOI: 10.1002/ksa.12348] [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: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION This study compares postoperative outcomes of robotic-assisted total knee arthroplasty (RA-TKA) versus navigation-guided total knee arthroplasty (NG-TKA). Using Nationwide Inpatient Sample (NIS) data, it provides an analysis of postoperative complications, mortality, hospital costs and duration of stay. METHODS The study analysed 217,715 patients (81,830 RA-TKA; 135,885 NG-TKA) using NIS data from 2016 to 2019. Elective TKA patients were identified through the International Classification of Diseases, 10th Revision codes. Statistical analyses, including logistic regression modelling, were performed using Statistical Package for the Social Sciences and MATLAB. RESULTS RA-TKA patients were younger (66.1 vs. 67.1 years, p < 0.0001) and had similar mortality rates (0.024% vs. 0.018%, p = 0.342) but shorter length of stay (LOS) (1.89 vs. 2.1 days, p < 0.0001). Mean total charges were comparable between RA-TKA ($66,180) and NG-TKA ($66,251, p = 0.669). RA-TKA demonstrated lower incidences of blood-related complications (11.67% vs. 14.19%, p < 0.0001), pulmonary oedema (0.0306% vs. 0.066%, p < 0.0001), deep vein thrombosis (0.196% vs. 0.254%, p = 0.006) and acute kidney injury (AKI) (1.356% vs. 1.483%, p = 0.016). CONCLUSION RA-TKA reduces postoperative complications and LOS without increasing costs, highlighting the relevance of this technology in patient care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- David Maman
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
| | - Lior Laver
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
- Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Roland Becker
- Department of Orthopedics and Traumatology, University Hospital Brandenburg, Brandenburg an der Havel, Berlin, Germany
| | - Assil Mahamid
- Department of Orthopedics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaron Berkovich
- Department of Orthopedics, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel
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Mancino F, Fontalis A, Grandhi TSP, Magan A, Plastow R, Kayani B, Haddad FS. Robotic arm-assisted conversion of unicompartmental knee arthroplasty to total knee arthroplasty. Bone Joint J 2024; 106-B:680-687. [PMID: 38945538 DOI: 10.1302/0301-620x.106b7.bjj-2023-0943.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Aims Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up. Methods This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36). Results There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439). Conclusion Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Tarani S P Grandhi
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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Clement ND, Galloway S, Baron J, Smith K, Weir DJ, Deehan DJ. Identifying subgroups of patients that may benefit from robotic arm-assisted total knee arthroplasty: Secondary analysis of data from a randomised controlled trial. Knee 2024; 48:94-104. [PMID: 38565038 DOI: 10.1016/j.knee.2024.03.005] [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: 06/27/2023] [Revised: 02/13/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The aims were to assess whether a specific subgroup(s) of patients had a clinically significant benefit in their knee specific outcome or health-related quality of life (HRQoL) when undergoing robotic total knee arthroplasty (rTKA) when compared to manually performed TKA (mTKA). METHODS One hundred patients were randomised to either rTKA or mTKA, 50 to each group, of which 46 and 41 were available for functional review at 6-months, respectively. Subgroup analysis was undertaken for sex, age (<67-years versus ≥ 67-years), preoperative WOMAC score (<40 versus ≥ 40) and EQ-5D utility (<0.604 versus ≥ 0.604). RESULTS Male patients undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (mean difference (MD) 16.3, p = 0.011) at 2-months, function (MD 12.6, p = 0.032) and total score (MD 12.7, p = 0.030), and OKS (MD 6.0, p = 0.030) at 6-months. Patients < 67-years old undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 10.3, p = 0.039) at 2-months, and function (MD 12.9, p = 0.040) and total (MD 13.1, p = 0.038) scores at 6-months. Patients with a preoperative WOMAC total score of < 40 points undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 14.6, p = 0.044) at 6-months. Patients with a preoperative EQ-5D utility of <0.604 undergoing rTKA had a clinically and statistically significant greater improvement in WOMAC pain (MD 15.5, p = 0.011) at 2-months. CONCLUSION Patients of male sex, younger age, worse preoperative knee specific function and HRQoL had a clinically significantly better early functional outcome with rTKA when compared to mTKA.
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Affiliation(s)
- Nick D Clement
- Royal Infirmary of Edinburgh, United Kingdom; Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | - Steven Galloway
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | - Jenny Baron
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | - Karen Smith
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | - David J Weir
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | - David J Deehan
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
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Clement ND, Galloway S, Baron J, Smith K, Weir DJ, Deehan DJ. Patients undergoing robotic arm-assisted total knee arthroplasty have a greater improvement in knee-specific pain but not in function. Bone Joint J 2024; 106-B:450-459. [PMID: 38688485 DOI: 10.1302/0301-620x.106b5.bjj-2023-1196.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim was to assess whether robotic-assisted total knee arthroplasty (rTKA) had greater knee-specific outcomes, improved fulfilment of expectations, health-related quality of life (HRQoL), and patient satisfaction when compared with manual TKA (mTKA). Methods A randomized controlled trial was undertaken (May 2019 to December 2021), and patients were allocated to either mTKA or rTKA. A total of 100 patients were randomized, 50 to each group, of whom 43 rTKA and 38 mTKA patients were available for review at 12 months following surgery. There were no statistically significant preoperative differences between the groups. The minimal clinically important difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score was defined as 7.5 points. Results There were no clinically or statistically significant differences between the knee-specific measures (WOMAC, Oxford Knee Score (OKS), Forgotten Joint Score (FJS)) or HRQoL measures (EuroQol five-dimension questionnaire (EQ-5D) and EuroQol visual analogue scale (EQ-VAS)) at 12 months between the groups. However, the rTKA group had significantly (p = 0.029) greater improvements in the WOMAC pain component (mean difference 9.7, 95% confidence interval (CI) 1.0 to 18.4) over the postoperative period (two, six, and 12 months), which was clinically meaningful. This was not observed for function (p = 0.248) or total (p = 0.147) WOMAC scores. The rTKA group was significantly (p = 0.039) more likely to have expectation of 'Relief of daytime pain in the joint' when compared with the mTKA group. There were no other significant differences in expectations met between the groups. There was no significant difference in patient satisfaction with their knee (p = 0.464), return to work (p = 0.464), activities (p = 0.293), or pain (p = 0.701). Conclusion Patients undergoing rTKA had a clinically meaningful greater improvement in their knee pain over the first 12 months, and were more likely to have fulfilment of their expectation of daytime pain relief compared with patients undergoing mTKA. However, rTKA was not associated with a clinically significant greater knee-specific function or HRQoL, according to current definitions.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthropaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Steven Galloway
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jenny Baron
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Karen Smith
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Weir
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Deehan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Mackie M, Barton KI, Sokol-Randell D, Lanting B. The Use of Biomarkers to Quantify Clinical Response to Total Knee Arthroplasty Interventions: A Systematic Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00005. [PMID: 38547046 PMCID: PMC10977533 DOI: 10.5435/jaaosglobal-d-23-00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
The primary objective of this review was to determine whether the attenuation of the postoperative inflammatory response (PIR) after total knee arthroplasty (TKA) leads to a notable improvement in clinical outcome scores. The secondary objective of this review was to determine the optimal approach in using inflammatory biomarkers, clinical inflammatory assessments, and imaging to quantify the PIR. A systematic literature search of eight major databases was conducted using a predetermined search strategy. C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), knee surface temperature (KST), and clinical outcome data were collected and graphically displayed. Eighty-six percent of the studies that reported a statistically significant decrease in inflammatory biomarkers in their treatment group demonstrated a concordant notable improvement in clinical outcome scores. Mean CRP, IL-6, ESR, and KST values peaked on postoperative day (POD) 2, POD1, POD7, and POD 1-3, respectively. The PIR is correlated with early pain and function recovery outcomes. Future studies comparing TKA surgical methodologies and perioperative protocols should assess PIR by incorporating inflammatory biomarkers, such as CRP and IL-6, and clinical inflammatory assessment adjuncts, to provide a more comprehensive comparison.
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Affiliation(s)
- Mark Mackie
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Kristen I. Barton
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Darek Sokol-Randell
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
| | - Brent Lanting
- From the Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Mr. Mackie and Dr. Lanting); Orthopaedic Surgery, London Health Sciences Centre, London, ON, Canada (Dr. Barton and Dr. Lanting); School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada (Dr. Barton); Department of Neurology, Memorial University, Newfoundland, Canada (Dr. Sokol-Randell); Rorabeck Bourne Joint Replacement Clinic, London Health Sciences Centre, Western University, London, ON, Canada (Dr. Lanting)
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Fontalis A, Kayani B, Plastow R, Giebaly DE, Tahmassebi J, Haddad IC, Chambers A, Mancino F, Konan S, Haddad FS. A prospective randomized controlled trial comparing CT-based planning with conventional total hip arthroplasty versus robotic arm-assisted total hip arthroplasty. Bone Joint J 2024; 106-B:324-335. [PMID: 38555946 DOI: 10.1302/0301-620x.106b4.bjj-2023-1045.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA. Methods This prospective randomized controlled trial (RCT) included 60 patients with symptomatic hip osteoarthritis undergoing conventional THA (CO THA) versus robotic arm-assisted THA (RO THA). Patients in both arms underwent pre- and postoperative CT scans, and a patient-specific plan was created using the robotic software. The COR, combined offset, acetabular orientation, and leg length discrepancy were measured on the pre- and postoperative CT scanogram at six weeks following surgery. Results There were no significant differences for any of the baseline characteristics including spinopelvic mobility. The absolute error for achieving the planned horizontal COR was median 1.4 mm (interquartile range (IQR) 0.87 to 3.42) in RO THA versus 4.3 mm (IQR 3 to 6.8; p < 0.001); vertical COR mean 0.91 mm (SD 0.73) in RO THA versus 2.3 mm (SD 1.3; p < 0.001); and combined offset median 2 mm (IQR 0.97 to 5.45) in RO THA versus 3.9 mm (IQR 2 to 7.9; p = 0.019). Improved accuracy was observed with RO THA in achieving the desired acetabular component positioning (root mean square error for anteversion and inclination was 2.6 and 1.3 vs 8.9 and 5.3, repectively) and leg length (mean 0.6 mm vs 1.4 mm; p < 0.001). Patient-reported outcome measures were comparable between the two groups at baseline and one year. Participants in the RO THA group needed fewer physiotherapy sessions postoperatively (median six (IQR 4.5 to 8) vs eight (IQR 6 to 11; p = 0.005). Conclusion This RCT suggested that robotic-arm assistance in THA was associated with improved accuracy in restoring the native COR, better preservation of the combined offset, leg length correction, and superior accuracy in achieving the desired acetabular component positioning. Further evaluation through long-term and registry data is necessary to assess whether these findings translate into improved implant survival and functional outcomes.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dia E Giebaly
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Isabella C Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alastair Chambers
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sujith Konan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- The Bone & Joint Journal , London, UK
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10
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Mokhtari L, Hosseinzadeh F, Nourazarian A. Biochemical implications of robotic surgery: a new frontier in the operating room. J Robot Surg 2024; 18:91. [PMID: 38401027 DOI: 10.1007/s11701-024-01861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.
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Affiliation(s)
- Leila Mokhtari
- Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran
| | | | - Alireza Nourazarian
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran.
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11
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Sershon R. CORR Insights®: Robotic-assisted TKA is Not Associated With Decreased Odds of Early Revision: An Analysis of the American Joint Replacement Registry. Clin Orthop Relat Res 2024; 482:311-312. [PMID: 38112613 PMCID: PMC10776142 DOI: 10.1097/corr.0000000000002863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Robert Sershon
- Orthopaedic Surgeon, Anderson Orthopaedic Research Institute, Alexandria, VA, USA
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12
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Villa JM, Hosseinzadeh S, Higuera-Rueda CA. What's New in Adult Reconstructive Knee Surgery. J Bone Joint Surg Am 2024; 106:93-101. [PMID: 37973029 DOI: 10.2106/jbjs.23.01054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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13
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Fontalis A, Hansjee S, Giebaly DE, Mancino F, Plastow R, Haddad FS. Troubleshooting Robotics During Total Hip and Knee Arthroplasty. Orthop Clin North Am 2024; 55:33-48. [PMID: 37980102 DOI: 10.1016/j.ocl.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
The introduction of new surgical technology highlights appreciable concerns; robotic arthroplasty is no exception. Acquiring comprehensive understanding of the robotic technology to avoid complications during surgery and devising troubleshooting strategies to overcome potential difficulties is of paramount importance. Troubleshooting algorithms depend on the stage of the procedure and problem encountered, such as loosening of the pins or array, registration or verification problems, or malfunctioning of the device, which is rare. This article aims to outline reproducible workflows and solutions for troubleshooting during robotic-arm assisted total hip arthroplasty and total knee arthroplasty.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK.
| | - Shanil Hansjee
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
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14
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Dretakis K, Igoumenou VG, Naoum S, Raptis K, Koutserimpas C. Robotic Arm-Assisted Total Knee Arthroplasty: Anatomical Alignment and Mid-Term Outcomes from the First Cohort Originating in Greece. J Long Term Eff Med Implants 2024; 34:55-63. [PMID: 38505894 DOI: 10.1615/jlongtermeffmedimplants.2023048690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Robotic arm-assisted total knee arthroplasty (RATKA) represents a haptic assistive robotic arm used for bone preparation. The purpose of this study was to present implant survivorship, complications and evaluate patients' satisfaction, clinical and functional outcome of RATKA with a minimum of 1-year follow-up. The Oxford Knee Score was recorded preoperatively and at last follow-up. Patients' satisfaction rates, as well as complications and re-operations were studied. Anatomical alignment including varus, valgus deformities and flexion, extension, pre-and postoperatively were evaluated. A total of 156 patients with mean age = 71.9 years were included in the study. The mean follow-up was 35.7 months, while one revision was performed due to infection. Statistically significant improvement of the Oxford Knee Score, as well as of the knee alignment deformities were recorded, while 99.4% of patients reported to be "very satisfied" or "satisfied" with the procedure. RATKA seems to be a safe, as well as reproductible procedure at short-and mid-term follow-up, while the accurate implant positioning may lead to favorable long-term outcomes.
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Affiliation(s)
- Konstantinos Dretakis
- 2nd Department of Orthopaedics and Traumatology, Hygeia General Hospital of Athens, Athens, Greece
| | | | - Symeon Naoum
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Konstantinos Raptis
- 2nd Department of Orthopaedics and Traumatology, Hygeia General Hospital of Athens, Athens, Greece; Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Greece
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15
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Wignadasan W, Chang J, Fontalis A, Plastow R, Haddad FS. Short term outcomes following robotic arm-assisted lateral unicompartmental knee arthroplasty. Front Surg 2023; 10:1215280. [PMID: 38162087 PMCID: PMC10757348 DOI: 10.3389/fsurg.2023.1215280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Robotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following RA-UKA for isolated lateral compartment osteoarthritis. The purpose of this study was to assess the short-term clinical and patient reported outcomes of lateral compartment UKA, utilising robotic-arm assistance. Methods This was a retrospective study of prospectively collected data of 21 consecutive patients who underwent lateral RA-UKA. The study included 9 (42.9%) males and 12 (57.1%) females with a mean age of 63.4 ± 9.2 years. The Oxford Knee Score (OKS) was measured pre-operatively and at 1-year post-operatively, while range of motion (ROM) and complications were also recorded. Results There was significant improvement of OKS at 1 year's follow up compared with the baseline score (21.8 ± 5.6 vs. 45.2 ± 2.8 respectively; p < 0.001). There was also an improvement in pre-operative ROM when compared to ROM at 1 year's follow up (123.5° ± 8° vs. 131.5° ± 6.3° respectively; p < 0.001). None of the study patients underwent revision surgery within 1 year's follow-up. Conclusion In our study, lateral RA-UKA resulted in significant improvements in clinical and patient reported outcomes with low complications rates. Further long-term comparative studies are needed to assess the utility of lateral RA-UKA vs. conventional UKA.
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Affiliation(s)
- Warran Wignadasan
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Justin Chang
- Department of Orthopaedic Surgery, Humber River Hospital, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Fontalis
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom
| | - Ricci Plastow
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S. Haddad
- Departmentof Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom
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16
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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: 7] [Impact Index Per Article: 7.0] [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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Ma M, Cao Z, Yang M, Kong X, Chai W. The invasiveness of robot-assisted total hip replacement is similar to that of conventional surgery. J Robot Surg 2023; 17:2987-2993. [PMID: 37891384 DOI: 10.1007/s11701-023-01740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Robot-assisted total hip arthroplasty (R-THA) is increasingly being performed throughout the world. The invasiveness of this operation is unknown. We retrospectively reviewed the cohort of consecutive osteonecrosis of the femoral head (ONFH) patients who received primary R-THA or manual THA (M-THA) from January 2020 to January 2022 in our institution. One experienced surgeon performed all procedures. We calculated the propensity score to match similar patients in different groups by multivariate logistic regression analysis for each patient. We included confounders consisting of age, sex, body mass index (BMI), and operation time. Preoperative serum markers and Harris hip scores (HHS), postoperative serum markers at first day and third day, complications rate, postoperative HHS and Forgotten Joint Score (FJS) at 6 months after surgery of different cohorts were compared. We analyzed 218 ONFH patients treated with THA (98 R-THA patients, and 120 M-THA patients). After propensity score matching, we generated cohorts of 95 patients in R-THA and M-THA groups. We found no significant difference in preoperative serum markers and HHS. In the R-THA cohort, the PLT count was significantly lower on the postoperative day 1 (192.36 ± 41.72 × 109/L Vs 210.47 ± 72.85 × 109/L, p < 0.05). The Hb level was significantly lower on the postoperative third day in the R-THA cohort (98.52 ± 12.99 g/L Vs 104.74 ± 13.15 g/L, p < 0.05). There was no significant difference in the other serum markers between the cohorts on postoperative day 1 and 3 (p > 0.05). The FJS was significantly higher in the R-THA than M-THA group (p = 0.01). There was no significant difference in the postoperative HHS or complication rate between the groups (p > 0.05). The R-THA is not associated with a serious invasiveness compared to M-THA. Patients who underwent R-THA had a better early function compared to those who underwent M-THA.
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Affiliation(s)
- Mingyang Ma
- Chinese PLA Medical School, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
| | - Zheng Cao
- Chinese PLA Medical School, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Minzhi Yang
- Chinese PLA Medical School, Beijing, China
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
| | - Xiangpeng Kong
- Chinese PLA Medical School, Beijing, China.
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China.
| | - Wei Chai
- Chinese PLA Medical School, Beijing, China.
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China.
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Wakelin EA, Ponder CE, Randall AL, Koenig JA, Plaskos C, DeClaire JH, Lawrence JM, Keggi JM. Intra-operative laxity and balance impact 2-year pain outcomes in TKA: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:5535-5545. [PMID: 37837574 DOI: 10.1007/s00167-023-07601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The objective of this study was to determine if intra-operatively measured joint gaps are associated with 2-year pain outcomes in total knee arthroplasty (TKA) and whether balance and laxity windows could be defined throughout flexion to optimize 2-year pain outcomes. Our hypothesis is that intra-operative joint gaps are associated with 2 year post-operative pain outcome. METHODS A prospective study investigating 310 robotically assisted TKAs was performed. Final intra-operative joint gap data were recorded using a digital tensioner and component alignment data were recorded by the robotics system. Patient demographics and Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded pre-operatively and KOOS and Hospital for Special Surgery (HSS) satisfaction were recorded at 2 years post-op. A random search Simulated Annealing (SANN) optimisation algorithm was used to determine global optimum laxity and balance windows at different flexion angles which maximized the 2-year KOOS pain scores. The windows were combined to determine the impact of achieving optimal laxity and balance throughout flexion. To improve clinical utility, boundaries identified by the SANN algorithm were rounded to the nearest 0.5 mm before statistical analysis. RESULTS Laxity and balance windows were defined in extension (Med lax: -2.0 to 2.5 mm, Lat lax: -0.5 to 2.5 mm, Balance: -3.0 to 0.0 mm), mid-flexion (Med lax: -1.0 to 2.5 mm, Lat lax: -0.5 to 3.0 mm, Balance: -2.0 to 2.0 mm), and flexion (Med lax: -2.0 to 3.5 mm, Lat lax: -2.0 to 1.5 mm, Balance: -3.0 to 3.0 mm). When all windows were satisfied, the greatest difference in KOOS pain score was observed (100.0 vs 94.4, p < 0.0001). The highest percentage of knees satisfying the Patient Acceptable Symptom State (PASS) for KOOS pain was also observed in knees which satisfied all windows compared to knees which did not (93% vs 71%, p = 0.0009). The proportion of knees which satisfy the PASS threshold decreased in knees which only satisfied 1-3 (29%) or 4-6 (69%) windows (p ≤ 0.0018). No optimal windows were found between component alignment and KOOS pain outcome (p ≥ 0.1180). High satisfaction was found across all groups (≥ 95%). CONCLUSION Intra-operatively measured joint gaps are associated with all KOOS sub-score outcomes at 2 years after TKA. Optimal windows for a clinically relevant improvement in post-operative KOOS pain were defined for laxity and balance but not for alignment indicating balance may have a greater impact on outcome than alignment. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Corey E Ponder
- Oklahoma Sports and Orthopedics Institute, Edmond, OK, USA
| | | | - Jan A Koenig
- Department of Orthopedic Surgery, NYU Langone Hospital, Long Island, NY, USA
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Lachance AD, Edelstein A, Stilwell M, Lutton J. No Difference in Range of Motion, Components, or Complications Following Conversion of Robotic-Assisted Total Knee Arthroplasty Compared to Manual TKA After Undergoing Manual or Robotic-Assisted Unicompartmental Knee Arthroplasty. Arthroplast Today 2023; 24:101269. [PMID: 38023646 PMCID: PMC10679885 DOI: 10.1016/j.artd.2023.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Conversion surgery from unicondylar knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains a challenge due to scarring, implant/cement removal, and loss of bony landmarks. Robotic-assisted (RA) TKA may assist in challenges seen in manual conversion TKA. The aim of this study is to identify if there are differences in components and functional outcomes dependent on manual/RA primary UKA and conversion TKA. Methods A retrospective chart review was performed on patients undergoing conversion from UKA to TKA over a 10-year period at a single institution. Data extracted included surgical technique, reason for UKA failure, range of motion at 1 year, need for augments, and utilization of revision components. Results Forty-nine patients (50 knees) with a UKA converted to a TKA were divided into 4 groups based on primary and conversion surgery: manual-to-manual (n = 11), manual-to-robot (n = 11), robot-to-manual (n = 11), and robot-to-robot (n = 17). There was no difference in need for augments (P = .376), size of poly (P = .23), postoperative flexion (P = .52), or extension (P = .76) at 1 year between the 4 groups. However, patients with primary manual UKA did require significantly more augments during revision (P = .032). Conclusions Our study did not show any statistically significant differences of primary RA or manual UKA to RA or manual TKA in terms of range of motion at 1 year, complications, or differences in components. RA conversion from UKA to TKA is a new but equivalent technique to manual conversion. Primary surgery may impact the requirement for augments during conversion surgery.
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Affiliation(s)
| | | | - Mason Stilwell
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
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20
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Bensa A, Sangiorgio A, Deabate L, Illuminati A, Pompa B, Filardo G. Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:4680-4691. [PMID: 37270464 DOI: 10.1007/s00167-023-07458-0] [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: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Robotic-assisted total knee arthroplasty (R-TKA) has emerged as an alternative to improve the results of the conventional manual TKA (C-TKA). The aim of this study was to analyse the high-level studies comparing R-TKA and C-TKA in terms of clinical outcomes, radiological results, perioperative parameters, and complications. METHODS The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 1 February 2023 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were: randomized controlled trials (RCTs), written in English language, published in the last 15 years, focusing on the comparison of C-TKA and R-TKA results. The quality of each article was assessed using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2). The statistical analysis was carried out using random effects (DerSimonian & Laird) for weighted mean difference (MD) of the continuous variables and Peto method for odds ratios of the dichotomous variables. RESULTS Among the 2905 articles retrieved, 14 RCTs on 12 series of patients treated with mechanically aligned implants were included. A total of 2255 patients (25.1% males and 74.9% females; mean age 62.9 ± 3.0; mean BMI 28.1 ± 1.3) were analysed. The results of this systematic review and meta-analysis showed that R-TKA did not provide overall superior results compared to C-TKA in mechanically aligned implants in terms of clinical and radiological outcomes. R-TKA showed longer operative time (MD = 15.3 min, p = 0.004) and similar complication rates compared to C-TKA. A statistically significant difference in favour of R-TKA was found in the posterior-stabilized subgroup in terms of radiological outcomes (hip-knee-ankle angle MD = 1.7, p < 0.001) compared to C-TKA, although without resulting in appreciable difference of clinical outcomes. CONCLUSION R-TKA did not provide overall superior results compared to C-TKA in terms of clinical and radiological outcomes, showing longer operative time and similar complication rates. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Luca Deabate
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | | | - Benedetta Pompa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Fontalis A, Raj RD, Haddad IC, Donovan C, Plastow R, Oussedik S, Gabr A, Haddad FS. Length of stay and discharge dispositions following robotic arm-assisted total knee arthroplasty and unicompartmental knee arthroplasty versus conventional technique and predictors of delayed discharge. Bone Jt Open 2023; 4:791-800. [PMID: 37852620 PMCID: PMC10614696 DOI: 10.1302/2633-1462.410.bjo-2023-0126.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Aims In-hospital length of stay (LOS) and discharge dispositions following arthroplasty could act as surrogate measures for improvement in patient pathways, and have major cost saving implications for healthcare providers. With the ever-growing adoption of robotic technology in arthroplasty, it is imperative to evaluate its impact on LOS. The objectives of this study were to compare LOS and discharge dispositions following robotic arm-assisted total knee arthroplasty (RO TKA) and unicompartmental arthroplasty (RO UKA) versus conventional technique (CO TKA and UKA). Methods This large-scale, single-institution study included patients of any age undergoing primary TKA (n = 1,375) or UKA (n = 337) for any cause between May 2019 and January 2023. Data extracted included patient demographics, LOS, need for post anaesthesia care unit (PACU) admission, anaesthesia type, readmission within 30 days, and discharge dispositions. Univariate and multivariate logistic regression models were also employed to identify factors and patient characteristics related to delayed discharge. Results The median LOS in the RO TKA group was 76 hours (interquartile range (IQR) 54 to 104) versus 82.5 (IQR 58 to 127) in the CO TKA group (p < 0.001) and 54 hours (IQR 34 to 77) in the RO UKA versus 58 (IQR 35 to 81) in the CO UKA (p = 0.031). Discharge dispositions were comparable between the two groups. A higher percentage of patients undergoing CO TKA required PACU admission (8% vs 5.2%; p = 0.040). Conclusion Our study showed that robotic arm assistance was associated with a shorter LOS in patients undergoing primary UKA and TKA, and no difference in the discharge destinations. Our results suggest that robotic arm assistance could be advantageous in partly addressing the upsurge of knee arthroplasty procedures and the concomitant healthcare burden; however, this needs to be corroborated by long-term cost-effectiveness analyses and data from randomized controlled studies.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rhody D. Raj
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Isabella C. Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Donovan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam Oussedik
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ayman Gabr
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S. Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- The Bone & Joint Journal, London, UK
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22
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Tay ML, Bolam SM, Monk AP, McGlashan SR, Young SW, Matthews BG. Better post-operative outcomes at 1-year follow-up are associated with lower levels of pre-operative synovitis and higher levels of IL-6 and VEGFA in unicompartmental knee arthroplasty patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:4109-4116. [PMID: 37449990 PMCID: PMC10471720 DOI: 10.1007/s00167-023-07503-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Osteoarthritis (OA) is associated with inflammation, and residual inflammation may influence outcomes following knee arthroplasty. This may be more relevant for patients undergoing unicompartmental knee arthroplasty (UKA) due to larger remaining areas of native tissue. This study aimed to: (1) characterise inflammatory profiles for medial UKA patients and (2) investigate whether inflammation markers are associated with post-operative outcomes. METHODS This prospective, observational study has national ethics approval. Bloods, synovial fluid, tibial plateaus and synovium were collected from medial UKA patients in between 1 January 2021 and 31 December 2021. Cytokine and chemokine concentrations in serum and synovial fluid (SF) were measured with multiplexed assays. Disease severity of cartilage and synovium was assessed using validated histological scores. Post-operative outcomes were measured with Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12) and pain scores. RESULTS The study included 35 patients. SF VEGFA was negatively correlated with pre-operative pain at rest (r - 0.5, p = 0.007), and FJS-12 at six-week (r 0.44, p = 0.02), six-month (r 0.61, p < 0.01) and one-year follow-up (r 0.63, p = 0.03). Serum and SF IL-6 were positively correlated with OKS at early follow-up (serum 6 weeks, r 0.39, p = 0.03; 6 months, r 0.48, p < 0.01; SF 6 weeks, r 0.35, p = 0.04). At six weeks, increased synovitis was negatively correlated with improvements in pain at rest (r - 0.41, p = 0.03) and with mobilisation (r - 0.37, p = 0.047). CONCLUSION Lower levels of synovitis and higher levels of IL-6 and VEGFA were associated with better post-operative outcomes after UKA, which could be helpful for identifying UKA patients in clinical practice. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private Bag 92-019, Auckland, 1023, New Zealand.
- Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Auckland, 0620, New Zealand.
| | - Scott M Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private Bag 92-019, Auckland, 1023, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Private Bag 92-024, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Private Bag 92-024, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92-019, Auckland, 0620, New Zealand
| | - Sue R McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, Private Bag 92-019, Auckland, 0620, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private Bag 92-019, Auckland, 1023, New Zealand
- Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Auckland, 0620, New Zealand
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, Private Bag 92-019, Auckland, 0620, New Zealand
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23
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Clement ND, Galloway S, Baron YJ, Smith K, Weir DJ, Deehan DJ. Robotic Arm-assisted versus Manual (ROAM) total knee arthroplasty: a randomized controlled trial. Bone Joint J 2023; 105-B:961-970. [PMID: 37652449 DOI: 10.1302/0301-620x.105b9.bjj-2023-0006.r3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims The primary aim was to assess whether robotic total knee arthroplasty (rTKA) had a greater early knee-specific outcome when compared to manual TKA (mTKA). Secondary aims were to assess whether rTKA was associated with improved expectation fulfilment, health-related quality of life (HRQoL), and patient satisfaction when compared to mTKA. Methods A randomized controlled trial was undertaken, and patients were randomized to either mTKA or rTKA. The primary objective was functional improvement at six months. Overall, 100 patients were randomized, 50 to each group, of whom 46 rTKA and 41 mTKA patients were available for review at six months following surgery. There were no differences between the two groups. Results There was no difference between rTKA and mTKA groups at six months according to the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) functional score (mean difference (MD) 3.8 (95% confidence interval (CI) -5.6 to 13.1); p = 0.425). There was a greater improvement in the WOMAC pain score at two months (MD 9.5 (95% CI 0.6 to 18.3); p = 0.037) in the rTKA group, although by six months no significant difference was observed (MD 6.7 (95% CI -3.6 to 17.1); p = 0.198). The rTKA group were more likely to achieve a minimal important change in their WOMAC pain score when compared to the mTKA group at two months (n = 36 (78.3%) vs n = 24 (58.5%); p = 0.047) and at six months (n = 40 (87.0%) vs n = 29 (68.3%); p = 0.036). There was no difference in satisfaction between the rTKA group (97.8%; n = 45/46) and the mTKA group (87.8%; n = 36/41) at six months (p = 0.096). There were no differences in EuroQol five-dimension questionnaire (EQ-5D) utility gain (p ≥ 0.389) or fulfilment of patient expectation (p ≥ 0.054) between the groups. Conclusion There were no statistically significant or clinically meaningful differences in the change in WOMAC function between mTKA and rTKA at six months. rTKA was associated with a higher likelihood of achieving a clinically important change in knee pain at two and six months, but no differences in knee-specific function, patient satisfaction, health-related quality of life, or expectation fulfilment were observed.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Steven Galloway
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Y Jenny Baron
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Karen Smith
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Weir
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David J Deehan
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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24
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Princess Grace Hospital, London, UK
| | - Vanya Gant
- Department of Microbiology, University College Hospital, London, UK
| | - Dominic R M Meek
- Department of Trauma and Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Fares S Haddad
- Princess Grace Hospital, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
- The Bone & Joint Journal , London, UK
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25
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Lisacek-Kiosoglous AB, Powling AS, Fontalis A, Gabr A, Mazomenos E, Haddad FS. Artificial intelligence in orthopaedic surgery. Bone Joint Res 2023; 12:447-454. [PMID: 37423607 DOI: 10.1302/2046-3758.127.bjr-2023-0111.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
The use of artificial intelligence (AI) is rapidly growing across many domains, of which the medical field is no exception. AI is an umbrella term defining the practical application of algorithms to generate useful output, without the need of human cognition. Owing to the expanding volume of patient information collected, known as 'big data', AI is showing promise as a useful tool in healthcare research and across all aspects of patient care pathways. Practical applications in orthopaedic surgery include: diagnostics, such as fracture recognition and tumour detection; predictive models of clinical and patient-reported outcome measures, such as calculating mortality rates and length of hospital stay; and real-time rehabilitation monitoring and surgical training. However, clinicians should remain cognizant of AI's limitations, as the development of robust reporting and validation frameworks is of paramount importance to prevent avoidable errors and biases. The aim of this review article is to provide a comprehensive understanding of AI and its subfields, as well as to delineate its existing clinical applications in trauma and orthopaedic surgery. Furthermore, this narrative review expands upon the limitations of AI and future direction.
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Affiliation(s)
- Anthony B Lisacek-Kiosoglous
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Amber S Powling
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Barts and The London School of Medicine and Dentistry, School of Medicine London, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Ayman Gabr
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Evangelos Mazomenos
- Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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26
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Prakash R, Agrawal Y. Robotic technology in total knee arthroplasty. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 37364881 DOI: 10.12968/hmed.2022.0491] [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: 06/28/2023]
Abstract
Key factors for successful total knee arthroplasty include accurate implant positioning with precise tibial and femoral resection, combined with appropriate soft tissue balancing to achieve the desired alignment. Robotic-assisted total knee arthroplasty allows surgeons to execute pre-planned strategies with precision, with growing evidence suggesting that robotic-assisted-total knee arthroplasty reduces radiological outliers. This has yet to be proven to translate into long-term improvements in patient-reported outcomes and implant survivorship. Robotic-assisted-total knee arthroplasty systems can be divided into fully autonomous and semi-autonomous systems. While fully autonomous systems showed initial promise, semi-autonomous systems are gaining popularity with encouraging early outcomes suggesting improved radiological and clinical outcomes, although concerns remain regarding a significant learning curve, installation costs, radiation exposure and cost associated with preoperative imaging. The future of total knee arthroplasty seems certain to involve robotic technology, although to what degree and in what capacity will depend on further high-quality studies assessing long-term outcomes, complications, survivorship and cost-benefit analyses.
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Affiliation(s)
- Rohan Prakash
- Department of Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - Yuvraj Agrawal
- Department of Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
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27
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Hewson DW, Scott CEH, Macfarlane AJR. Regional analgesia for total hip arthroplasty and Schwartz's paradox. Br J Anaesth 2023; 130:650-654. [PMID: 37105898 DOI: 10.1016/j.bja.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Enhanced recovery after total hip arthroplasty aims to facilitate return to function and early hospital discharge, but the role of novel fascial plane block techniques in such pathways is uncertain. A randomised trial by Kukreja and colleagues describes superior quality of recovery after hip arthroplasty in patients receiving a pericapsular nerve group (PENG) block. We discuss the trial findings in the context of ongoing uncertainty regarding best analgesic practice for this surgical procedure.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care Medicine, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Anaesthesia, Queen's Medicine Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK; Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Alan J R Macfarlane
- Department of Anaesthetics, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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28
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Batailler C, Putzeys P, Lacaze F, Vincelot-Chainard C, Fontalis A, Servien E, Lustig S. Patellofemoral Arthroplasty Is an Efficient Strategy for Isolated Patellofemoral Osteoarthritis with or without Robotic-Assisted System. J Pers Med 2023; 13:jpm13040625. [PMID: 37109011 PMCID: PMC10142406 DOI: 10.3390/jpm13040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique.
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Affiliation(s)
- Cécile Batailler
- Department of Orthopaedics, Croix Rousse Hospital, Claude Bernard Lyon 1 University, 69004 Lyon, France
- IFSTTAR, LBMC UMR_T9406, Claude Bernard Lyon 1 University, 69100 Lyon, France
| | - Pit Putzeys
- Department of Orthopaedics, Hôpitaux Robert Schuman, L-2540 Luxembourg, Luxembourg
| | - Franck Lacaze
- Department of Orthopaedics, ORTHOSUD, Clinique St Jean Sud de France, 34430 Saint Jean de Vedas, France
| | | | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | - Elvire Servien
- Department of Orthopaedics, Croix Rousse Hospital, Claude Bernard Lyon 1 University, 69004 Lyon, France
- Interuniversity Laboratory of Biology of Mobility (LIBM-EA 7424), Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Sébastien Lustig
- Department of Orthopaedics, Croix Rousse Hospital, Claude Bernard Lyon 1 University, 69004 Lyon, France
- IFSTTAR, LBMC UMR_T9406, Claude Bernard Lyon 1 University, 69100 Lyon, France
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29
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Alshatwi R, Alfadhel S, Alrasheed M, Alhakbani A, AlShaya O. Comparison of Postoperative Pain and Function in Robotic Total Knee Arthroplasty and Conventional Total Knee Arthroplasty Amongst Patients at King Fahad Medical City in Riyadh, Saudi Arabia. Cureus 2023; 15:e36285. [PMID: 37073178 PMCID: PMC10105976 DOI: 10.7759/cureus.36285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
Background Total knee arthroplasty (TKA) is the definitive surgical treatment for end-stage osteoarthritis and has been proven to relieve pain and improve function. With the rise in demand and the number of TKA procedures every year, more studies have been conducted on robotic TKA. Objective The objective of this study is to compare the postoperative pain between robotic and conventional TKA and the postoperative functional level between robotic and conventional TKA. Method This is a quantitative, observational, prospective study conducted from February 2022 to August 2022 amongst patients in the orthopaedic department of King Fahad Medical City, Riyadh, Saudi Arabia, who have undergone primary TKA for end-stage osteoarthritis using robotic TKA and conventional TKA. After applying the exclusion and inclusion criteria, a total of 26 patients (12 robotic and 14 conventional) were included in the study. The patients were assessed at three time points: two weeks, six weeks, and three months post-op. They were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and the visual analogue scores (VAS) used to assess pain. Result A total of 26 patients were included in this research. The patients were divided into two groups: 12 robotic TKA patients and 14 conventional TKA patients. In this study, while comparing patients who underwent robotic TKA with those who underwent conventional TKA, no statistical significance was found regarding pain and function at all stages postoperatively. Conclusion There was no short-term difference between robotic and conventional TKA regarding pain and function. There is a need for further extensive research on robotic TKA in terms of cost-effectiveness, complications, implant survivorship, and long-term outcomes.
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30
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Robotic-Arm-Assisted Total Hip Arthroplasty: A Review of the Workflow, Outcomes and Its Role in Addressing the Challenge of Spinopelvic Imbalance. Medicina (B Aires) 2022; 58:medicina58111616. [DOI: 10.3390/medicina58111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There is mounting evidence that a significant percentage of dislocations occur within the perceived “safe zones”; hence, in the challenging subset of patients with a stiff spinopelvic construct, it is imperative to employ individualised component positioning based on the patients’ phenotype. Restoring the native centre of rotation, preserving offset, achieving the desired combined anteversion and avoiding leg length inequality are all very important surgeon-controlled variables that have been shown to be associated with postoperative outcomes. The latest version of the software has a feature of virtual range of motion (VROM), which preoperatively identifies potential dynamic causes of impingement that can cause instability. This review presents the workflow of RoTHA, especially focusing on pragmatic solutions to tackle the challenge of spinopelvic imbalance. Furthermore, it presents an overview of the existing evidence concerning RoTHA and touches upon future direction.
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