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Prashanth B, Sangani K, Reddy YM. Robot-assisted total knee arthroplasty using modified sub-vastus approach: A series of 120 knees. J Clin Orthop Trauma 2025; 68:103078. [PMID: 40524732 PMCID: PMC12167487 DOI: 10.1016/j.jcot.2025.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 05/25/2025] [Accepted: 05/28/2025] [Indexed: 06/19/2025] Open
Abstract
Background The application of the Sub-vastus (SV) approach in Robot-assisted total knee arthroplasty (RATKA) is a relatively new practice with many potential benefits. This study aimed to assess the cases that underwent robot-assisted knee replacement through the sub-vastus approach, using functional and clinical parameters. Methods This monocentric, single-surgeon, retrospective observational study included 81 consecutive cases (120 knees) who had undergone Robot-assisted total knee arthroplasty with the Sub-vastus approach. Their Postoperative evaluation included hemoglobin levels, functional outcomes like the straight leg raising test (SLRT), walking ability, and the Oxford Knee Score (OKS). Results The average age of participants was 63.3 years. The mean hospital stay was 3.4 days (median 3 days). Perioperative drop in Hemoglobin concentration averaged 1.27 g/dl for unilateral and 1.5 g/dl for bilateral cases. By the second postoperative day, 85 % of the study group were able to perform active straight leg raising and 66 % were able to walk with support. These numbers increased to 95 % by the third day. The mean OKS was 45.832 (SD: 1.29). Conclusion The SV approach, when combined with RATKA, can yield improved functional results by showing the short-term benefits of a quadriceps-sparing technique, like less blood loss, faster recovery, and shorter hospital stay, while also enhancing surgical precision and accuracy in implant placement, thereby improving longevity. This combination is also effective in addressing severe deformities and obese cases, which previously were a limitation of the SV approach. Incorporating an oblique under-vastus release of the suprapatellar pouch and capsule was found to facilitate surgical access and may enhance procedural efficiency.
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Affiliation(s)
- B.N. Prashanth
- Narayana Healthcity Hospital, Benguluru, Karnataka, India, 560099
| | - Karthik Sangani
- Narayana Healthcity Hospital, Benguluru, Karnataka, India, 560099
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Singh Rana SS, Ghahremani JS, Ramkumar PN, Navarro RA. A Bioethical Perspective on Orthopaedic Robot-Assisted Surgery: Consent, Access, and Accountability. J Bone Joint Surg Am 2024; 107:1411-1415. [PMID: 39693414 DOI: 10.2106/jbjs.24.00708] [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: 12/20/2024]
Affiliation(s)
| | - Jacob S Ghahremani
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Ronald A Navarro
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
- Kaiser Permanente South Bay Medical Center, Harbor City, California
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MacNeille R, Law TY, Roche M, Chow J. Does robotic-assisted unicompartmental knee arthroplasty improve alignment and outcomes? J ISAKOS 2024; 9:100336. [PMID: 39413925 DOI: 10.1016/j.jisako.2024.100336] [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: 10/04/2024] [Accepted: 10/04/2024] [Indexed: 10/18/2024]
Abstract
Unicompartmental knee arthroplasty (UKA) continues to increase in popularity as an excellent option for patients with single compartment disease. Robotic-assisted UKA has emerged as an optional tool with hopes for improvement in component placement, limb alignment, and patient outcomes. Furthermore, as patients continue to educate themselves, robotic assistance will become increasingly prevalent. There are now various robotic platforms on the market, each with varying differences, and more published data are emerging on alignment and outcomes. The literature to date largely concludes that robotic-assisted UKA provides more accuracy than manual UKA. Short- to mid-term outcomes may be improved with robotic UKA, but definitive differences in outcomes are uncertain. Survivorship with robotic UKA is non-inferior to reported manual UKA survivorship rates, and more long-term data are needed to fully elucidate this point. Orthopaedic surgeons should weigh these potential advantages against the drawbacks including cost and operative time when making a decision about whether robotic technology is right for their practice.
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Affiliation(s)
- Rhett MacNeille
- Abrazo Scottsdale Hospital, 3929 E Bell Rd, Phoenix, AZ, 85032, USA.
| | - Tsun Yee Law
- Hospital for Special Surgery Florida, 300 Palm Beach Lakes Boulevard, West Palm Beach, FL, 33401, USA.
| | - Martin Roche
- Hospital for Special Surgery Florida, 300 Palm Beach Lakes Boulevard, West Palm Beach, FL, 33401, USA.
| | - James Chow
- Abrazo Scottsdale Hospital, 3929 E Bell Rd, Phoenix, AZ, 85032, USA.
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Vossen RJM, Burger JA, Ten Noever de Brauw GV, Bayoumi T, Fiore JA, Ruderman LV, Zuiderbaan HA, Pearle AD. Preservation of prearthritic coronal knee phenotype and prearthritic coronal alignment yielded improved Kujala scores following ligament-guided medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:3185-3197. [PMID: 38804655 DOI: 10.1002/ksa.12282] [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: 03/18/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE There is a lack of literature evaluating outcomes of the ligament-guided approach in medial unicompartmental knee arthroplasty (UKA). An improved comprehension of the distribution of coronal plane alignment of the knee (CPAK) phenotypes and sagittal tibial wear patterns and their associations with patient-reported outcome measures (PROMs) and implant survivorship could provide insights into its further application in daily practice. METHODS A registry was reviewed for patients with a minimal 2-year follow-up who underwent robotic-assisted, ligament-guided, medial UKA between 2008 and 2016. Survivorship and postoperative PROMs were collected. CPAK phenotypes and sagittal tibial wear patterns were determined. Survivorship, Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala and patient satisfaction were compared between phenotypes and sagittal tibial wear patterns. RESULTS A total of 618 knees were included at a mean follow-up of 4.1 [2.0-9.6] years. Four-year conversion to the TKA survival rate was 98.9% [98.4%-99.3%] and 94.3% [93.3%-95.3%] for all-cause revision. Patients with preservation of the CPAK phenotype (84.5 ± 14.9, 81.8 ± 15.5, p = 0.033) and restoration of prearthritic coronal alignment (84.1 ± 14.9, 81.7 ± 15.9, p = 0.045) had a significantly higher Kujala score. No other significant differences in survivorship or PROMs were observed between phenotypes or sagittal tibial wear patterns. Additionally, no difference in survival rates was observed between preserved or altered phenotypes. CONCLUSION This study demonstrated that preservation of CPAK phenotype and preservation of prearthritic coronal alignment yielded a significantly higher Kujala score. No other significant differences in PROMs or implant survivorship were observed, suggesting that robotic-assisted, ligament-guided medial UKA provides equal outcomes for all observed phenotypes and sagittal tibial wear patterns in medial compartment OA as long as preoperative CPAK phenotype is preserved postoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Roderick J M Vossen
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Joost A Burger
- Charité-Universitatsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität, Berlin, Germany
| | - Gaby V Ten Noever de Brauw
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Tarik Bayoumi
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jake A Fiore
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Lindsey V Ruderman
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Medisch Kliniek Velsen, Department of Orthopaedic Surgery and Sports Medicine, Velsen-Noord, The Netherlands
| | - Andrew D Pearle
- Department of Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
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Langer S, Lallinger V, Heine N, Zapf J, Glowalla C. [Three-dimensional individual joint reconstruction through the Mako robotic arm-assisted surgical technique : Possibilities and limitations of the surgical technique]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:845-852. [PMID: 39210088 DOI: 10.1007/s00132-024-04554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Although knee arthroplasty represents a very successful treatment for osteoarthritis or joint destruction, a relevant number of patients is still not completely satisfied with the outcome. Higher satisfaction and faster rehabilitation seem to be achievable through patient-individualized alignment of the prosthesis and especially through reproducible robotic-assisted implantation. IMPORTANCE OF ROBOTICS The topic of robotics in orthopedics and especially in knee endoprosthesis is not new and began in the 1990s with the Robodoc system. The resurgence of robotics with new systems can be referred to as an innovation in the orthopedic operating room. Interest in this has risen significantly, not only among surgeons, but especially among patients, primarily because it seems to offer better joint function and patient satisfaction, as well as faster rehabilitation.
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Affiliation(s)
- Severin Langer
- Klinik für Orthopädie, Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
- Abteilung für Endoprothetik, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland.
| | - Vincent Lallinger
- Klinik für Orthopädie, Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Niels Heine
- Klinik für Orthopädie, Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Julian Zapf
- Klinik für Orthopädie, Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Claudio Glowalla
- Klinik für Orthopädie, Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
- Abteilung für Endoprothetik, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
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Bayoumi T, Ten Noever de Brauw GV, Ruderman LV, van der List JP, Kerkhoffs GMMJ, Pearle AD, Zuiderbaan HA. The phenotypic diversity of anteromedial osteoarthritis before and after treatment with medial unicompartmental knee arthroplasty: A radiographic analysis of 1000 knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:274-286. [PMID: 38226437 DOI: 10.1002/ksa.12043] [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: 10/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This study aimed to assess phenotypic variation in the coronal plane of knees with anteromedial osteoarthritis using the functional knee phenotype classification, before and after treatment with medial unicompartmental knee arthroplasty (UKA). METHODS The study comprised 1000 knees of 835 patients (45% females, 55% males, 90% Caucasian) who underwent medial UKA for anteromedial osteoarthritis. Pre and postoperative alignment was evaluated through the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). Knees were classified according to the functional knee phenotype system which combines limb phenotype (HKA), and femoral and tibial knee phenotypes (FMA and TMA, respectively). Restoration of prearthritic coronal alignment following medial UKA was evaluated by phenotype. RESULTS Preoperatively, 76 distinct and 25 relevant (prevalence ≥1%) functional knee phenotypes were identified, of which VARHKA 6°VARFMA 3°NEUTMA 0° was the most common (9.4% of knees). The most prevalent limb phenotype, VARHKA 6°, comprised 15 distinct knee phenotypes (FMA and TMA combinations). Postoperatively, 58 distinct and 17 relevant functional knee phenotypes were observed, of which VARHKA 3°NEUFMA 0°NEUTMA 0° had the highest prevalence at 18.3%. Knees with combined tibial and femoral deformities were associated with a lower probability of restoration of prearthritic coronal alignment following medial UKA, compared to knees without extra-articular deformity, or knees with an isolated tibial or femoral deformity. CONCLUSION Phenotype analysis using the functional knee phenotype system demonstrated a wide diversity of coronal alignment phenotypes among knees with anteromedial osteoarthritis in a predominantly Caucasian population. Following medial UKA, a reduction from 25 preoperative to 17 postoperative relevant phenotypes was observed. Consideration of phenotypic variation can be of importance when aiming to restore prearthritic coronal alignment during medial UKA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Tarik Bayoumi
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey V Ruderman
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen-Noord, The Netherlands
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Bayoumi T, Ten Noever de Brauw GV, Ruderman LV, van der List JP, Kerkhoffs GMMJ, Zuiderbaan HA, Pearle AD. Magnitude of Change in Leg Length and Clinical Impact Following Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2024; 39:68-75. [PMID: 37479193 DOI: 10.1016/j.arth.2023.07.013] [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: 03/07/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Change in leg length and leg-length discrepancy (LLD) are common concerns among patients undergoing medial unicompartmental knee arthroplasty (UKA). This study aimed to quantify the magnitude of leg-length change, prevalence of postoperative LLD, and their clinical implications following medial UKA. METHODS Leg length and mechanical hip-knee-ankle angle (mHKA) were retrospectively measured in 332 patients following unilateral robotic-arm assisted medial UKA for medial compartment osteoarthritis, using calibrated long-leg radiographs. The Knee Injury and Osteoarthritis Otcome Score for Joint Replacement and patient satisfaction were analyzed to assess impact of leg-length change and LLD on outcomes. RESULTS Following medial UKA, median leg-length change was 2.0 mm (interquartile range, -1.0 to 5.0 mm; P < .001) with a mean correction in mHKA of 4.4° ± 2.7 (P < .001). A total of 158 patients (48%) had a leg-length increase by 0 to 5 mm, 64 (19%) by 6 to 10 mm, and 11 (3%) by >10 mm. Leg-length change was positively correlated with mHKA correction (R = 0.44, P < .001). Postoperatively, moderate (5 to 10 mm) and substantial LLD (≥10 mm) were present in 49% and 17% of patients, respectively. Four-year Knee Injury and Osteoarthritis Outcome Score for Joint Replacement were comparable between patients with and without substantial postoperative LLD (P = .976). Proportions of satisfied patients were similar between groups (P = .687). CONCLUSION Following medial UKA, the majority of patients had a moderate increase in leg length, the magnitude of which was positively correlated to the correction in mechanical alignment. Postoperative substantial LLD was not uncommon (17% prevalence); however, it had no significant impact on patient-reported outcomes or satisfaction at 4 years follow-up.
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Affiliation(s)
- Tarik Bayoumi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York; Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gaby V Ten Noever de Brauw
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York; Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Lindsey V Ruderman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Sports, Ageing & Vitality, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Sports, Ageing & Vitality, Amsterdam, The Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, New York
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Ten Noever de Brauw GV, Bayoumi T, Ruderman LV, Kerkhoffs GMMJ, Pearle AD, Zuiderbaan HA. Knees with anteromedial osteoarthritis show a substantial phenotypic variation prior and following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5579-5590. [PMID: 37848566 DOI: 10.1007/s00167-023-07603-9] [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: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the phenotypic variation using the Coronal Plane Alignment of the Knee (CPAK) classification among 1000 knees with anteromedial osteoarthritis (OA) both prior to and following medial unicompartmental knee arthroplasty (UKA). The secondary aim of this study was to investigate whether knees maintained their preoperative CPAK phenotype and to evaluate the phenotypic alterations following medial UKA. METHODS The CPAK classification was used to analyze 1000 knees that underwent medial UKA as treatment for anteromedial OA. Knees were categorized into nine distinct CPAK phenotypes based on their arithmetic hip-knee-ankle angle (aHKA), which estimates the pre-arthritic alignment, and joint line obliquity (JLO), both pre- and postoperatively. Phenotypic variation was analyzed by sex and age, and the phenotypic alterations following medial UKA were evaluated by phenotype. RESULTS Preoperatively, CPAK phenotype I had the highest prevalence (45.0%). Among males, the preoperative prevalence of CPAK phenotype I was significantly higher compared to females (53.2% vs. 35.0%, respectively; p ≤ .001), whereas females exhibited a significantly higher occurrence of CPAK phenotype V compared to males (9.8% vs. 4.4%, respectively; p ≤ .015). Following medial UKA, CPAK phenotype II had the highest prevalence (53.3%). Overall, 45.1% of knees maintained their preoperative CPAK phenotype following medial UKA, which was most frequently observed among CPAK phenotype II (67.7%) and III (65.8%). CONCLUSION There is a substantial variation in CPAK phenotypes among knees with anteromedial OA, as well as following treatment with medial UKA. This variability challenges the assumption of uniform characteristics among knees with an identical wear pattern associated with anteromedial OA and emphasizes the complexity and variability of this specific form of OA. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- G V Ten Noever de Brauw
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center and Sports Medicine, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - H A Zuiderbaan
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands
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Ruderman LV, Bayoumi T, Burger JA, Zuiderbaan HA, Pearle AD. Higher incidence of patellar incongruence after under correction of pre-arthritic coronal alignment following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5773-5782. [PMID: 37934285 DOI: 10.1007/s00167-023-07645-z] [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: 09/06/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study aimed to compare patellofemoral joint alignment of knees with restored pre-arthritic coronal alignment versus knees with under- or overcorrection from their pre-arthritic coronal alignment following medial unicompartmental knee arthroplasty (UKA) and evaluate the effect of patellofemoral joint alignment on patient-reported outcomes. METHODS A retrospective analysis of 517 knees following robotic-arm assisted medial UKA was conducted. Postoperative mechanical hip-knee-ankle angle (mHKA) was compared to estimated pre-arthritic coronal alignment, using the arithmetic hip-knee-ankle angle (aHKA). Knees were considered restored to the pre-arthritic coronal alignment if mHKA was within 2.0° of aHKA (Group 1). Non-restored knees were subdivided into > 2.0° over correction (Group 2), or > 2.0° under correction (Group 3) from the pre-arthritic coronal alignment. Patellar congruence and patellar tilt angles were compared between groups. The Kujala score and Knee Injury and Osteoarthritic Outcome Score for Joint Replacement (KOOS, JR) were analyzed by group. Continuous data was compared using analysis of variance or Kruskal-Wallis tests. Chi-squared tests were used to compare discrete variables. Logistic regressions were conducted to estimate the probability of postoperative patellofemoral malalignment. RESULTS Group 1 included 357 knees (69.1%), Group 2 included 57 knees (11.0%), and Group 3 included 57 knees (11.0%). The prevalence of postoperative abnormal patellar congruence (i.e. ≥ 17°) was higher in Group 3 at 40.4% (p = 0.009), with a higher odds ratio of having an abnormal patellar congruence angle (2.3, p = 0.01) compared to Group 1. The prevalence of postoperative abnormal patellar tilt (i.e. ≥ 14°) was comparable between groups (n.s.). At mean follow up of 4.4 ± 1.6 years, Kujala was worse in Group 3 (76.6 ± 17.4 compared to 84.0 ± 14.9 and 85.0 ± 14.4 in Groups 1 and 2, respectively; p = 0.006). Mean KOOS, JR outcomes were comparable among groups. No significantly inferior Kujala or KOOS, JR outcomes were observed in patients across all groups with abnormal patellar congruence or tilt angles. CONCLUSION Knees with under correction from their pre-arthritic coronal alignment following medial UKA were associated with a two-fold higher probability of having postoperative patellofemoral incongruence, as well as inferior mid-term Kujala scores compared to knees with restored pre-arthritic coronal alignment and knees with overcorrection from their pre-arthritic coronal alignment. Patellofemoral incongruence alone did not negatively impact functional outcome scores. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- L V Ruderman
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, USA.
| | - T Bayoumi
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, USA
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J A Burger
- Department of Orthopaedic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - H A Zuiderbaan
- Department of Orthopaedic Surgery, Medical Clinic Velsen, Velsen, The Netherlands
| | - A D Pearle
- Hospital for Special Surgery, Department of Orthopaedic Surgery, Computer Assisted Surgery Center & Sports Medicine, Weill Medical College of Cornell University, New York, USA
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Mekkawy KL, Rodriguez HC, Pannu TS, Rowland RJ, Roche MW, Corces A. Morbidly Obese Patients Undergoing Unicompartmental Knee Arthroplasty Compared to Total Knee Arthroplasty: A Retrospective Case-Controlled Analysis. J Arthroplasty 2023; 38:2510-2516.e1. [PMID: 37301237 DOI: 10.1016/j.arth.2023.05.093] [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: 03/01/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND In this study, we assess the effects that morbid obesity (body mass index (BMI) ≥ 40) has on: (1) Ninety-day medical complications and readmission rates; (2) costs of care and lengths of stay (LOS); and (3) 2-year implant complications in patients undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA). METHODS A retrospective query of TKA and UKA patients were identified using a national database. Morbidly obese UKA patients were matched 1:5 to morbidly obese TKA patients by demographic and comorbidity profiles. Subgroup analyses were conducted using the same process between morbidly obese UKA patients and BMI <40 TKA patients, as well as to BMI <40 UKA patients. RESULTS Morbidly obese patients who underwent UKA had significantly fewer medical complications, readmissions, and periprosthetic joint infections than TKA patients; however, UKA patients had greater odds of mechanical loosening (ML). The TKA patients had significantly longer LOS (3.0 versus 2.4 days, P < .001), as well as significantly greater costs of care than UKA patients ($12,869 versus $7,105). Morbidly obese UKA patients had similar rates of medical complications, and significantly lower readmissions, decreased LOS, and decreased costs when compared to TKA patients who had a BMI <40. CONCLUSION In patients who have morbid obesity, complications were decreased in UKA compared to TKA. Moreover, morbidly obese UKA patients had lower medical utilizations and similar complication rates when compared to TKA patients with the recommended cutoff of BMI <40. However, UKA patients had greater rates of ML than TKA patients. A UKA may be an acceptable treatment option for unicompartmental osteoarthritis in morbidly obese patients.
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Affiliation(s)
- Kevin L Mekkawy
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Hugo C Rodriguez
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida; Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Tejbir S Pannu
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Robert J Rowland
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
| | - Martin W Roche
- Holy Cross Orthopedic Research Institute, Holy Cross Health, Fort Lauderdale, Florida; Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, Florida
| | - Arturo Corces
- Larkin Community Hospital, Department of Orthopaedic Surgery, South Miami, Florida
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11
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Kim SE, Han HS. Robotic-assisted unicompartmental knee arthroplasty: historical perspectives and current innovations. Biomed Eng Lett 2023; 13:543-552. [PMID: 37872988 PMCID: PMC10590358 DOI: 10.1007/s13534-023-00323-6] [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: 06/21/2023] [Revised: 08/14/2023] [Accepted: 09/16/2023] [Indexed: 10/25/2023] Open
Abstract
Robotic assisted unicompartmental knee arthroplasty (RAUKA) has emerged as a successful approach for optimizing implant positioning accuracy, minimizing soft tissue injury, and improving patient-reported outcomes. The application of RAUKA is expected to increase because of its advantages over conventional unicompartmental knee arthroplasty. This review article provides an overview of RAUKA, encompassing the historical development of the procedure, the features of the robotic arm and navigation systems, and the characteristics of contemporary RAUKA. The article also includes a comparison between conventional unicompartmental arthroplasty and RAUKA, as well as a discussion of current challenges and future advancements in the field of RAUKA.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Republic of Korea
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12
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Yang HY, Seon JK. The landscape of surgical robotics in orthopedics surgery. Biomed Eng Lett 2023; 13:537-542. [PMID: 37873001 PMCID: PMC10590337 DOI: 10.1007/s13534-023-00321-8] [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: 06/15/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 10/25/2023] Open
Abstract
Orthopedic surgery is one of the first surgical specialties to apply surgical robotics in clinical practice, which has become an interesting field over the years with promising results. Surgical robotics can facilitate total joint arthroplasty by providing robotic support to accurately prepare the bone, improving the ability to reproduce alignment, and restoring normal kinematics. Various robotic systems are available on the market, each tailored to specific types of surgeries and characterized by a series of features with different requirements and/or modus operandi. Here, a narrative review of the current state of surgical robotic systems for total joint knee arthroplasty is presented, covering the different categories of robots, which are classified based on the operation, requirements, and level of interaction with the surgeon. The different robotic systems include closed/open platform, image-based/imageless, and passive/active/semi-active systems. The main goal of a robotic system is to increase the accuracy and precision of the operation regardless of the type of system. Despite the short history of surgical robots, they have shown clinical effectiveness compared to conventional techniques in orthopedic surgery. When considering which robotic system to use, surgeons should carefully evaluate the different benefits and drawbacks to select the surgical robot that fits their needs the best.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Seoyang-ro 322, Hwasun-gun, Chonnam, Republic of Korea
| | - Jong Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hwasun Hospital, Seoyang-ro 322, Hwasun-gun, Chonnam, Republic of Korea
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13
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Bayoumi T, Burger JA, Ruderman LV, van der List JP, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Restoration or relative overcorrection of pre-arthritic coronal alignment leads to improved results following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:3981-3991. [PMID: 37145133 DOI: 10.1007/s00167-023-07441-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/23/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE A pre-arthritic alignment strategy for medial unicompartmental knee arthroplasty (UKA) aims to restore a patient's native lower limb alignment which may translate into improved outcomes. This study aimed to assess whether patients with pre-arthritically aligned knees versus patients with non-pre-arthritically aligned knees demonstrated improved mid-term outcomes and survivorship following medial UKA. The hypothesis was that pre-arthritic alignment in medial UKA would lead to better postoperative outcomes. METHODS A retrospective study of 537 robotic-assisted fixed-bearing medial UKA was conducted. During this procedure, the surgical goal was to restore pre-arthritic alignment guided by re-tensioning of the medial collateral ligament (MCL). For study purposes, coronal alignment was retrospectively evaluated using the mechanical hip-knee-ankle angle (mHKA). Pre-arthritic alignment was estimated through the arithmetic hip-knee-ankle (aHKA) algorithm. Knees were grouped according to the difference between postoperative mHKA and estimated pre-arthritic alignment (i.e., mHKA - aHKA) as Group 1 (pre-arthritically aligned: mHKA restored within 2.0° of the aHKA), Group 2 (mHKA > 2.0° overcorrected relative to the aHKA), or Group 3 (mHKA > 2.0° undercorrected relative to the aHKA). Outcomes included the Knee Injury and Osteoarthritic Outcome Score for Joint Replacement (KOOS, JR), Kujala, proportions of knees achieving the patient acceptable symptom state (PASS) for these scores, and survivorship. PASS thresholds for KOOS, JR and Kujala were determined using a receiver operating characteristic curve method. RESULTS A total of 369 knees were categorized as Group 1, 107 as Group 2, and 61 as Group 3. At 4.4 ± 1.6 years follow-up, mean KOOS, JR was comparable among groups, while Kujala was significantly worse in Group 3. The proportion of knees achieving the PASS for Kujala (76.5 points) was lower in Group 3 (n = 32; 59%) compared to Group 1 (n = 260; 74%) (p = 0.02). 5-year survivorship was higher in Group 1 and Group 2 (99% and 100%, respectively) compared to Group 3 (91%) (p = 0.04). CONCLUSION Pre-arthritically aligned knees and knees with relative overcorrection from their pre-arthritic alignment following medial UKA demonstrated improved mid-term outcomes and survivorship compared to knees with relative under correction from their pre-arthritic alignment. These results encourage restoring or relatively overcorrecting pre-arthritic alignment to optimize outcomes following medial UKA, and caution against under correction from the pre-arthritic alignment. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Tarik Bayoumi
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA.
| | - Joost A Burger
- Department of Orthopaedic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Lindsey V Ruderman
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sports, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA
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14
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Gowd AK, Plate JF, Lichtig A, Gencer A, Yanmis O, D'Agostino R, Poehling GG. Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience. J ISAKOS 2023; 8:255-260. [PMID: 37004741 DOI: 10.1016/j.jisako.2023.03.002] [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: 08/24/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. METHODS A prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010-December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. RESULTS In total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ± 10.7 years and mean follow-up was 76.4 ± 17.4 months. Mean BMI was 32.3 ± 6.5 kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p = 0.01), greater operative joint space (p = 0.04), previous surgery (p = 0.01), inlay implant (p = 0.04) and pain syndrome (p = 0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p < 0.01), history of pain syndrome (p < 0.01) and greater preoperative joint space (>2 mm) (p < 0.01). There was no association of BMI to conversion to TKA. CONCLUSION Robotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Asher Lichtig
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Ahmet Gencer
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Orhan Yanmis
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Ralph D'Agostino
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
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15
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Roche MW, Vakharia RM, Law TY, Sabeh KG. Accuracy of Intraoperative Mechanical Axis Alignment to Long-Leg Radiographs following Robotic-Arm-Assisted Unicompartmental Knee Arthroplasty. J Knee Surg 2023; 36:752-758. [PMID: 35114720 DOI: 10.1055/s-0042-1742647] [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: 02/07/2023]
Abstract
Improper alignment and implant positioning following unicompartmental knee arthroplasty (UKA) has been shown to lead to postoperative pain and increase the incidence of revision procedures. The use of robotic-arm assistance for UKA (RAUKA) has become an area of interest to help overcome these challenges. The accuracy of intraoperative alignment compared with standing long-leg X-rays postoperatively following medial RAUKA has been in question. Therefore, the purpose of this study was to (1) determine final mean intraoperative coronal alignment in extension utilizing an image based intraoperative navigation system, and (2) compare final intraoperative alignment to 6-week weight-bearing (WB) long-leg X-rays. Patients who underwent RAUKA for medial compartmental osteoarthritis were identified from January 1, 2018, to August 31, 2019, through our institution's joint registry. The query yielded 136 (72 right and 64 left) patients with a mean age of 72.02 years and mean body mass index (BMI) of 28.65 kg/m2 who underwent RAUKA. Final intraoperative alignment was compared with WB long leg X-rays 6 weeks postoperatively by measuring the mechanical alignment. Statistical analysis was primarily descriptive. Pearson's correlation coefficient was used to determine the relationship between intraoperative alignment to 6-week alignment. A p-value of <0.05 was considered statistically significant. Mean intraoperative coronal alignment after resections and trialing was 4.39 varus ± 2.40 degrees for the right knee, and 4.81 varus ± 2.29 degrees for the left knee. WB long-leg X-rays 6 weeks postoperatively demonstrated mechanical axis alignment for the right and left knees to be 3.01 varus ± 2.10 and 3.7 varus ± 2.38 degrees, respectively. This resulted in a change in alignment of 1.36 ± 1.76 and 1.12 ± 1.84 degrees for the right and left knees, respectively (p < 0.05). Pearson's correlation coefficient demonstrated a correlation of 0.69 between intraoperative to long-leg-X-ray alignment. RAUKA demonstrates excellent consistency when comparing postoperative WB long-leg X-rays to final intraoperative image-based non-WB alignment.
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Affiliation(s)
- Martin W Roche
- Hospital for Special Surgery Florida, Department of Orthopaedic Surgery, West Palm Beach, Florida
| | - Rushabh M Vakharia
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Tsun Y Law
- Department of Orthopaedic Surgery, Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, Florida
| | - Karim G Sabeh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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16
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Kulkarni PG, Paudel N, Magar S, Santilli MF, Kashyap S, Baranwal AK, Zamboni P, Vasavada P, Katiyar A, Singh AV. Overcoming Challenges and Innovations in Orthopedic Prosthesis Design: An Interdisciplinary Perspective. BIOMEDICAL MATERIALS & DEVICES (NEW YORK, N.Y.) 2023; 2:1-12. [PMID: 37363137 PMCID: PMC10180679 DOI: 10.1007/s44174-023-00087-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 06/28/2023]
Abstract
Recent advances in the orthopedic prostheses design have significantly improved the quality of life for individuals with orthopedic disabilities. However, there are still critical challenges that need to be addressed to further enhance the functionality of orthopedic prostheses improving biocompatibility to promote better integration with natural tissues, enhancing durability to withstand the demands of daily use, and improving sensory feedback for better control of movement are the most pressing issues. To address these challenges, promising emerging solutions such as smart prosthetics, 3D printing, regenerative medicine, and artificial intelligence have been developed. These innovative technologies hold the potential to significantly enhance the functionality of orthopedic prostheses. Realizing the full potential of these next-generation orthopedic prostheses requires addressing several critical factors. These include interdisciplinary collaboration between experts in orthopedics, materials science, biology, and engineering, increased investment in research and development, standardization of components to ensure quality and reliability, and improved access to prosthetics. A comprehensive review of these challenges and considerations for future orthopedic prosthesis design is s provided in this paper addressing the further advances to the field. By addressing these issues, we can continue to improve the lives of individuals with orthopedic disabilities and further enhance the field of orthopedic prosthetics.
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Affiliation(s)
| | - Namuna Paudel
- Department of Chemistry, Amrit Campus, Institute of Science and Technology, Tribhuvan University, Lainchaur, Kathmandu, 44600 Nepal
| | - Shilpa Magar
- Seeta Nursing Home, Shivaji Nagar, Nashik, Maharashtra 422002 India
| | | | | | | | - Paolo Zamboni
- Chair Vascular Diseases Center, University of Ferrara, 44124 Ferrara, Italy
| | - Priyank Vasavada
- M.S. Ramaiah Medical College and Hospital, Bengaluru, 560054 India
| | - Aman Katiyar
- Jain University, Bengaluru, Karnataka 560069 India
| | - Ajay Vikram Singh
- Department of Chemical and Product Safety, German Federal Institute of Risk Assessment (BfR), Maxdohrnstrasse 8-10, 10589 Berlin, Germany
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17
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Bayoumi T, Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Prospective Multicenter Study. J Bone Joint Surg Am 2023:00004623-990000000-00793. [PMID: 37146125 DOI: 10.2106/jbjs.22.01104] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) has been shown to result in high short- and mid-term survivorship. However, it is not known whether these outcomes are maintained at long-term follow-up. This study aimed to evaluate long-term implant survivorship, modes of failure, and patient satisfaction following robotic-arm-assisted medial UKA. METHODS A prospective multicenter study of 474 consecutive patients (531 knees) undergoing robotic-arm-assisted medial UKA was conducted. A cemented, fixed-bearing system with a metal-backed onlay tibial implant was used in all cases. Patients were contacted at 10-year follow-up to determine implant survivorship and satisfaction. Survival was analyzed using Kaplan-Meier models. RESULTS Data were analyzed for 366 patients (411 knees) with a mean follow-up of 10.2 ± 0.4 years. A total of 29 revisions were reported, corresponding to a 10-year survivorship of 91.7% (95% confidence interval, 88.8% to 94.6%). Of all revisions, 26 UKAs were revised to total knee arthroplasty. Unexplained pain and aseptic loosening were the most commonly reported modes of failure, accounting for 38% and 35% of revisions, respectively. Of patients without revision, 91% were either satisfied or very satisfied with their overall knee function. CONCLUSIONS This prospective multicenter study found high 10-year survivorship and patient satisfaction following robotic-arm-assisted medial UKA. Pain and fixation failure remained common causes for revision following cemented fixed-bearing medial UKA, despite the use of a robotic-arm-assisted technique. Prospective comparative studies are needed to assess the clinical value of robotic assistance over conventional techniques in UKA. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarik Bayoumi
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Laura J Kleeblad
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, Oregon
| | - Thomas M Coon
- Coon Joint Replacement Institute, Department of Orthopaedic Surgery, St. Helena, California
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, Florida
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Computer Assisted Surgery and Sports Medicine, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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18
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Bayoumi T, Burger JA, Zuiderbaan HA, Ruderman LV, Nguyen JT, Pearle AD. Robotic-assisted medial unicompartmental knee arthroplasty restores estimated pre-arthritic coronal limb alignment: A retrospective cohort study. Knee 2023; 41:180-189. [PMID: 36706493 DOI: 10.1016/j.knee.2023.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/29/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Robotic-assisted medial unicompartmental knee arthroplasty (UKA) aims to restore pre-arthritic (constitutional) limb alignment, by re-tensioning of the medial collateral ligament (MCL). This study aimed to determine whether pre-arthritic coronal alignment was restored following robotic-assisted medial UKA in patients with medial compartment osteoarthritis. METHOD A retrospective study was undertaken, including 102 patients with a unilateral robotic-assisted medial UKA and a contralateral unaffected knee. Both the validated arithmetic hip-knee-ankle angle (aHKA) and alignment of the contralateral unaffected knee were used to estimate pre-arthritic alignment. The aHKA is a radiographic method to estimate the pre-arthritic mechanical hip-knee-ankle angle (mHKA). To verify restoration of pre-arthritic alignment, postoperative mHKA was compared to the aHKA. Additionally, postoperative mHKA, joint line congruence (JLCA), and knee joint line obliquity (KJLO) angles were compared between the operative and contralateral unaffected knee. Equivalence between postoperative and pre-arthritic alignment was assessed through the two-one-sided t-test (TOST), using equivalence margins of ±2.0°. RESULTS Postoperative mHKA was equivalent to the aHKA (mean difference -0.38°, 90% CI -0.69 to -0.07;p < .001), with 93 knees (91%) restored within 3.0° their aHKA. Postoperative mHKA, JLCA and KJLO were equivalent between the operative and contralateral unaffected knees, with mean differences of -0.65°, -0.65°, and -0.40°, respectively; all p < .001. CONCLUSIONS Postoperative and pre-arthritic coronal alignment were equivalent following robotic-assisted medial UKA, with 91% of knees restored within 3.0° of their pre-arthritic mechanical axis. These results demonstrate that both mechanical alignment and joint line congruence are restored by MCL re-tensioning in patients undergoing robotic-assisted medial UKA for medial compartment osteoarthritis.
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Affiliation(s)
- Tarik Bayoumi
- Department of Orthopedic Surgery, Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
| | - Joost A Burger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
| | - Hendrik A Zuiderbaan
- Department of Orthopedic Surgery, Medische Kliniek Velsen, Velsen, The Netherlands
| | - Lindsey V Ruderman
- Department of Orthopedic Surgery, Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, USA
| | - Andrew D Pearle
- Department of Orthopedic Surgery, Computer Assisted Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
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19
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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: 1.0] [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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20
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Femorotibial alignment measured during robotic assisted knee surgery is reliable: radiologic and gait analysis. Arch Orthop Trauma Surg 2022; 142:1645-1651. [PMID: 34216259 DOI: 10.1007/s00402-021-04033-5] [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: 12/07/2020] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Femorotibial alignment is crucial for the outcome of unicompartmental knee arthroplasty (UKA). Robotic-assisted systems are useful to increase the accuracy of alignment in UKA. However, no study has assessed if the femorotibial alignment measured by the image-free robotic system is reliable. The aim of this study was to determine whether measurement of the mechanical femorotibial axis (mFTA) in the coronal plane with handheld robotic assistance during surgery is equivalent to a static measurement on radiographs and to a dynamic measurement during walking. METHODS Twenty patients scheduled for robotic-assisted medial UKA using handheld technology were included in this prospective study. Three measurements of the frontal femorotibial axis were compared: intra-operative acquisition by computer assistance (dynamic, non-weightbearing position), radiographic measurements on long leg X-ray (static, weightbearing position), and by gait analysis during walking (dynamic, weightbearing position). RESULTS There was no significant difference in the mFTA between computer (174.4 ± 3.4°), radiological (173.9 ± 3.3°), and gait analysis (172.9 ± 5.1°) measurements (p = 0.5). There was a strong positive correlation (r = 0.6577355, p = 0.0016) between robotic-assisted measurements and gait analysis. CONCLUSION There was no significant difference in the femorotibial axis measured by the image-free robotic assistance, from the preoperative radiographs or by gait analysis. The reliability of intra-operative measurements of the frontal femorotibial axis by these robotic-assisted systems is acceptable.
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Chen X, Deng S, Sun ML, He R. Robotic arm-assisted arthroplasty: The latest developments. Chin J Traumatol 2022; 25:125-131. [PMID: 34556374 PMCID: PMC9125720 DOI: 10.1016/j.cjtee.2021.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/18/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023] Open
Abstract
Joint arthroplasty is an effective method for treating end-stage joint lesions and damages. Robotic arm-assisted arthroplasty, a rapidly developing technology that combines navigation technology, minimally invasive technology, and precise control technology of the robotic arm, can achieve accurate preoperative planning, optimal selection of implants, minimally invasive surgery, precise osteotomy, and accurate placement of the artificial joint. It has the characteristics of high accuracy and stability, and thus is more and more widely used in the field of joint surgery. In this paper, we systematically reviewed the application and clinical efficacy of robotic arm-assisted technology in hip and knee arthroplasty to provide reference for its future promotion.
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Mehdian R, Howard M. Artificial Intelligence in Trauma and Orthopedics. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kumar A, Hung CH, Hsieh SL, Kuo CC, Mao JT, Lin ET, Hsu HC. Makoplasty medial unicondylar knee replacement: Correction or postoperative angle matters? Int J Med Robot 2021; 18:e2356. [PMID: 34921488 DOI: 10.1002/rcs.2356] [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: 10/20/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Various considerations prevail around optimal postoperative varus deformity, correction angle and physiological constitutional varus deformity. The goal of our present study was to understand correlation between these parameters and their influence over Western Ontario McMaster University Osteoarthritis Index scale (WOMAC). MATERIALS AND METHODS Consecutive robotic-arm-assisted medial onlay fixed bearing unicompartmental knee arthroplasty (UKA) in 143 knees studied. WOMAC score was recorded preoperatively and at specific intervals after surgery for consecutive 2 years. RESULTS Mean preoperative and postoperative varus deformities were 10.2° and 4.8°, respectively, and mean correction angle was 5.4°. The preoperative varus and correction angles were found well correlated (r = 0.815). The amount of improvement in the WOMAC total score was not influenced by the postoperative varus angle. CONCLUSION The correction angle has a stronger correlation with preoperative varus deformity, and postoperative varus deformity does not imply favourable clinical outcomes.
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Affiliation(s)
- Abhishek Kumar
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hung Hung
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Shang-Lin Hsieh
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Chien-Chung Kuo
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Ting Mao
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Erh-Ti Lin
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopaedics, China Medical University Hospital, Taichung, Taiwan
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Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic-assisted total hip arthroplasty: an economic analysis. J Comp Eff Res 2021; 10:1225-1234. [PMID: 34581189 DOI: 10.2217/cer-2020-0255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included. 90-day EOC cost, index costs, length of stay and post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facility admissions and used fewer home health agency visits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than those of mTHA patients (p = 0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated with RATHA were driven by reduced utilization and cost of post-index rehabilitation services.
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Affiliation(s)
| | | | | | | | - Carlos Lavernia
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
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25
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Sun Y, Liu W, Hou J, Hu X, Zhang W. Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis. BMJ Open 2021; 11:e044778. [PMID: 34380715 PMCID: PMC8359483 DOI: 10.1136/bmjopen-2020-044778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA. DESIGN Systematic review and meta-analysis. DATA SOURCES The PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020. ELIGIBILITY CRITERIA Case-control studies comparing robotic-assisted and conventional UKA. DATA EXTRACTION AND SYNTHESIS Data from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ2 and I2 tests. All analyses were performed using the 'metafor' package of R V.3.6.2 software. RESULTS A total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis. CONCLUSIONS This study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required. PROSPERO REGISTRATION NUMBER CRD42021246927.
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Affiliation(s)
- Yifeng Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| | - Wei Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| | - Jian Hou
- Emergency Department, Jimo Traditional Chinese Hospital, Qingdao, People's Republic of China
| | - Xiuhua Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| | - Wenqiang Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
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26
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Liu P, Lu FF, Liu GJ, Mu XH, Sun YQ, Zhang QD, Wang WG, Guo WS. Robotic-assisted unicompartmental knee arthroplasty: a review. ARTHROPLASTY 2021; 3:15. [PMID: 35236463 PMCID: PMC8796542 DOI: 10.1186/s42836-021-00071-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Presented here is an up-to-date review concerning robotic-assisted unicompartmental knee arthroplasty (rUKA), including its rationale, operative system, pros and cons. Methods We did a systematic research in electronic databases, including PubMed, Cochrane Library, Web of Science, and Embase up to March 30, 2020 to retrieve literature pertaining to rUKA. The search strategies “(robotic* AND knee arthroplasty OR knee replacement)” and “(knee arthroplasty OR knee replacement NOT total)” were used. Studies describing rUKA and clinical trials, dry bone or cadaveric researches regarding technologies, positioning, alignment, function, or survivorship of implants were included in this review. All retrieved studies were first browsed for eligibility on the basis of title and abstract, and the selected studies were further evaluated by reading full text for final inclusion. Results Robotic-assisted technology has been found to increase the accuracy of bone preparation and implant placement, reduce technical variability and outliers, and enhance reproduction of limb alignment. Additionally, early clinical outcomes were excellent, but mid-term follow-up showed no superiority in component survivorship. The potential drawbacks of the robotic-assisted technology include relatively-low time- and cost-effectiveness, development of some rUKA-related complications, and lack of support by high-quality literature. Conclusion This review shows that rUKA can decrease the number of outliers concerning the optimal implant positioning and limb alignment. However, due to absence of extensive studies on clinical outcomes and long-term results, it remains unclear whether the improved component positioning translates to better clinical outcomes or long-term survivorship of the implant. Nevertheless, since an accurate implant position is presumably beneficial, robotic-assisted technology is worth recommendation in UKA.
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Affiliation(s)
- Pei Liu
- Department of Adult Joint Reconstruction, Henan Luoyang Orthopaedic Hospital (Henan Provincial Orthopaedic Hospital), Yongping Road, Zhengdong New District, Zhengzhou, China
| | - Fei-Fan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Yinghuadong Road, Chaoyang District, Beijing, China
| | - Guo-Jie Liu
- Department of Adult Joint Reconstruction, Henan Luoyang Orthopaedic Hospital (Henan Provincial Orthopaedic Hospital), Yongping Road, Zhengdong New District, Zhengzhou, China
| | - Xiao-Hong Mu
- Department Orthopedics 4, Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China
| | - Yong-Qiang Sun
- Department of Adult Joint Reconstruction, Henan Luoyang Orthopaedic Hospital (Henan Provincial Orthopaedic Hospital), Yongping Road, Zhengdong New District, Zhengzhou, China
| | - Qi-Dong Zhang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wei-Guo Wang
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wan-Shou Guo
- Department of Orthopaedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, No. 2, Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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DeFrance MJ, Yayac MF, Courtney PM, Squire MW. The Impact of Author Financial Conflicts on Robotic-Assisted Joint Arthroplasty Research. J Arthroplasty 2021; 36:1462-1469. [PMID: 33199093 DOI: 10.1016/j.arth.2020.10.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent studies have suggested clinical superiority with robotic-assisted arthroplasty compared to traditional techniques. However, concerns exist regarding the author's financial conflicts of interest (COI), which may influence research outcomes. This study aimed to determine whether COI relating to robotic-assisted arthroplasty influences the results of published outcomes following total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA). METHODS We performed a systematic review to identify all studies evaluating the use of robotics in THA, TKA, and UKA. An author's financial COI was identified if they reported a relevant disclosure through the American Academy of Orthopedic Surgeons or within the study article. We then queried the Open Payments website to record all payments made from a robotic company in the year prior to publication. Each study was categorized as either favoring robotics (n = 42), neutral (n = 10), or favoring traditional techniques (n = 2). We then compared the number of conflicted authors, journal impact factor, level of evidence, and mean annual industry payment to each author. RESULTS Of the 54 studies meeting inclusion criteria, 49 (91%) had an author financial COI. Conflicted studies were more likely to report favorable results of robotics than nonconflicted studies. When compared to studies favoring conventional techniques, those demonstrating favorable robotics outcomes had a higher number of conflicted authors and a higher mean industry payment per author. There was no difference in the level of evidence or journal impact factor. DISCUSSION Nearly all studies comparing robotic THA, TKA, and UKA to conventional techniques involve financially conflicted authors. Further studies without COI may provide unbiased results.
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Affiliation(s)
| | - Michael F Yayac
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew W Squire
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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28
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Mehdian R, Howard M. Artificial Intelligence in Trauma and Orthopaedics. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eugster M, Zoller EI, Krenn P, Blache S, Friederich NF, Muller-Gerbl M, Cattin PC, Rauter G. Quantitative Evaluation of the Thickness of the Available Manipulation Volume Inside the Knee Joint Capsule for Minimally Invasive Robotic Unicondylar Knee Arthroplasty. IEEE Trans Biomed Eng 2020; 68:2412-2422. [PMID: 33259290 DOI: 10.1109/tbme.2020.3041512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Developing robotic tools that introduce substantial changes in the surgical workflow is challenging because quantitative requirements are missing. Experiments on cadavers can provide valuable information to derive workspace requirements, tool size, and surgical workflow. This work aimed to quantify the volume inside the knee joint available for manipulation of minimally invasive robotic surgical tools. In particular, we aim to develop a novel procedure for minimally invasive unicompartmental knee arthroplasty (UKA) using a robotic laser-cutting tool. METHODS Contrast solution was injected into nine cadaveric knees and computed tomography scans were performed to evaluate the tool manipulation volume inside the knee joints. The volume and distribution of the contrast solution inside the knee joints were analyzed with respect to the femur, tibia, and the anatomical locations that need to be reached by a laser-cutting tool to perform bone resection for a standard UKA implant. RESULTS Quantitative information was determined about the tool manipulation volume inside these nine knee joints and its distribution around the cutting lines required for a standard implant. CONCLUSION Based on the volume distribution, we could suggest a possible workflow for minimally invasive UKA, which provides a large manipulation volume, and deducted that for the proposed workflow, an instrument with a thickness of 5-8 mm should be feasible. SIGNIFICANCE We present quantitative information on the three-dimensional distribution of the maximally available volume inside the knee joint. Such quantitative information lays the basis for developing surgical tools that introduce substantial changes in the surgical workflow.
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Thilak J, Thadi M, Mane PP, Sharma A, Mohan V, Babu BC. Accuracy of tibial component positioning in the robotic arm assisted versus conventional unicompartmental knee arthroplasty. J Orthop 2020; 22:367-371. [PMID: 32952328 PMCID: PMC7486415 DOI: 10.1016/j.jor.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Our study aims to determine the planned accuracy of the tibial component placement in robotic arm assisted unicompartmental knee arthroplasty (UKA) versus the conventional jig based UKA of the initial cases done in India for the first time with this particular robotic system.Materials & Methods: Study group 1 consisted of patients who underwent robotic arm (MAKO, Stryker, USA) assisted UKA. Group 2 consists of patients who underwent a standard conventional jig based (Oxford knee, Biomet, UK). Post-operative radiographs were taken to determine the Tibial Implant position and orientation which were compared to their preoperative plan respectively by two independent observers. The mean error value was obtained for both study groups respectively and compared to determine the accuracy of the post-operative tibial implant placement. RESULTS In the Robotic arm assisted UKA, the deviation of post-operative varus angle from preoperative planned angle was about 0.43° and post-operative Tibial slope alignment differed from preoperative plan was 0.41°. In the Conventional UKA group post-operative varus angle differed from preoperative planned angle by about 2.12° and post-operative Tibial slope alignment deviation from preoperative plan was 2.47°. CONCLUSIONS Robotic arm assisted system was more accurate compared to the conventional jig-based technique in achieving the planned orientation and alignment of the tibial implant in the initial learning phase of this particular Robotic System used for the first time in India. MESH TERMS partial knee replacement, robotic assisted surgery.
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Affiliation(s)
- Jai Thilak
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Mohan Thadi
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | - Anubhav Sharma
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vipin Mohan
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu C. Babu
- Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Lin J, Yan S, Ye Z, Zhao X. A systematic review of MAKO-assisted unicompartmental knee arthroplasty. Int J Med Robot 2020; 16:1-7. [PMID: 32445224 DOI: 10.1002/rcs.2124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Unicompartmental knee arthroplasty (UKA), which has many potential advantages compared with total knee arthroplasty, was widely used across the world in recent years. The introduction of the robot systems greatly makes up for the defects of the conventional UKA surgery such as higher complication rates and revision rates. MAKO system, a new image-guided robot system relies on a preoperative computed tomography scan to assist in preoperative mapping and planning, offers an opportunity to improve the outcome of UKA surgeries. In order to have a more comprehensive and in-depth understanding of MAKO-assisted UKA, the studies on MAKO-assisted UKA were summarized. MAKO-assisted UKA is better than conventional UKA surgery on implant accuracy, soft tissue balance, patient function scores and satisfaction, complications rates, and learning curve in short-term outcome; however, the mid-term and long-term outcomes of MAKO-assisted UKA need to be further studied.
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Affiliation(s)
- Jiyan Lin
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xiang Zhao
- Department of Orthopeadics, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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32
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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: 7] [Impact Index Per Article: 1.4] [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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CORR Insights®: Valgus Correctability and Meniscal Extrusion Were Associated With Alignment After Unicompartmental Knee Arthroplasty. Clin Orthop Relat Res 2020; 478:1645-1647. [PMID: 32379135 PMCID: PMC7310332 DOI: 10.1097/corr.0000000000001302] [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: 01/31/2023]
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Picard F, Deakin AH, Riches PE, Deep K, Baines J. Computer assisted orthopaedic surgery: Past, present and future. Med Eng Phys 2020; 72:55-65. [PMID: 31554577 DOI: 10.1016/j.medengphy.2019.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022]
Abstract
Computer technology is ubiquitous and relied upon in virtually all professional activities including neurosurgery, which is why it is surprising that it is not the case for orthopaedic surgery with fewer than 5% of surgeons using available computer technology in their procedures. In this review, we explore the evolution and background of Computer Assisted Orthopaedic Surgery (CAOS), delving into the basic principles behind the technology and the changes in the discussion on the subject throughout the years and the impact these discussions had on the field. We found evidence that industry had an important role in driving the discussion at least in knee arthroplasty-a leading field of CAOS-with the ratio between patents and publications increased from approximately 1:10 in 2004 to almost 1:3 in 2014. The adoption of CAOS is largely restrained by economics and ergonomics with sceptics challenging the accuracy and precision of navigation during the early years of CAOS moving to patient functional improvements and long term survivorship. Nevertheless, the future of CAOS remains positive with the prospect of new technologies such as improvements in image-guided surgery, enhanced navigation systems, robotics and artificial intelligence.
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Affiliation(s)
- Frederic Picard
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK; Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, UK.
| | | | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Wolfson Centre, 106 Rottenrow, Glasgow, G4 0NW, UK
| | - Kamal Deep
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
| | - Joseph Baines
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
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Zambianchi F, Franceschi G, Rivi E, Banchelli F, Marcovigi A, Khabbazè C, Catani F. Clinical results and short-term survivorship of robotic-arm-assisted medial and lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:1551-1559. [PMID: 31218389 DOI: 10.1007/s00167-019-05566-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/13/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE The aim of this multicentre, retrospective, observational study was to determine the incidence of revision and clinical results of a large cohort of robotic-arm-assisted medial and lateral UKAs at short-term follow-up. It was hypothesized that patients who receive robotic-arm-assisted UKA will have high survivorship rates and satisfactory clinical results. METHODS Between 2013 and 2016, 437 patients (470 knees) underwent robotic-arm-assisted medial and lateral UKAs at two centres. Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score 12 (FJS-12) and Short-Form Physical and Mental Health Summary Scales (SF-12) were administered to estimate patients' overall health status pre- and post-operatively. Results were dichotomized as 'excellent' and 'poor' if KOOS/FJS-12 were more than or equal to 90 and SF-12 was more or equal to 45. Associations between patients' demographic characteristics and clinical outcomes were investigated. Post-operative complications and pain persistence were recorded. RESULTS Following exclusions and losses to follow-up, 338 medial and 67 lateral robotic-arm-assisted UKAs were assessed at a mean follow-up of 33.5 and 36.3 months, respectively. Three medial UKAs were revised, resulting in a survivorship of 99.0%. No lateral implants underwent revision (survivorship 100%). On average, significant improvement in all clinical scores was reported in both medial and lateral UKA patients. In medial UKA patients, male gender was associated with higher probability of better scores in overall KOOS, FJS-12 and in specific KOOS subscales. No other associations were reported between biometric parameters and outcome for either medial or lateral UKA. CONCLUSIONS Robotic-assisted medial and lateral UKAs demonstrated satisfactory clinical outcomes and excellent survivorship at 3-year follow-up. Continued patient follow-up is needed to determine the long-term device performance and clinical satisfaction. LEVEL OF EVIDENCE Retrospective cohort study, Level IV.
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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, 71, 41124, Modena, Italy.
| | - Giorgio Franceschi
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, PD, Italy
| | - Elisa Rivi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio-Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Federico Banchelli
- Statistics Unit, Department of Diagnostics, 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, 71, 41124, Modena, Italy
| | - Claudio Khabbazè
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, PD, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio-Emilia, Via del Pozzo, 71, 41124, Modena, Italy
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Leelasestaporn C, Tarnpichprasert T, Arirachakaran A, Kongtharvonskul J. Comparison of 1-year outcomes between MAKO versus NAVIO robot-assisted medial UKA: nonrandomized, prospective, comparative study. Knee Surg Relat Res 2020; 32:13. [PMID: 32660619 PMCID: PMC7219215 DOI: 10.1186/s43019-020-00030-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background We have conducted a prospective cohort study with the aim of comparing operative time, intraoperative blood loss, and radiologic and clinical outcomes between imageless (NAVIO) and image-based (MAKO) robot-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis (OA) of the knee. Methods A total of 33 patients with medial compartment OA of the knee were prospectively allocated on alternate operative days of their surgery to MAKO (16 patients) or NAVIO (17 patients) robot-assisted UKA. The primary outcome (Knee Society Score [KSS] and Knee Functional Score [KFS]) and the secondary outcomes (intraoperative time of seven steps [registration of hip and ankle, femur and tibia, ligament tension, implant planning, preparation femur, tibia and trial implant], component alignment [coronal and sagittal of femur, tibia implant], blood loss, complications, and revision at 1 year after surgery) were compared between two groups. Statistical significance was set at P < 0.05. Results Mean KSS measured at baseline and 1 year were, respectively, 70.3 (5.6) and 96.9 (5.7) in the NAVIO group and 72.3 (4.5) and 94.7 (10.01) in the MAKO group. Mean KFS measured at baseline and 1 year were, respectively, 95.5 (7.9) and 99.9 (0.25) in the NAVIO group and 67.3 (7.8) and 99.5 (1.2) in the MAKO group. There were no significant differences for KFS and KSS outcomes (P = 0.203 and P = 0.457, respectively) between the NAVIO and MAKO groups. Mean operative time and blood loss in the NAVIO versus MAKO robot-assisted UKA groups were 98 min versus 82.5 min and 136.3 ml versus 80 ml, respectively, and these differences were statistically significant. In the MAKO group, the intraoperative time was statistically significantly shorter in registration of hip and ankle center, femur and tibia, femur preparation, and trial implantation compared with the NAVIO group. There were no significant differences of component alignment and radiologic alignment at 1 year between the two groups. No perioperative or delayed complications (infection, periprosthetic fracture, thromboembolism, and compromised wound healing) and revisions were reported in either group. Conclusions This study demonstrated that two robotic systems showed no difference in clinical outcomes at 1 year and radiologic alignment of implants, whereas operative time and intraoperative blood loss were found to be less in MAKO robot-assisted UKA. Trial registration ClinicalTrials.gov, NCT03954912. Registered on 17 May 2019. Level of evidence II
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Affiliation(s)
| | | | | | - Jatupon Kongtharvonskul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. .,Orthopedic Department, Payathai 3 Hospital, Bangkok, Thailand.
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Kleeblad LJ, Strickland SM, Nwachukwu BU, Kerkhoffs GMMJ, Pearle AD. Satisfaction with return to sports after unicompartmental knee arthroplasty and what type of sports are patients doing. Knee 2020; 27:509-517. [PMID: 31926669 DOI: 10.1016/j.knee.2019.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 10/14/2019] [Accepted: 11/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The present study provides insight into patient satisfaction with return to sports after unicompartmental knee arthroplasty (UKA) and to what type of activities patients return. This is important because indications for UKA have expanded and younger and more active patients undergo surgery currently. METHODS Patients who received a UKA were contacted between 12 and 24 months' post-surgery, receiving a questionnaire to evaluate postoperative satisfaction with return to sports, level of return, type of activities performed pre- and postoperatively, and (activity) outcome scores (NRS, UCLA, HAAS). Descriptive statistical analysis focused on the influence of patients' sex and age, and a regression model was fitted to assess the predictors for high satisfaction postoperatively. RESULTS One hundred and sixty-four patients (179 UKAs) with a mean age of 62.3 years responded at an average follow-up of 20.2 months. Preoperatively, 132 patients (81%) participated in sports, which increased to 147 patients (90%) after UKA. Analyzing outcomes for each knee individually, satisfaction with return to sports was recorded in 83% (149/179). Return to a higher or similar level was reported in 85.4% of the cases (117/137). Most common sports after UKA were cycling (45%), swimming (38%), and stationary cycling (27%). Overall, 93.9% of patients were able to return to low impact sports, 63.9% to intermediate and 32.7% to high impact sports. Regarding activity scores, preoperative NRS score improved from 6.40 ± 2.10 to 1.33 ± 1.73 postoperatively (p < .001). The mean preoperative UCLA score improved from 5.93 ± 2.19 to 6.78 ± 1.92 (p < .001) and HAAS score from 9.13 ± 3.55 to 11.08 ± 2.83 postoperatively (p < .001). Regression analyses showed that male sex, preoperative UCLA score and sports participation predicted high activity scores postoperatively. CONCLUSION The vast majority of patients undergoing medial UKA returned to sports postoperatively, of which over 80% was satisfied with their restoration of sports ability. Male patients, patients aged ≥70, and patients who participated in low-impact sports preoperatively achieved the highest satisfaction rates. Regarding type of sports, male patients and patients aged ≤55 were most likely to return to high and intermediate impact sports. This study may offer valuable information to help manage patients' expectations regarding their ability to return to sports based on demographics and type of preoperative sporting activities. LEVEL OF EVIDENCE Case series; Level of evidence IV.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America.
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States of America
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Expanding Robotic Arm-Assisted Knee Surgery: The First Attempt to Use the System for Knee Revision Arthroplasty. Case Rep Orthop 2020; 2020:4806987. [PMID: 32099707 PMCID: PMC7037895 DOI: 10.1155/2020/4806987] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/03/2020] [Indexed: 11/17/2022] Open
Abstract
Robotic arm-assisted arthroplasty was introduced in 2006 and has expanded its applications into unicompartmental knee, total knee, and total hip replacement. The first case of a revision surgery from conventional unicompartmental to total knee arthroplasty with the utilization of the robotic arm-assisted MAKO system is presented. An 87-year-old female presented with deteriorating left knee pain due to failure of medial unicompartmental knee arthroplasty at the outpatient clinic. The patient was advised to undergo revision surgery. Through medial parapatellar arthrotomy, the joint was exposed. With the use of the MAKO system, the estimated depth of the medial plateau according to CT planning was found to be 10 mm more distal than the lateral. The resection line of the remaining plateau was placed deliberately 2 mm more distal in order to achieve satisfactory replacement of the bony gap of the medial tibial condyle by a 10 mm augment. The patient had an uneventful recovery. A plethora of additional applications in the future, such as total shoulder or reverse total shoulder arthroplasty, megaprosthesis placement in oncological patients, and total hip or knee revision surgeries, may improve patient-related outcomes.
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Robinson PG, Clement ND, Hamilton D, Blyth MJG, Haddad FS, Patton JT. A systematic review of robotic-assisted unicompartmental knee arthroplasty: prosthesis design and type should be reported. Bone Joint J 2019; 101-B:838-847. [PMID: 31256672 DOI: 10.1302/0301-620x.101b7.bjj-2018-1317.r1] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. MATERIALS AND METHODS A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "knee", and "surgery". The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies. RESULTS A total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001). CONCLUSION There is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838-847.
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Affiliation(s)
| | - N D Clement
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - D Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - M J G Blyth
- Glasgow Royal Infirmary Orthopaedic Research Unit, Glasgow, UK
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
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Robotic-assisted unicompartmental knee replacement offers no early advantage over conventional unicompartmental knee replacement. Knee Surg Sports Traumatol Arthrosc 2019; 27:2303-2308. [PMID: 30747237 DOI: 10.1007/s00167-019-05386-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/28/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) is effective for treating degenerative joint disease in a single compartment. Robotic-arm-assisted arthroplasty (RAA) has gained popularity and has theoretical benefits of improved outcomes over conventional (CONV) UKA due to the technical precision of bone preparation. This study compares the short-term clinical outcomes, including survivorship and patient-reported functional outcomes, for a series of medial UKAs performed with RAA and CONV. METHODS One hundred seventy-six consecutive fixed-bearing medial UKAs were retrospectively identified with a minimum follow-up of 2 years. One hundred and eighteen CONV and 58 RAA were performed. Pre- and post-operative SF12, WOMAC, and KSS Functional Questionnaires were available for all patients. RESULTS At 2 years, both groups improved in all functional outcomes, with no significant difference between the RAA and CONV cohorts. However, the RAA cohort had a significantly longer operative time (p < 0.001) and a higher early revision rate than the CONV group (7 [12.0%] vs. 7 [6.8%]; p < 0.05). CONCLUSIONS These results demonstrate that at short-term follow-up of 2 years, RAA was not superior to CONV in terms of functional scores and instead was associated with greater operative time and cost and lower survivorship. Therefore, at this time usage of RAA in UKA is not recommended compared to conventional UKA. Longer term studies are necessary to draw conclusions about the overall outcomes of RAA compared to CONV. LEVEL OF EVIDENCE III.
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Lonner JH, Kerr GJ. Low rate of iatrogenic complications during unicompartmental knee arthroplasty with two semiautonomous robotic systems. Knee 2019; 26:745-749. [PMID: 30902518 DOI: 10.1016/j.knee.2019.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/02/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intraoperative complications due to utilization of robotic assistance during unicompartmental knee arthroplasty have not been reported. While inadvertent soft tissue injury has been reported during total knee and hip arthroplasty with autonomous style robotic systems, the incidence of these problems with semiautonomous (i.e. surgeon-driven) systems is unknown. METHODS We report on a series of 1064 consecutive unicompartmental knee arthroplasties performed by one surgeon with either one of two commercially available semiautonomous robotic systems. RESULTS There were no soft tissue, bone injuries or other complications related to the use of the robotic bone preparation method. Six complications related to the use of standard computer navigation pins occurred (0.6%) - one pseudoaneurysm of a branch of the tibialis anterior artery, one tibial metaphyseal stress fracture, and four areas of pin site irritation/superficial infection that resolved with a short course of oral antibiotics. CONCLUSION Current semiautonomous robotic methods are safe, with few complications using meticulous surgical techniques.
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Affiliation(s)
- Jess H Lonner
- Rothman Orthopaedic Institute, Sidney Kimmel Medical College at Thomas Jefferson University, 925 Chestnut St., Philadelphia, PA 19107, United States of America.
| | - Glenn J Kerr
- OrthoVirginia, St. Francis Medical Center, Bon Secours, 13710 St. Francis Blvd, Midlothian, VA 23114, United States of America
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Zambianchi F, Franceschi G, Rivi E, Banchelli F, Marcovigi A, Nardacchione R, Ensini A, Catani F. Does component placement affect short-term clinical outcome in robotic-arm assisted unicompartmental knee arthroplasty? Bone Joint J 2019; 101-B:435-442. [DOI: 10.1302/0301-620x.101b4.bjj-2018-0753.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA). Patients and Methods Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded. Results Following exclusions and losses to follow-up, 334 medial robotic-arm assisted UKAs were assessed at a mean follow-up of 30.0 months (8.0 to 54.9). None of the measured parameters were associated with overall KOOS outcome. Correlations were described between specific KOOS subscales and intraoperative, post-implantation robotic data, and between FJS-12 and femoral component sagittal alignment. Three UKAs were revised, resulting in 99.0% survival at two years (95% confidence interval (CI) 97.9 to 100.0). Conclusion Although little correlation was found between intraoperative robotic data and overall clinical outcome, surgeons should consider information regarding 3D component placement and soft-tissue balancing to improve patient satisfaction. Reproducible and precise placement of components has been confirmed as essential for satisfactory clinical outcome. Cite this article: Bone Joint J 2019;101-B:435–442.
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Affiliation(s)
- F. Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - G. Franceschi
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, Italy
| | - E. Rivi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - F. Banchelli
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio-Emilia, Modena, Italy
| | - A. Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - R. Nardacchione
- Department of Knee Surgery, Policlinico Abano Terme, Abano Terme, Italy
| | - A. Ensini
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - F. Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1232-1240. [PMID: 30066017 DOI: 10.1007/s00167-018-5081-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this case-control study was to compare implant position and revision rate for UKA, performed with either a robotic-assisted system or with conventional technique. METHODS Eighty UKA (57 medial, 23 lateral) were performed with robotic assistance (BlueBelt Navio system) between 2013 and 2017. These patients were matched with 80 patients undergoing UKA using the same prosthesis, implanted using conventional technique. The sagittal and coronal component position was assessed on postoperative radiographs. The revision rate was reported at last follow-up. RESULTS The mean follow-up was 19.7 months ± 9 for the robotic-assisted group, and 24.2 months ± 16 for the control group. The rate of postoperative limb alignment outliers (± 2°) was significantly higher in the control group than in the robotic-assisted group for both lateral UKA (26% in robotic group versus 61% in control group; p = 0.018) and medial UKA (16% versus 32%, resp.; p = 0.038). The coronal and sagittal tibial baseplate position had significantly less outliers (± 3°) in the robotic-assisted group, than in the control group. Revision rates were: 5% (n = 4/80) for robotic assisted UKA and 9% (n = 7/80) for conventional UKA (n.s.). The reasons for revision were different between groups, with 86% of revisions in the control group occurring in association with component malposition or limb malalignment, compared with none in the robotic-assisted group. CONCLUSION Robotic-assisted UKA has a lower rate of postoperative limb alignment outliers, as well as a lower revision rate, compared to conventional technique. The accuracy of implant positioning is improved by this robotic-assisted system. LEVEL OF EVIDENCE Level of evidence III. Retrospective case-control study CLINICAL RELEVANCE: This is the first paper comparing implant position, clinical outcome, and revision rate for UKA performed using the Navio robotic system with a control group.
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Affiliation(s)
- Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France.
| | - Nathan White
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | | | - Philippe Neyret
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
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Robotic-Assisted 3D Bio-printing for Repairing Bone and Cartilage Defects through a Minimally Invasive Approach. Sci Rep 2019; 9:3746. [PMID: 30842477 PMCID: PMC6403301 DOI: 10.1038/s41598-019-38972-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/11/2019] [Indexed: 01/09/2023] Open
Abstract
There is an unmet need for new techniques and methods of healing critical size tissue defects, by further reduction of invasiveness in implant, cell and tissue-based surgery. This paper presents the development of a new regenerative medicine that combines 3D bio-printing and robotic-assisted minimally invasive surgery techniques to meet this need. We investigated the feasibility of Remote Centre of Motion (RCM) and viscous material extrusion 3D printing. A hypothetical, intra-articular, regenerative medicine-based treatment technique for focal cartilage defects of the knee was used as a potential example of the application of 3D printing in vivo. The results of this study suggest, that RCM mechanism is feasible with viscous material extrusion 3D printing processes, without a major trade-off in imprint quality. The achieved printing accuracy at an average dimensional error of 0.06 ± 0.14 mm in this new modality of 3D printing is comparable to those described in literature for other types of bio-printing. Robotic assisted 3D bio-printing demonstrated here is a viable option for focal cartilage defect restoration.
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[Digitalization and artificial intelligence in orthopedics and traumatology]. DER ORTHOPADE 2018; 47:1039-1054. [PMID: 30298333 DOI: 10.1007/s00132-018-3642-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In the course of digitalization it is becoming increasingly rare for medical documents to be handwritten. As a result, digitalization has already become an integral part of routine patient care but in contrast to other specialist disciplines, such as radiology or laboratory medicine, orthopedics and trauma surgery are still at the beginning of new technologies. Artificial intelligence is not only used in the form of surgical robots in joint surgery or in the design of individualized implants but also provides valuable decision-making aids through appropriate algorithms for diagnosis and treatment. It can be assumed that these technologies will be further developed and used increasingly more in the coming years. Typical examples are intuitively operable and autonomously working programs and systems that support the networking and work of medical personnel and make processes inside and outside inpatient care more precise and less vulnerable to disturbances.
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Deese JM, Gratto-Cox G, Carter DA, Sasser TM, Brown KL. Patient reported and clinical outcomes of robotic-arm assisted unicondylar knee arthroplasty: Minimum two year follow-up. J Orthop 2018; 15:847-853. [PMID: 30140132 DOI: 10.1016/j.jor.2018.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background Unicompartmental knee arthroplasty (UKA) originated in the 1950's. There have been many enhancements to the implants and the technique, improving the precision and accuracy of this challenging operation. Specifically for Robotic Arm Interactive Orthopedic System (Rio; Mako Stryker, Fort Lauderdale, FL), there are many studies reporting clinical outcomes, but our search offered nothing regarding patient reported outcomes using validated surveys. Methods Patients with onlay tibial components presenting for routine follow-up of robotic-arm assisted UKA performed between May 2009 and September 2013 were invited to participate. Four joints had simultaneous patella femoral resurfacing. Knee Injury and Osteoarthritis Outcomes Score (KOOS) and the 2011 Knee Society Scores were collected. Radiographic evidence of osteoarthritis in the non-operative knee compartments was documented. Results Eighty-one patients presented for follow-up and consented to participate. Mean follow up was 54 months. Mean patient reported KOOS activities of daily living and pain scores were each 90. Knee Society 2011 mean objective score was 96 and mean function score 81. There was one revision to total knee at 40 months post-op for pain after injury. Seventy-seven percent reported their knee always felt "Normal", 20% sometimes, and only 3% reported that it never felt normal. Conclusion Literature on UKA failure rates suggests that UKA may be a less forgiving procedure than total knee arthroplasty. Robotic-arm assisted surgery is reported to improve the accuracy of implant placement. Based on our prospectively collected positive patient outcomes, the authors have achieved good results from performing robotic-arm assisted UKA on select patients.
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Affiliation(s)
- J Melvin Deese
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Gwen Gratto-Cox
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Denny A Carter
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Thomas M Sasser
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
| | - Karah L Brown
- Summit Sports Medicine and Orthopaedic Surgery, 3025 Shrine Road Suite 390, Brunswick, GA, 31520, USA
- Southeast Georgia Health System, 2415 Parkwood Drive, Brunswick, GA, 31520, USA
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Parsley BS. Robotics in Orthopedics: A Brave New World. J Arthroplasty 2018; 33:2355-2357. [PMID: 29605151 DOI: 10.1016/j.arth.2018.02.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/08/2018] [Indexed: 02/01/2023] Open
Abstract
Future health-care projection projects a significant growth in population by 2020. Health care has seen an exponential growth in technology to address the growing population with the decreasing number of physicians and health-care workers. Robotics in health care has been introduced to address this growing need. Early adoption of robotics was limited because of the limited application of the technology, the cumbersome nature of the equipment, and technical complications. A continued improvement in efficacy, adaptability, and cost reduction has stimulated increased interest in robotic-assisted surgery. The evolution in orthopedic surgery has allowed for advanced surgical planning, precision robotic machining of bone, improved implant-bone contact, optimization of implant placement, and optimization of the mechanical alignment. The potential benefits of robotic surgery include improved surgical work flow, improvements in efficacy and reduction in surgical time. Robotic-assisted surgery will continue to evolve in the orthopedic field.
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Affiliation(s)
- Brian S Parsley
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Bellaire, TX
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Robotic-Assisted Unicompartmental Knee Arthroplasty: State-of-the Art and Review of the Literature. J Arthroplasty 2018; 33:1994-2001. [PMID: 29555499 DOI: 10.1016/j.arth.2018.01.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty is a successful treatment for unicompartmental knee osteoarthritis that has lower complication rates, faster recovery, and a more natural feeling knee compared to total knee arthroplasty. However, long-term survival has been a persistent concern. As more surgeon-controlled variables have been linked to survival, interest in robotic-assisted surgery has continued to grow. METHODS A review and synthesis of the literature on the subject of robotic-assisted unicompartmental knee arthroplasty was performed. RESULTS We present the driving factors behind the development of robotic-assisted techniques in unicompartmental knee arthroplasty and the current state-of-the art. The ability of surgeons to achieve intraoperative targets with robotic assistance and the outcomes of robotic-assisted surgery are also described. CONCLUSION Robotic-assisted surgery has become increasingly popular in unicompartmental knee arthroplasty, as it allows surgeons to more accurately and reproducibly plan and achieve operative targets during surgery. Cost remains a concern, and it remains to be seen whether robotic-assisted surgery will improve long-term survivorship after unicompartmental knee arthroplasty.
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Kouk S, Kalbian I, Wolfe E, Strickland SM. Robot-Assisted Medial Compartment Arthroplasty Following Remote Patellectomy: A Case Report. J Orthop Case Rep 2018; 8:11-14. [PMID: 29854684 PMCID: PMC5974668 DOI: 10.13107/jocr.2250-0685.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Total patellectomies are uncommon procedures that are reserved as salvage treatment for severely comminuted fractures of the patella. Due to the alteration of normal joint mechanics, these patients present later on in life with degenerative cartilage damage to the femorotibial joint and altered extensor mechanism. There are very few reports of unicondylar knee arthroplasties following previous patellectomy and none that specifically address robot-assisted unicompartmental knee arthroplasty. A recent case report by Pang et al. described the use of minimally invasive fixed-bearing unicondylar knee arthroplasty in a patellectomized patient with moderate medial compartment osteoarthritis. Our report details a case with more significant chondral loss along with patellar tendon subluxation. Case Report This is a case report of a patient with severe medial compartment osteoarthritis after a patellectomy following a motor vehicle collision. After failing conservative treatment, the patient underwent a medial MAKOplasty with complete resolution of arthritic pain. Conclusion Significant pain relief and improved knee function can be achieved with MAKOPlasty partial knee resurfacing system in a previously patellectomized patient with severe medial compartment osteoarthritis.
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Affiliation(s)
- Shalen Kouk
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA
| | - Irene Kalbian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Elizabeth Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Sabrina M Strickland
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, USA
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Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Midterm Survivorship and Patient Satisfaction of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2018; 33:1719-1726. [PMID: 29486909 DOI: 10.1016/j.arth.2018.01.036] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/02/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies have showed improved accuracy of lower leg alignment, precise component position, and soft-tissue balance with robotic-assisted unicompartmental knee arthroplasty (UKA). No studies, however, have assessed the effect on midterm survivorship. Therefore, the purpose of this prospective, multicenter study was to determine midtem survivorship, modes of failure, and satisfaction of robotic-assisted medial UKA. METHODS A total of 473 consecutive patients (528 knees) underwent robotic-arm-assisted medial UKA surgery at 4 separate institutions between March 2009 and December 2011. All patients received a fixed-bearing, metal-backed onlay tibial component. Each patient was contacted at minimum 5-year follow-up and asked a series of questions to determine survival and satisfaction. Kaplan-Meier method was used to determine survivorship. RESULTS Data were collected for 384 patients (432 knees) with a mean follow-up of 5.7 years (5.0-7.7). The follow-up rate was 81.2%. In total, 13 revisions were performed, of which 11 knees were converted to total knee arthroplasty and in 2 cases 1 UKA component was revised, resulting in 97% survivorship. The mean time to revision was 2.27 years. The most common failure mode was aseptic loosening (7/13). Fourteen reoperations were reported. Of all unrevised patients, 91% was either very satisfied or satisfied with their knee function. CONCLUSION Robotic-arm-assisted medial UKA showed high survivorship and satisfaction at midterm follow-up in this prospective, multicenter study. However, in spite of the robotic technique, early fixation failure remains the primary cause for revision with cemented implants. Comparative studies are necessary to confirm these findings and compare to conventional implanted UKA and total knee arthroplasty.
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Affiliation(s)
- Laura J Kleeblad
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
| | - Todd A Borus
- Department of Orthopaedic Surgery, Rebound Orthopedics & Neurosurgery, Portland, OR
| | - Thomas M Coon
- Department of Orthopaedic Surgery, Coon Joint Replacement Institute, St. Helena, CA
| | - Jon Dounchis
- Department of Orthopaedic Surgery, NCH Orthopedics, Naples, FL
| | - Joseph T Nguyen
- Biostatistics Core, Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY
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