Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 2019;8:327-336. [DOI: 10.2217/cer-2018-0136] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open

For:	Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 2019;8:327-336. [DOI: 10.2217/cer-2018-0136] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open

Number

Cited by Other Article(s)

Ziedas AC, Michaelson J, Knesek D, Laker M, Frush T, Markel DC. Cemented and Cementless Robotic-Assisted versus Manual Total Knee Arthroplasty Outcomes: A Single Center Michigan Arthroplasty Registry Collaborative Quality Initiative-Based Study. J Arthroplasty 2025:S0883-5403(25)00380-8. [PMID: 40280209 DOI: 10.1016/j.arth.2025.04.043] [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: 12/04/2024] [Revised: 04/14/2025] [Accepted: 04/15/2025] [Indexed: 04/29/2025] Open

Abstract

BACKGROUND

The purpose of our study was to determine whether a difference existed between cemented and cementless robotic-assisted total knee arthroplasty (RA-TKA) and manual TKA with regard to revision rates and 90-day outcomes. We hypothesized these techniques would have similar results.

METHODS

A single center's data from the Michigan Arthroplasty Registry Collaborative Quality Initiative were queried for all primary TKAs from January 2012 to July 2023. The RA-TKA and manual cohorts were compared for revisions and 90-day complications, including emergency department (ED) visits, readmissions, and returns to the operating room Chi-square and Fisher's exact tests were used for categorical data, and t-tests for continuous data. Of the 7,417 cemented TKAs (mean age 67 ± 9.6 years, 70% women), 273 were RA-TKA and 7,144 were manual. Of the 2,407 cementless TKAs (mean age 65 ± 8.6 years, 53% women), 730 were RA-TKA and 1,677 were manual.

RESULTS

Cemented RA-TKA had more periprosthetic joint infection revisions, more 90-day ED visits, and readmissions for wound complications compared to cemented manual TKA. Cementless RA-TKA had more 90-day readmissions for wound complications, while manual TKA had more 90-day ED visits for postoperative pain. Cemented and cementless RA-TKA had longer surgical time, shorter length of stay, and shorter time to revision. There were 283 revisions performed on cemented manual TKA (nine RA-TKAs, 3.2%, 274 manual, 3.8%, (P = 0.87)). There were 56 revisions performed on cementless knees (13 RA-TKAs, 1.7%, 43 manual 2.5% (P = 0.303)). Cumulative percent revision at 5 years was 3.9% for cemented RA-TKA, 3.5% for cemented manual TKA, 1.8% for cementless RA-TKA, and 2.8% for cementless manual TKA.

CONCLUSIONS

Both RA-TKA and manual TKA have similar revision rates, while RA-TKA had more wound complications. Cementless RA-TKA may be beneficial in reducing postoperative pain.

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Mulpur P, Jayakumar T, Kikkuri RR, Annapareddy A, Hippalgaonkar K, Reddy AVG. Trends in adoption of robotics in arthroplasty: an analysis of the Indian landscape. J Robot Surg 2025;19:62. [PMID: 39915360 DOI: 10.1007/s11701-025-02224-5] [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: 12/25/2024] [Accepted: 01/25/2025] [Indexed: 05/07/2025]

Abstract

Robotic-assisted technology in total joint arthroplasty (TJA) offers improved precision in component placement and alignment, addressing challenges, such as ligament imbalance, malalignment, and patient dissatisfaction. In India, where diverse healthcare settings exist, trends in robotic adoption remain underexplored. This study examines the adoption patterns and geographic distribution of robotic systems for TJA in India, highlighting market dynamics over the past 5 years. A cross-sectional observational study was conducted using data from manufacturers of robotic arthroplasty systems. Annual installations, tier-wise city classifications, and geographic distributions were analyzed. Statistical methods included descriptive analysis for installation trends, time-series visualization for adoption trajectories, and linear regression to forecast 2025 installations. As of September 2024, 290 robotic systems were installed across India. Among these, the CUVIS system (Meril) accounted for 89 installations (30.7%), followed by CORI (Smith and Nephew) with 66 installations (22.8%), and VELYS (DePuy) with 52 installations (17.9%). The MAKO system (Stryker) contributed 38 installations (13.1%), while MISSO (Meril) and ROSA (Zimmer) had 25 (8.6%) and 20 (6.9%) installations, respectively. Tier I hospitals dominated with 50% of installations, while Tier III and IV facilities accounted for only 10%. Linear regression predicts steady growth, with over 80 new robotic installations in 2025. Robotic technology adoption in Indian TJA has surged, with a strong preference for systems offering precision and versatility. However, barriers such as high costs and limited training impede penetration in lower tier facilities. Addressing these challenges could enhance equitable access and support the integration of robotics into diverse healthcare settings.

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Eijking HM, Dorling IM, van Haaren EH, Hendrickx R, Nijenhuis T, Schotanus MGM, Bouwman L, Most J, Boonen B. Image-based robotic (ROSA^® knee system) total knee arthroplasty with inverse kinematic alignment compared to conventional total knee arthroplasty : Study protocol and the inverse kinematic alignment in 8-steps using the ROSA^® Knee system for knee balancing technique explained. J Orthop Surg Res 2025;20:47. [PMID: 39815282 PMCID: PMC11734351 DOI: 10.1186/s13018-024-05427-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 12/26/2024] [Indexed: 01/18/2025] Open

Abstract

INTRODUCTION

In 2020, 368 million people globally were affected by knee osteoarthritis, and prevalence is projected to increase with 74% by 2050. Relatively high rates of dissatisfactory results after total knee arthroplasty (TKA), as reported by approximately 20% of patients, may be caused by sub-optimal knee alignment and balancing. While mechanical alignment has traditionally been the goal, patient-specific alignment strategies are gaining interest. Robotic assistance could potentially facilitate implementation of these alignment strategies through data-based surgical planning, accurate execution of the surgical plan and validation. The clinical value of surgical assistance in diverging from mechanical alignment remains to be investigated. In the present study, robotic-assisted TKA will be performed to pursue inverse kinematic alignment (iKA) within predefined boundaries, focusing on restoring native tibia joint line.

METHODS

This randomized controlled trial evaluates clinical effectiveness of robotic-assisted TKA (ROSA® Knee System, Zimmer Biomet, Montreal, Quebec, Canada) aiming for iKA compared to conventional TKA aiming for mechanical alignment. A total of 150 participants will be randomized (1:1) to either treatment to provide an 80% power for a 4.8-point clinically important difference in the primary outcome measure, the Oxford Knee Score (OKS) 12 months after surgery. Allocation was achieved using computer-based randomization. Outcomes will be analyzed using linear mixed models with time and group as main factors and interaction-term. Secondary outcomes include clinical metrics (leg alignment, implant and patient survival), surgical parameters (adverse events, surgery duration, blood loss, hospital stay length, medication use), patient-reported outcomes (symptoms, quality of life, pain), mobility and physical activity measurements, metabolic syndrome, cost-efficacy, and gait and continuous glucose monitoring.

ETHICS AND DISSEMINATION

This study has been approved by the Medical Ethical Committee Zuyd and Zuyderland Medical Centre (NL79161.096.21/METCZ20220006), September 2022.

TRIAL REGISTRATION NUMBER

NCT05685693 (clinicaltrials.gov).

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Affiliation(s)

Henriëtte M Eijking Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands Department Clinical Engineering, Faculty of Science and Engineering, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
Isobel M Dorling Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands Department Orthopedic Surgery, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
Emil H van Haaren Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
Roel Hendrickx Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
Thijs Nijenhuis Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
Martijn G M Schotanus Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands Department Orthopedic Surgery, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
Lee Bouwman Department Clinical Engineering, Faculty of Science and Engineering, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
Jasper Most Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands Department Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
Bert Boonen Excellence Center for Hip & Knee Arthroplasty, Department of Orthopedic Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.

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Howell CC, Witvoet S, Scholl L, Coppolecchia A, Bhowmik-Stoker M, Chen AF. Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score-Matched Patient Cohorts. J Am Acad Orthop Surg 2025;33:83-91. [PMID: 39029449 DOI: 10.5435/jaaos-d-23-01117] [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] [Received: 12/07/2023] [Accepted: 05/22/2024] [Indexed: 07/21/2024] Open

Abstract

INTRODUCTION

There is a paucity of research comparing postoperative complication rates between manual total knee arthroplasty (M-TKA) and robotic-assisted total knee arthroplasty (RA-TKA). This study aims to compare 90-day postoperative complication, readmission, and emergency department rates between RA-TKA and M-TKA.

METHODS

A retrospective review of a multihospital database identified patients who underwent TKA between January 2016 and May 2023. Surgeons who used the robotic-assisted surgery technique in <10% or >90% of their cases annually were excluded. This resulted in 15,999 cases (8,853 RA-TKAs; 7,146 M-TKAs) from 282 surgeons. RA-TKA and M-TKA cohorts were one-to-one matched based on patient sex, age, body mass index, hospital setting, surgeon experience, primary payer, and anesthesia type. Each cohort consisted of 7,146 patients (N = 14,292). 90-day revisits, specifically readmissions, readmissions with >23 hours of observation, and ED visit rates were compared between cohorts. Complications were classified according to the Clinical Classification Software schema and compared between cohorts. Mann-Whitney U, chi-squared, and Fisher exact tests, along with Bonferroni correction, were used to statistically compare cohorts.

RESULTS

All-cause 90-day readmission rates were 2.4% for RA-TKA and 2.6% for M-TKA ( P = 0.36). RA-TKA had fewer revisits (RA-TKA: 7.8%; M-TKA: 8.8%, P = 0.027) and rates of readmission with >23 hours of observation (RA-TKA: 1.4%; M-TKA: 2.0%, P = 0.003). RA-TKA had fewer hospital revisits due to joint stiffness (RA-TKA: 17 revisits; M-TKA: 42 revisits, P = 0.002) and chronic pain (RA-TKA: 1 revisit; M-TKA: 8 revisits, P = 0.039). Fewer readmissions were observed for acute injuries (lower extremity muscle/tendon strains) in the RA-TKA cohort (RA-TKA: 1; M-TKA: 9, P = 0.021). RA-TKA had fewer ED visits due to hematomas (RA-TKA: 0 visits; M-TKA: 7 visits, P = 0.016).

CONCLUSION

In this retrospective matched cohort analysis, RA-TKA was associated with markedly fewer revisits and readmissions with >23 hours of observation compared with M-TKA. No differences in all-cause 90-day readmission were observed between cohorts.

LEVEL OF EVIDENCE

Level III.

STUDY DESIGN

Retrospective review.

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Maman D, Laver L, Becker R, Mahamid A, Berkovich Y. Robotic-assisted total knee arthroplasty reduces postoperative complications and length of stay without increased cost compared to navigation-guided techniques: A national analysis. Knee Surg Sports Traumatol Arthrosc 2025;33:336-342. [PMID: 38953206 PMCID: PMC11716347 DOI: 10.1002/ksa.12348] [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: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/03/2024]

Norton J, Sambandam S, Mounasamy V, Weinschenk RC. Robotic arm-assisted versus conventional total knee arthroplasty: comparing complications, costs, and postoperative opioid use in propensity-matched cohorts. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024;34:3917-3929. [PMID: 39237651 DOI: 10.1007/s00590-024-04077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 08/18/2024] [Indexed: 09/07/2024]

Maman D, Laver L, Becker R, Takrori LA, Mahamid A, Finkel B, Gan‐Or H, Yonai Y, Berkovich Y. Trends and epidemiology in robotic-assisted total knee arthroplasty: Reduced complications and shorter hospital stays. Knee Surg Sports Traumatol Arthrosc 2024;32:3281-3288. [PMID: 39016343 PMCID: PMC11605021 DOI: 10.1002/ksa.12353] [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: 05/22/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024]

Abstract

INTRODUCTION

This study provides an in-depth analysis of the immediate postoperative outcomes and implications or robotic-assisted total knee arthroplasty (RA-TKA) compared with conventional TKA (C-TKA), particularly with regard to mortality, complications, hospital stay and costs, drawing from a comprehensive nationwide data set.

METHODS

The Nationwide Inpatient Sample (NIS) database, the largest all-payer inpatient healthcare database in the United States, was used to identify all patients who underwent RA-TKA or C-TKA from 2016 to 2019. A total of 527,376 cases, representing 2,638,679 patients who underwent elective TKA were identified, of which 88,415 had RA-TKA. To mitigate potential variations and selection bias in baseline characteristics between the two groups, a propensity score-matched analysis was employed to further balance and refine our data set, resulting in 176,830 patients evenly distributed between the groups. Analysis was performed according to demographics, immediate post-operative complications, and economic data, including payor class, length of stay and total charges.

RESULTS

There was a marked shift towards RA-TKA, from an initial 0.70% in 2016 to a notable 7.30% by 2019. Patients who underwent RA-TKA were slightly younger (66.2 ± SD years), compared to the C-TKA group (66.7 ± SD years). Hospital stay was 1.89 days and 2.29 days for RA-TKA and C-TKA, respectively. Charges metrics revealed slightly higher charges for RA-TKA. Less postoperative complications were found in the RA-TKA group, such as blood loss, anaemia, acute kidney injury, venous thromboembolism, pulmonary embolism, pneumonia and surgical wound complication. Even following the propensity score matching, these findings remained consistent and statistically significant.

CONCLUSIONS

RA-TKA use in the United States has grown substantially in the last few years and has been associated with significantly reduced immediate post-operative complications and length of hospital stay compared to C-TKA, offering safer surgical management for TKA patients. Further studies on the short- and long-term outcomes of RA-TKA would improve the understanding of the full potential of this technology.

LEVELS OF EVIDENCE

Level III.

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Alrayes MM, Sukeik M. Robotics in total knee replacement: Current use and future implications. World J Orthop 2024;15:489-494. [PMID: 38947269 PMCID: PMC11212528 DOI: 10.5312/wjo.v15.i6.489] [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: 01/07/2024] [Revised: 04/29/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open

Pipino G, Giai Via A, Ratano M, Spoliti M, Lanzetti RM, Oliva F. Robotic Total Knee Arthroplasty: An Update. J Pers Med 2024;14:589. [PMID: 38929810 PMCID: PMC11204817 DOI: 10.3390/jpm14060589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open

Figueroa D, Guiloff R, Prado T, Figureoa L, Sotomayor JJ, Alarcon A, Figueroa F, Vaisman A, Calvo R. Early Postoperative Results in Robotic-Arm-Assisted Total Knee Replacement versus Conventional Technique: First Latin American Experience. J Knee Surg 2024;37:391-401. [PMID: 37459892 DOI: 10.1055/a-2130-4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]

Abstract

Early results with robotic-arm-assisted total knee arthroplasty (TKA) are encouraging; nevertheless, literature might be unrepresentative, as it comes mostly from American, European, and Asian countries. There is limited experience and no comparative clinical reports in Latin America, a region of mainly low- and middle-income countries with limited access to these promising technologies. This study aims to compare the early postoperative results of the first Latin American experience with robotic-arm-assisted TKA versus conventional TKA. A cohort study was performed, including 181 consecutive patients (195 knees) with advanced symptomatic knee osteoarthritis (OA) undergoing primary TKA between March 2016 and October 2019. The cohort included 111 consecutive patients (123 knees) undergoing conventional TKA, followed by 70 consecutive patients (72 knees) undergoing robotic-arm-assisted TKA. The same surgical team (surgeon 1 and surgeon 2) performed all procedures. Patients with previous osteotomy, posttraumatic OA, and revision components were not considered. The same anesthetic and rehabilitation protocol was followed. The investigated clinical outcomes (for the first 60 postoperative days) were: surgical tourniquet time, time to home discharge, time to ambulation, postoperative daily pain (Visual Analog Scale), opioid use, range of motion, blood loss, complications, and postoperative mechanical axis. The early clinical postoperative results of this first Latin American comparative experience of robotic-arm-assisted TKA versus conventional technique showed lower opioids requirements and faster functional recovery of ambulation in those patients operated with the robotic system; nevertheless, surgical times were higher, without differences in total postoperative complications and other clinical outcomes.

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Sarrel K, Hameed D, Dubin J, Mont MA, Jacofsky DJ, Coppolecchia AB. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res 2024;13:e230040. [PMID: 38488048 PMCID: PMC11044952 DOI: 10.57264/cer-2023-0040] [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: 03/24/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open

Cornish BM, Diamond LE, Saxby DJ, Lloyd DG, Shi B, Lyon J, Abbruzzese K, Gallie P, Maharaj J. Sagittal plane knee kinematics can be measured during activities of daily living following total knee arthroplasty with two IMU. PLoS One 2024;19:e0297899. [PMID: 38359050 PMCID: PMC10868843 DOI: 10.1371/journal.pone.0297899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open

Abstract

Knee function is rarely measured objectively during functional tasks following total knee arthroplasty. Inertial measurement units (IMU) can measure knee kinematics and range of motion (ROM) during dynamic activities and offer an easy-to-use system for knee function assessment post total knee arthroplasty. However, IMU must be validated against gold standard three-dimensional optical motion capture systems (OMC) across a range of tasks if they are to see widespread uptake. We computed knee rotations and ROM from commercial IMU sensor measurements during walking, squatting, sit-to-stand, stair ascent, and stair descent in 21 patients one-year post total knee arthroplasty using two methods: direct computation using segment orientations (r_IMU), and an IMU-driven iCloud-based interactive lower limb model (m_IMU). This cross-sectional study compared computed knee angles and ROM to a gold-standard OMC and inverse kinematics method using Pearson's correlation coefficient (R) and root-mean-square-differences (RMSD). The r_IMU and m_IMU methods estimated sagittal plane knee angles with excellent correlation (>0.95) compared to OMC for walking, squatting, sit-to-stand, and stair-ascent, and very good correlation (>0.90) for stair descent. For squatting, sit-to-stand, and walking, the mean RMSD for r_IMU and m_IMU compared to OMC were <4 degrees, < 5 degrees, and <6 degrees, respectively but higher for stair ascent and descent (~12 degrees). Frontal and transverse plane knee kinematics estimated using r_IMU and m_IMU showed poor to moderate correlation compared to OMC. There were no differences in ROM measurements during squatting, sit-to-stand, and walking across the two methods. Thus, IMUs can measure sagittal plane knee angles and ROM with high accuracy for a variety of tasks and may be a useful in-clinic tool for objective assessment of knee function following total knee arthroplasty.

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Affiliation(s)

Bradley M. Cornish Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
Laura E. Diamond Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
David John Saxby Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
David G. Lloyd Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
Beichen Shi Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
Jenna Lyon Stryker Corporation, Kalamazoo, Michigan, Unites States of America
Kevin Abbruzzese Stryker Corporation, Kalamazoo, Michigan, Unites States of America
Price Gallie Coast Orthopaedics and Sports Medicine, Gold Coast, Queensland, Australia
Jayishni Maharaj Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia

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DeClaire JH, Wakelin EA, Chattinger K, Plaskos C. Modern robotics platform associated with reduced 90-day complications in hospital setting. Technol Health Care 2024;32:3713-3725. [PMID: 38073353 DOI: 10.3233/thc-231198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]

Hoeffel D, Goldstein L, Intwala D, Kaindl L, Dineen A, Patel L, Mayle R. Systematic review and meta-analysis of economic and healthcare resource utilization outcomes for robotic versus manual total knee arthroplasty. J Robot Surg 2023;17:2899-2910. [PMID: 37819597 PMCID: PMC10678833 DOI: 10.1007/s11701-023-01703-x] [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: 06/01/2023] [Accepted: 08/19/2023] [Indexed: 10/13/2023]

Dragosloveanu S, Petre MA, Capitanu BS, Dragosloveanu CDM, Cergan R, Scheau C. Initial Learning Curve for Robot-Assisted Total Knee Arthroplasty in a Dedicated Orthopedics Center. J Clin Med 2023;12:6950. [PMID: 37959414 PMCID: PMC10649181 DOI: 10.3390/jcm12216950] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023] Open

Song SJ, Park CH. Learning curve for robot-assisted knee arthroplasty; optimizing the learning curve to improve efficiency. Biomed Eng Lett 2023;13:515-521. [PMID: 37872999 PMCID: PMC10590338 DOI: 10.1007/s13534-023-00311-w] [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: 05/13/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 10/25/2023] Open

Demirtas Y, Emet A, Ayik G, Cakmak G, Aksahin E, Celebi L. A novel robot-assisted knee arthroplasty system (ROSA) and 1-year outcome: A single center experience. Medicine (Baltimore) 2023;102:e35710. [PMID: 37861507 PMCID: PMC10589563 DOI: 10.1097/md.0000000000035710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open

Zhang JJY, Chen JY, Tay DKJ, Pang HN, Yeo SJ, Liow MHL. Cost-Effectiveness of Robot-Assisted Total Knee Arthroplasty: A Markov Decision Analysis. J Arthroplasty 2023;38:1434-1437. [PMID: 36805115 DOI: 10.1016/j.arth.2023.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open

Griffin J, Davis ET, Parsons H, Gemperle Mannion E, Khatri C, Ellard DR, Blyth MJ, Clement ND, Deehan D, Flynn N, Fox J, Grant NJ, Haddad FS, Hutchinson CE, Mason J, Mohindru B, Scott CEH, Smith TO, Skinner JA, Toms AD, Rees S, Underwood M, Metcalfe A. Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial (RACER-knee): a study protocol. BMJ Open 2023;13:e068255. [PMID: 37295832 PMCID: PMC10277111 DOI: 10.1136/bmjopen-2022-068255] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open

Abstract

INTRODUCTION

Robotic-assisted knee replacement systems have been introduced to healthcare services worldwide in an effort to improve clinical outcomes for people, although high-quality evidence that they are clinically, or cost-effective remains sparse. Robotic-arm systems may improve surgical accuracy and could contribute to reduced pain, improved function and lower overall cost of total knee replacement (TKR) surgery. However, TKR with conventional instruments may be just as effective and may be quicker and cheaper. There is a need for a robust evaluation of this technology, including cost-effectiveness analyses using both within-trial and modelling approaches. This trial will compare robotic-assisted against conventional TKR to provide high-quality evidence on whether robotic-assisted knee replacement is beneficial to patients and cost-effective for healthcare systems.

METHODS AND ANALYSIS

The Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial-Knee is a multicentre, participant-assessor blinded, randomised controlled trial to evaluate the clinical and cost-effectiveness of robotic-assisted TKR compared with TKR using conventional instruments. A total of 332 participants will be randomised (1:1) to provide 90% power for a 12-point difference in the primary outcome measure; the Forgotten Joint Score at 12 months postrandomisation. Allocation concealment will be achieved using computer-based randomisation performed on the day of surgery and methods for blinding will include sham incisions for marker clusters and blinded operation notes. The primary analysis will adhere to the intention-to-treat principle. Results will be reported in line with the Consolidated Standards of Reporting Trials statement. A parallel study will collect data on the learning effects associated with robotic-arm systems.

ETHICS AND DISSEMINATION

The trial has been approved by an ethics committee for patient participation (East Midlands-Nottingham 2 Research Ethics Committee, 29 July 2020. NRES number: 20/EM/0159). All results from the study will be disseminated using peer-reviewed publications, presentations at international conferences, lay summaries and social media as appropriate.

TRIAL REGISTRATION NUMBER

ISRCTN27624068.

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Affiliation(s)

James Griffin Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Edward T Davis Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
Helen Parsons Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Elke Gemperle Mannion Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
Chetan Khatri Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
David R Ellard Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Mark J Blyth Orthopaedic Research Unit, Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
Nicholas David Clement Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK Department of Orthopaedics, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
David Deehan Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
Nicholas Flynn Portsmouth Hospitals NHS Trust, Portsmouth, UK
Josephine Fox Patient Representative, Coventry, UK
Nicholas J Grant Patient Representative, Coventry, UK
Fares S Haddad University College London Hospitals NHS Foundation Trust, London, UK
Charles E Hutchinson University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK Warwick Medical School, University of Warwick, Coventry, UK
James Mason Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
Bishal Mohindru Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
Chloe E H Scott Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
Toby O Smith Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
John A Skinner Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
Andrew D Toms Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
Sophie Rees Bristol Trials Centre, University of Bristol, Bristol, UK
Martin Underwood Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
Andrew Metcalfe Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

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Ward GH, Montalbano MJ. Postoperative scores for robot-assisted and conventional total knee arthroplasty: A meta-analysis. J Clin Orthop Trauma 2023;41:102189. [PMID: 37389103 PMCID: PMC10300356 DOI: 10.1016/j.jcot.2023.102189] [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: 08/11/2022] [Revised: 03/17/2023] [Accepted: 06/10/2023] [Indexed: 07/01/2023] Open

Barsoum W, Gregory D, Needham K, Mont M, Sodhi N, Coppolecchia A, Jacofsky D. Advantages of robotic arm-assisted total hip arthroplasty: a 90-day episode-of-care clinical utility and cost analysis. J Comp Eff Res 2023;12:e220208. [PMID: 37144744 PMCID: PMC10402783 DOI: 10.57264/cer-2022-0208] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/15/2023] [Indexed: 05/06/2023] Open

Eason T, Mihalko W, Toy PC. Robotic-Assisted Total Knee Arthroplasty is Safe in the Ambulatory Surgery Center Setting. Orthop Clin North Am 2023;54:153-159. [PMID: 36894288 DOI: 10.1016/j.ocl.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]

Abstract

BACKGROUND

Robotic-assisted total knee arthroplasty (RA-TKA) has become more popular in the United States. With the significant trend towards performing TKA in outpatient and ambulatory surgery center (ASC) settings, this study was implemented to determine the safety and efficacy of RA-TKA in an ASC.

METHOD

A retrospective review identified 172 outpatient TKAs (86 RA-TKAs and 86 TKAs) performed between January 2020 and January 2021. All surgeries were performed by the same surgeon at the same free-standing ASC. Patients were followed for at least 90 days after surgery; complications, reoperations, readmissions, operative time, and patient-reported outcomes were recorded.

RESULTS

In both groups, all patients were successfully discharged home from the ASC on the day of surgery. No differences were noted in overall complications, reoperations, hospital admissions, or delays in discharge. RA-TKA had slightly longer operative times (79 vs 75 min [p = 0.017]) and total length of stay at the ASC (468 vs 412 min [p < 0.0001]) than conventional TKA. No significant differences were noted in outcome scores at 2-, 6-, or 12-week follow-ups.

CONCLUSIONS

Our results showed that RA-TKA can be successfully implemented in an ASC, with similar outcomes compared with TKA using conventional instrumentation. Initial surgical times were increased secondary to the learning curve of implementing RA-TKA. Long-term follow-up is necessary to determine implant longevity and long-term outcomes.

METHOD

RESULTS

CONCLUSIONS

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Pannu TS, Limtong J, Villa JM, Patel PD, Higuera CA. Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes-A Single Surgeon Experience. J Knee Surg 2023;36:456-457. [PMID: 34600435 DOI: 10.1055/s-0041-1736149] [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: 02/07/2023]

Vermue H, Stroobant L, Pringels L, Chevalier A, Victor J. The Definition of the Tibial Sagittal Plane and the Paradox of Imageless Navigation and Robotics: A Cadaveric Study. J Arthroplasty 2023;38:S374-S378. [PMID: 36828051 DOI: 10.1016/j.arth.2023.02.039] [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: 10/20/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open

Abstract

BACKGROUND

The accuracy, precision, and repeatability by which the tibial sagittal plane can be found with imageless technology is currently unknown. The purpose of this study was to identify any differences between imageless and image-based technology to define the sagittal plane of the tibia.

METHODS

A computed tomography (CT) was obtained of 18 cadavers with the knee fully extended. The surgical trans-epicondylar axis and several tibial rotation references were acquired on the CT scan. After a medial parapatellar approach, the same anatomical landmarks were acquired in vivo. In the horizontal plane, the angle between the surgical trans-epicondylar axis and the tibial rotational axes was assessed.

RESULTS

Highest accuracy was found for posterior cruciate ligament (PCL)-anterior cruciate ligament (ACL, -1.48°, standard deviation [SD] 13.64; imageless), tibial medial condyle (TMC)-tibial lateral condyle (TLC, 1.72°, SD 4.24; image-based), the ACL-medial border of tibial tuberosity (MTT, -2.89°, SD 18.86; image-based). Highest precision was acquired with image-based technology: TMC-TLC (SD 4.24), PCL-ACL (SD 5.86), and PCL-medial third of tibial tuberosity (M3TT, SD 7.10). Excellent intraobserver and interobserver correlation coefficients were observed with image-based technology: PCL-MTT, anterior medial condyle (AMC)-anterior lateral condyle (ALC), and TMC-TLC (Intraobserver and interobserver correlation coefficients 0.90-0.98).

CONCLUSION

The tibial sagittal plane could be defined with highest accuracy, precision, and repeatability on a preoperative CT. Imageless methodology lacked the precision and repeatability of image-based technology. With the current pursuit of high accuracy and precision in total knee arthroplasty, the reference frame used to quantify implant position should be highly accurate and precise as well.

LEVEL OF EVIDENCE

IV, Case Series.

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Image-Free Robotic-Assisted Total Knee Arthroplasty Results in Quicker Recovery but Equivalent One-Year Outcomes Compared to Conventional Total Knee Arthroplasty. J Arthroplasty 2023;38:S232-S237. [PMID: 36801477 DOI: 10.1016/j.arth.2023.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open

Is the femoral intramedullary alignment already actual in total knee arthroplasty? J Exp Orthop 2023;10:16. [PMID: 36786874 PMCID: PMC9929006 DOI: 10.1186/s40634-022-00563-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open

Moving beyond radiographic alignment: applying the Wald Principles in the adoption of robotic total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023;47:365-373. [PMID: 35532787 PMCID: PMC9877041 DOI: 10.1007/s00264-022-05411-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 01/29/2023]

Ezeokoli EU, John J, Gupta R, Jawad A, Cavinatto L. Index surgery and ninety day re-operation cost comparison of robotic-assisted versus manual total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023;47:359-364. [PMID: 36574020 DOI: 10.1007/s00264-022-05674-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]

Trends in Computer-Assisted Surgery for Total Knee Arthroplasty in Germany: An Analysis Based on the Operative Procedure Classification System between 2010 to 2021. J Clin Med 2023;12:jcm12020549. [PMID: 36675478 PMCID: PMC9863460 DOI: 10.3390/jcm12020549] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open

Abstract

Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (-3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard.

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Meghpara MM, Goh GS, Magnuson JA, Hozack WJ, Courtney PM, Krueger CA, Krueger CA. The Ability of Robot-Assisted Total Knee Arthroplasty in Matching the Efficiency of Its Conventional Counterpart at an Orthopaedic Specialty Hospital. J Arthroplasty 2023;38:72-77.e3. [PMID: 35940350 DOI: 10.1016/j.arth.2022.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open

Samuel LT, Karnuta JM, Banerjee A, Briskin I, Cantrell WA, George JW, Higuera-Rueda CA, Kamath AF, Khlopas A, Klika A, Krebs VE, Mesko NW, Mont MA, Murray TG, Piuzzi NS, Shah P, Stearns K, Sultan AA, Molloy RM. Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis. J Knee Surg 2023;36:105-114. [PMID: 34187067 DOI: 10.1055/s-0041-1731323] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal-Wallis, Pearson's Chi-squared, and Fisher's exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p < 0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0-13.0] vs. 11.5 [9.5-15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p < 0.001) and higher proportion of home discharges (p < 0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.

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Hickey MD, Masri BA, Hodgson AJ. Can Technology Assistance be Cost Effective in TKA? A Simulation-Based Analysis of a Risk-prioritized, Practice-specific Framework. Clin Orthop Relat Res 2023;481:157-173. [PMID: 36073992 PMCID: PMC9750678 DOI: 10.1097/corr.0000000000002375] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/03/2022] [Indexed: 01/31/2023]

Abstract

BACKGROUND

Robotic, navigated, and patient-specific instrumentation (PSI) TKA procedures have been introduced to improve component placement precision and improve implant survivorship and other clinical outcomes. However, the best available evidence has shown that these technologies are ineffective in reducing revision rates in the general TKA patient population. Nonetheless, it seems plausible that these technologies could be an effective and cost-effective means of reducing revision risk in clinical populations that are at an elevated risk of revision because of patient-specific demographics (such as older age at index surgery, elevated BMI, and being a man). Since clinical trials on this topic would need to be very large, a simulation approach could provide insight on which clinical populations would be the most promising for analysis.

QUESTIONS/PURPOSES

We conducted a simulation-based analysis and asked: (1) Given key demographic parameters characterizing a patient population, together with estimates of the precision achievable with selected forms of technology assistance in TKA, can we estimate the expected distributions of anticipated reductions in lifetime revision risk for that population and the associated improvements in quality-adjusted life years (QALYs) that would be expected to result? (2) Are there realistic practice characteristics (such as combinations of local patient demographics and capital and per-procedure costs) for which applying a per-patient risk-prioritized policy for using technology-assisted TKA could be considered cost-effective based on projected cost savings from reductions in revision rates?

METHODS

We designed simulations of hypothetical practice-specific clinical scenarios, each characterized by patient volume, patient demographics, and technology-assisted surgical technique, using demographic information drawn from other studies to characterize two contrasting simulated clinical scenarios in which the distributions of factors describing patients undergoing TKA place one population at a comparatively elevated risk of revision (elevated-risk population) and the second at a comparatively reduced risk of revision (lower-risk population). We used results from previous systematic reviews and meta-analyses to estimate the implant precision in coronal plane alignment for patient-specific instrumentation, navigated, and robotic technology. We generated simulated TKA patient populations based on risk estimates from large clinical studies, structured reviews, and meta-analyses and calculated the patient-specific reduction in the revision risk and the change in QALYs attributable to the technology-assisted intervention in each of the two simulated clinical scenarios. We also incorporated a sensitivity analysis, incorporating variations in the effect size of deviations from overall coronal alignment on revision risk and difference in health state utilities acquired through a structured review process. We then simulated the outcomes of 25,000 operations per patient using the precisions associated with the conventional TKA technique, the three technology-assisted techniques, and a hypothetical technology-assisted intervention that could consistently deliver perfectly neutral overall coronal alignment, which is unachievable in practice. A risk-prioritized treatment policy was emulated by ordering the simulated patients from the highest to lowest predicted increase in QALYs, such that simulated patients who would see the greatest increase in the QALYs (and therefore the greatest reduction in lifetime revision risk) were the patients to receive technology-assisted TKA intervention in a practice. We used cost estimates acquired through a structured review process and calculated the net added costs of each of the three technology-assisted techniques as a function of the percent utilization (proportion of patients treated with technology assistance in a practice), factoring in fixed costs, per-procedure variable costs, and savings occurring from the prevention of future revision surgery. Finally, we calculated the incremental cost-effectiveness ratio (ICER) and marginal cost-effectiveness ratio (MCER) for each technology-assisted technique for the two clinical scenarios. We then used a Monte Carlo approach to simulate variations in key patient risk, health state, and economic factors as well as to obtain a distribution of estimates for cost-effectiveness. We considered an intervention to be cost effective if either the ICER or MCER values were below USD/QALY 63,000.

RESULTS

For the lower-risk population, the median reduction in the revision risk was 0.9% (0.4% to 2.2%, extrema from the sensitivity analysis) and 1.8% (0.9% to 4.4%) for PSI and robotic TKA, respectively, and 1.9% (1.0% to 4.6%) for ideal TKA. In contrast, the median reduction in the revision risk in the elevated-risk clinical scenario was 2.0% (1.2% to 3.4%) and 4.6% (2.7% to 8.5%) for PSI and robotic TKA and 5.1% (3.0% to 9.4%) for ideal TKA. Estimated differences in the cumulative gain in QALYs attributable to technology-assisted TKA ranged from 0.6 (0.2 to 1.8) to 4.0 (1.8 to 10.0) QALYs per 100 patients, depending on the intervention type and clinical scenario. For PSI, we found treating 15% of patients in the lower-risk population and 77% in the elevated-risk population could meet the threshold for being considered cost effective. For navigated TKA systems offering high alignment precision, we found the intervention could meet this threshold for practice sizes of at least 300 patients per year and a percent utilization of 27% in the lower-risk population. In the elevated-risk population, cost-effectiveness could be achieved in practice volumes as small as 100 patients per year with a percent utilization of at least 6%, and cost savings could be achieved with a percent utilization of at least 45%. We found that robotic TKA could only meet the threshold for being considered cost-effectiveness in the lower-risk population if yearly patient volumes exceeded 600 and for a limited range of percent utilization (27% to 32%). However, in the elevated-risk patient population, robotic TKA with high alignment precision could potentially be cost effective for practice sizes as small as 100 patients per year and a percent utilization of at least 20% if a risk-prioritized treatment protocol were used.

CONCLUSION

Based on these simulations, a selective-use policy for technology-assisted TKA that prioritizes using technology assistance for those patients at a higher risk of revision based on patient-specific factors could potentially meet the cost-effectiveness threshold in selected circumstances (for example, primarily in elevated-risk populations and larger practice sizes). Whether it does meet that threshold would depend significantly on the surgical precision that can be achieved in practice for a given proposed technology as well as on the true local costs of using the proposed technology. We further recommend that any future randomized trials seeking to demonstrate possible effects of technology assistance on revision risk focus on clinical populations that are at higher risk of revision (such as, patient populations that are relatively younger, have higher BMIs, and higher proportions of men).

CLINICAL RELEVANCE

This study suggests that technology assistance is only likely to prove cost effective in selected circumstances rather than in all clinical populations and practice settings. In general, we project that surgical navigation is most likely to prove cost effective in the widest range of circumstances, that PSI may be cost effective or cost neutral in a moderate range of circumstances, and that robotic surgery is only likely to be cost effective in moderately large practices containing patients who are on average at an intrinsically elevated risk of revision.

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Cost-effectiveness analysis of robotic-arm assisted total knee arthroplasty. PLoS One 2022;17:e0277980. [PMID: 36441807 PMCID: PMC9704609 DOI: 10.1371/journal.pone.0277980] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open

Abstract

PURPOSE

Total knee arthroplasty (TKA) is widely recognized as an effective treatment for end-stage knee osteoarthritis (OA). Compared with conventional TKA, robotic-arm assisted TKA may improve patients' functionality and resulting quality of life by more accurate and precise component placement. Currently, the literature on cost-effectiveness of robotic-arm assisted TKA in the US is limited. The objective of this study was to assess the cost-effectiveness of robotic-arm assisted TKA relative to TKA in the Medicare-aged population including exploring the impact of hospital volume on cost-effectiveness outcomes.

METHODS

We developed a decision-analytic model to evaluate the costs, health outcomes, and incremental cost-effectiveness ratio (ICER) of robotic-arm assisted TKA vs TKA in Medicare population with OA. We evaluated cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY). We sourced costs from the literature including episode-of-care (EOC) costs from a Medicare study. We assessed cost-effectiveness of robotic-arm assisted TKA by hospital procedure volume and conducted deterministic (DSA) and probabilistic sensitivity analysis (PSA).

RESULTS

For the average patient treated in a hospital with an annual volume of 50 procedures, robotic-arm assisted TKA resulted in a total QALY of 6.18 relative to 6.17 under conventional TKA. Total discounted costs per patient were $32,535 and $31,917 for robotic-arm assisted TKA and conventional TKA, respectively. Robotic-arm assisted TKA was cost-effective in the base case with an ICER of $41,331/QALY. In univariate DSA, cost-effectiveness outcomes were most sensitive to the annual hospital procedure volume. Robotic-arm assisted TKA was cost-effective at a WTP of $50,000/QALY only when hospital volume exceeded 49 procedures per year. In PSA, robotic-arm assisted TKA was cost-effective at a $50,000/QALY WTP threshold in 50.4% of 10,000 simulations.

CONCLUSIONS

Despite high robotic purchase costs, robotic-arm assisted TKA is likely to be cost-effective relative to TKA in the Medicare population with knee OA in high-volume hospitals through lowering revision rates and decreasing post-acute care costs. Higher-volume hospitals may deliver higher value in performing in robotic-arm assisted TKA.

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Mullaji AB, Khalifa AA. Is it prime time for robotic-assisted TKAs? A systematic review of current studies. J Orthop 2022;34:31-39. [PMID: 35992614 PMCID: PMC9389136 DOI: 10.1016/j.jor.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 07/23/2022] [Indexed: 12/13/2022] Open

Abstract

INTRODUCTION

Less-than-optimum positioning of femoral and tibial components and improper soft tissue tension, with abnormal loads and reduced range of motion, may cause lower patient satisfaction rates. To reduce surgeon-related variables during TKA, technology-assisted TKA was introduced, including computer navigation and robotic-assisted surgery (RATKA). Although several studies show promising short- and long-term functional and radiological outcomes of RATKA, there are still concerns related to its absolute superiority over conventional TKA.

METHODS

This review aims to provide an updated insight into the most recent articles reporting on outcomes (functional, radiological, and complications) of RATKA through a systematic search of major databases. A comprehensive English literature search was performed by both authors through four databases (Embase, PubMed, Web of Science, and Scopus). The full text of the final eligible studies was evaluated for inclusion, resulting in 13 studies that are included in this review.

RESULTS

There were 2112 knees in the 13 studies, with a follow-up ranging from three months to 13 years; only three were randomized controlled trials (RCTs), and nine directly compared the results of RATKA with CTKA technique. Seven studies reported the operative time ranging from 76.8 to 156 min; six reported a longer operative time with RATKA. Length of hospital stay (LOS) was reported in six studies which ranged from 0.48 to 2.1 days; in four studies the LOS was shorter with RATKA. In seven of the nine studies comparing RATKA with CTKA, no difference in functional outcomes was found. Four out of six studies reported that the overall alignment had mechanical alignment within ±3° of neutral alignment in all RATKA patients with an HKA ranging from -0.3 to 1.8°. Only one study reported better radiological outcomes in the RATKA group. In six comparative studies, no difference was found in the incidence of complications between RATKA and CTKA.

CONCLUSION

Although robotic-assisted total knee arthroplasty is a promising technology that provides better component alignment and superior early functional outcomes, the justification for its widespread adoption needs more robust evidence through well-designed and better long-term studies demonstrating superior, predictable, and durable clinical results compared to conventional total knee arthroplasty techniques.

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Mancino F, Jones CW, Benazzo F, Singlitico A, Giuliani A, De Martino I. Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives. Orthop Res Rev 2022;14:339-349. [PMID: 36274930 PMCID: PMC9586165 DOI: 10.2147/orr.s294369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open

The evolution of robotic systems for total knee arthroplasty, each system must be assessed for its own value: a systematic review of clinical evidence and meta-analysis. Arch Orthop Trauma Surg 2022;143:3369-3381. [PMID: 36153769 DOI: 10.1007/s00402-022-04632-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/18/2022] [Indexed: 02/09/2023]

Abstract

INTRODUCTION

Robotic systems have been introduced to improve the precision of total knee arthroplasty. However, different robotic systems are available, each with unique features used to plan and execute the surgery. As such, due to this diversity, the clinical evaluation of each robotic platform should be separated.

METHODS

An extensive literature search of PubMed, Medline, Embase and Web of Science was conducted with subsequent meta-analysis. Randomised controlled trials, comparative studies, and cohort studies were included regarding robot-assisted total knee arthroplasty. Evaluated outcomes included clinical results, surgical precision, ligament balance, surgical time, learning curve, complications and revision rates. These were split up based on the robot-specific brand: ROBODOC (T-SOLUTION ONE), OMNIBOT, MAKO, NAVIO (CORI) and ROSA.

RESULTS

With a follow-up of more than 10 years, no improved clinical outcomes have been noted with the ROBODOC system compared to the conventional technique. If available, other platforms only present short-term clinical outcomes. Radiological outcomes are published for most robotic setups, demonstrating improved surgical precision compared to the conventional technique. Gap balance assessment is performed differently between all systems, leading to heterogeneous outcomes regarding its relationship on clinical outcomes. There is a similar learning curve based on operative time for all robotic platforms. In most studies, robot assistance requires longer operative time compared to the conventional technique. Complications and revision rates are published for ROBODOC and MAKO, without clear differences to conventional total knee arthroplasty.

CONCLUSION

The main finding of this systematic review is that the current evidence regarding each robotic system is diverse in quantity and quality. Each system has its own specificities and must be assessed for its own value. Regarding scientific literature, the generic term of robotic should be banned from the general conclusion.

LEVEL OF EVIDENCE

Systematic review level IV.

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Tuecking LR, Ettinger M, Windhagen H, Savov P. [Market overview: Robotic-assisted arthroplasty : Current robotic systems, learning curve and cost analysis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022;51:727-738. [PMID: 35945459 DOI: 10.1007/s00132-022-04286-x] [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: 07/11/2022] [Indexed: 06/15/2023]

Kolessar DJ, Hayes DS, Harding JL, Rudraraju RT, Graham JH. Robotic-Arm Assisted Technology's Impact on Knee Arthroplasty and Associated Healthcare Costs. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022;9:57-66. [PMID: 36072348 PMCID: PMC9398468 DOI: 10.36469/001c.37024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]

Abstract

Background: The number of total knee arthroplasties (TKA) carried out globally is expected to substantially rise in the coming decades. Consequently, focus has been increasing on improving surgical techniques and minimizing expenses. Robotic arm-assisted knee arthroplasty has garnered interest to reduce surgical errors and improve precision. Objectives: Our primary aim was to compare the episode-of-care cost up to 90 days for unicompartmental knee arthroplasty (UKA) and TKA performed before and after the introduction of robotic arm-assisted technology. The secondary aim was to compare the volume of UKA vs TKA. Methods: This was a retrospective study design at a single healthcare system. For the cost analysis, we excluded patients with bilateral knee arthroplasty, body mass index >40, postoperative infection, or noninstitutional health plan insurance. Costs were obtained through an integrated billing system and affiliated institutional insurance company. Results: Knee arthroplasty volume increased 28% after the introduction of robotic-assisted technology. The TKA volume increased by 17%, while the UKA volume increased 190%. Post introduction, 97% of UKA cases used robotic arm-assisted technology. The cost analysis included 178 patients (manual UKA, n = 6; robotic UKA, n = 19; manual TKA, n = 58, robotic TKA, n = 85). Robotic arm-assisted TKA and UKA were less costly in terms of patient room and operating room costs but had higher imaging, recovery room, anesthesia, and supply costs. Overall, the perioperative costs were higher for robotic UKA and TKA. Postoperative costs were lower for robotic arm-assisted surgeries, and patients used less home health and home rehabilitation. Discussion: Surgeons performed higher volumes of UKA, and UKA comprised a greater percentage of total surgical volume after the introduction of this technology. The selective cost analysis indicated robotic arm-assisted technology is less expensive in several cost categories but overall more expensive by up to $550 due to higher cost categories including supplies and recovery room. Conclusions: Our findings show a change in surgeons' practice to include increased incidence and volume of UKA procedures and highlights several cost-saving categories through the use of robotic arm-assisted technology. Overall, robotic arm-assisted knee arthroplasty cost more than manual techniques at our institution. This analysis will help optimize costs in the future.

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Shin C, Crovetti C, Huo E, Lionberger D. Unsatisfactory accuracy of recent robotic assisting system ROSA for total knee arthroplasty. J Exp Orthop 2022;9:82. [PMID: 35984537 PMCID: PMC9391541 DOI: 10.1186/s40634-022-00522-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open

Bhowmik-Stoker M, Mathew KK, Chen Z, Chen AF, Hozack WJ, Mahoney O, Orozco FR, Mont MA. Return to Work and Driving After Robotic Arm–Assisted Total Knee Arthroplasty. Arthroplast Today 2022;16:219-223. [PMID: 35880225 PMCID: PMC9307493 DOI: 10.1016/j.artd.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 10/26/2022] Open

Gregory DA, Coppolecchia A, Scotti DJ, Chen Z, Mont MA, Jacofsky D. A 90-Day Episode-of-Care Analysis Including Computed Tomography Scans of Robotic-Arm Assisted versus Manual Total Knee Arthroplasty. J Knee Surg 2022. [PMID: 35817055 DOI: 10.1055/s-0042-1749083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Deckey DG, Verhey JT, Rosenow CS, Doan MK, McQuivey KS, Joseph AM, Schwartz AJ, Clarke HD, Bingham JS. Robotic-Assisted Total Knee Arthroplasty Allows for Trainee Involvement and Teaching Without Lengthening Operative Time. J Arthroplasty 2022;37:S201-S206. [PMID: 35184933 DOI: 10.1016/j.arth.2021.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open

Abstract

BACKGROUND

Robot-assisted total knee arthroplasty (RA-TKA) is more accurate than mechanical total knee arthroplasty (M-TKA) and can provide real-time feedback about alignment and soft-tissue balancing that may be helpful in trainee education. However, both robotic-assist and trainee involvement potentially increase the surgical time. This study sought to evaluate whether RA-TKA procedures were longer than M-TKA procedures and whether trainee participation added additional surgical time.

METHODS

This retrospective cohort study reviewed 220 consecutive primary TKAs (110 M-TKA and 110 RA-TKA) performed by an orthopedic trainee under supervision or performed by the consultant surgeon with an assistant present. For M-TKAs, a measured resection technique was used. For all RA-TKAs, the MAKO robotic system (Stryker, USA) was used. Tourniquet time was measured from inflation immediately prior to skin incision to deflation after placement of the final polyethylene insert. Procedures performed by a consulting surgeon with a surgical assist were used as controls for procedures performed by the trainee. In trainee-conducted procedures, the trainee is responsible for performing all critical aspects of the procedure while the consulting surgeon provides supervision and acts as first assist.

RESULTS

103 M-TKA and 96 RA-TKA were included. Tourniquet time was significantly longer for RA-TKAs vs M-TKAs (100 vs 89 minutes, P < .0001). However, there were no significant differences in tourniquet times between surgery performed by a trainee vs the consulting surgeon with surgical assist for either M-TKA (P = .3452) or RA-TKA (P = .6724).

CONCLUSIONS

While RA-TKA takes longer, orthopedic trainees do not add additional time. Trainees at all stages of postgraduate learning can be educated in the use of robotic technology and potentially benefit from real-time feedback without further compromising surgical efficiency or increasing patient risk.

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Ong KL, Coppolecchia A, Chen Z, Watson HN, Jacofsky D, Mont MA. Robotic-Arm Assisted Total Knee Arthroplasty: Cost Savings Demonstrated at One Year. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022;14:309-318. [PMID: 35531481 PMCID: PMC9075896 DOI: 10.2147/ceor.s357112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open

Abstract

Purpose

Robotic-arm assisted total knee arthroplasty (RATKA) has the potential to enhance radiographic, clinical, and patient-reported outcomes. The purpose of this study was to compare resource utilization, episode-of-care (EOC) costs, readmissions, and complications of robotic-arm assisted total knee arthroplasty (RATKA) and manual TKA (MTKA).

Methods

TKA procedures were identified from a private payer claims database. RATKA procedures required both a robotic arm-assisted procedure code and a 60-day pre-operative computed tomography scan. Propensity score matching (1:5 RATKA to MTKA) was performed, based on various patient characteristics and comorbidities. After matching, 4452 patients (742 RATKA and 3710 MTKA) were analyzed for 90-day and one-year EOC costs, index TKA costs, lengths of stay (LOS), discharge statuses, rehabilitation utilizations, as well as 90-day and one-year readmissions- and knee-related complications.

Results

RATKA patients had shorter LOS (mean 1.56 versus 1.91 days; p < 0.001), lower index costs by $1762 ($32,747 versus $34,509; p = 0.003), and higher discharges to home rates (51.8 versus 47.8%; p = 0.049) than MTKA patients. RATKA patients had less 90-day (68.5 versus 72.0%; p = 0.048) and one-year (70.8 versus 75.0%; p = 0.016) home health utilizations. The RATKA cohort had lower 90-day ($39,260 versus $41,458; p = 0.001) and one-year ($51,462 versus $54,171; p = 0.011) EOC costs. No significant differences in readmission and overall complication rates were observed (p > 0.05).

Conclusion

RATKA was associated with lower index costs and EOC costs at both 90 days and one year. These patients had shorter LOS, were discharged home more frequently, and used less home health services. Cost savings were demonstrated for RATKA beyond the 90-day period with an increase in savings between 90-day and one-year time points. These data may be of importance to payers and providers interested in the longer-term value of RATKA.

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Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon. J Knee Surg 2022;35:409-415. [PMID: 32838457 DOI: 10.1055/s-0040-1715126] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

The learning curve has been established for robotic-assisted total knee arthroplasty (RATKA) during the first month of use; however, there have been no studies evaluating this on a longer term. Therefore, the purpose of this study was to compare operative times for three cohorts during the first year following adoption of RATKA (initial, 6 months, and 1 year) and a prior cohort of manual TKA. We investigated both mean operative times and the variability of operative time in each cohort. This is a learning curve study comparing a single surgeon's experience using RAKTA. The study groups were made up of two cohorts of 60 cementless RATKAs performed at ∼6 months and 1 year of use. A learning curve was created based on the mean operative times and individual operative times were stratified into different cohorts for comparison. Study groups were compared with the surgeon's initial group of 20 cemented RATKAs and 60 cementless manual cases. Descriptive numbers were compiled and mean operative times were compared using Student's t-tests for significant differences with a p-value of < 0.05. The mean surgical times continued to decrease after 6 months of RATKA. In 1 year, the surgeon was performing 88% of the RATKA between 50 and 69 minutes. The initial cohort and 1-year robotic-assisted mean operative times were 81 and 62 minutes, respectively (p < 0.00001). Mean 6-month robotic-assisted operative times were similar to manual times (p = 0.12). A significant lower time was found between the mean operative times for the 1-year robotic-assisted and manual (p = 0.008) TKAs. The data show continued improvement of operative times at 6 months and 1 year when using this new technology. The results of this study are important because they demonstrate how the complexity of a technology which initially increases operative time can be overcome and become more time-effective than conventional techniques.

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Wakelin EA, Shalhoub S, Lawrence JM, Keggi JM, DeClaire JH, Randall AL, Ponder CE, Koenig JA, Lyman S, Plaskos C. Improved total knee arthroplasty pain outcome when joint gap targets are achieved throughout flexion. Knee Surg Sports Traumatol Arthrosc 2022;30:939-947. [PMID: 33580346 DOI: 10.1007/s00167-021-06482-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 12/20/2022]

Abstract

PURPOSE

Achieving a balanced knee is accepted as an important goal in total knee arthroplasty; however, the definition of ideal balance remains controversial. This study therefore endeavoured to determine: (1) whether medio-lateral gap balance in extension, midflexion, and flexion are associated with improved outcome scores at one-year post-operatively and (2) whether these relationships can be used to identify windows of optimal gap balance throughout flexion.

METHODS

135 patients were enrolled in a multicenter, multi-surgeon, prospective investigation using a robot-assisted surgical platform and posterior cruciate ligament sacrificing gap balancing technique. Joint gaps were measured under a controlled tension of 70-90 N from 10°-90° flexion. Linear correlations between joint gaps and one-year KOOS outcomes were investigated. KOOS Pain and Activities of Daily Living sub-scores were used to define clinically relevant joint gap target thresholds in extension, midflexion, and flexion. Gap thresholds were then combined to investigate the synergistic effects of satisfying multiple targets.

RESULTS

Significant linear correlations were found throughout extension, midflexion, and flexion. Joint gap thresholds of an equally balanced or tighter medial compartment in extension, medial laxity ± 1 mm compared to the final insert thickness in midflexion, and a medio-lateral imbalance of less than 1.5 mm in flexion generated subgroups that reported significantly improved KOOS pain scores at one year (median ∆ = 8.3, 5.6 and 2.8 points, respectively). Combining any two targets resulted in further improved outcomes, with the greatest improvement observed when all three targets were satisfied (median ∆ = 11.2, p = 0.002).

CONCLUSION

Gap thresholds identified in this study provide clinically relevant and achievable targets for optimising soft tissue balance in posterior cruciate ligament sacrificing gap balancing total knee arthroplasty. When all three balance windows were achieved, clinically meaningful pain improvement was observed.

LEVEL OF EVIDENCE

Level II.

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Zhang J, Ndou WS, Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022;30:2677-2695. [PMID: 33547914 PMCID: PMC9309123 DOI: 10.1007/s00167-021-06464-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 12/28/2022]

Abstract

This systematic review and meta-analysis were conducted to compare the accuracy of component positioning, alignment and balancing techniques employed, patient-reported outcomes, and complications of robotic-arm assisted total knee arthroplasty (RATKA) with manual TKA (mTKA) and the associated learning curve. Searches of PubMed, Medline and Google Scholar were performed in October 2020 using PRISMA guidelines. Search terms included "robotic", "knee" and "arthroplasty". The criteria for inclusion were published clinical research articles reporting the learning curve for RATKA and those comparing the component position accuracy, alignment and balancing techniques, functional outcomes, or complications with mTKA. There were 198 articles identified, following full text screening, 16 studies satisfied the inclusion criteria and reported the learning curve of rTKA (n=5), component positioning accuracy (n=6), alignment and balancing techniques (n=7), functional outcomes (n=7), or complications (n=5). Two studies reported the learning curve using CUSUM analysis to establish an inflexion point for proficiency which ranged from 7 to 11 cases and there was no learning curve for component positioning accuracy. The meta-analysis showed a significantly lower difference between planned component position and implanted component position, and the spread was narrower for RATKA compared with the mTKA group (Femur coronal: mean 1.31, 95% confidence interval (CI) 1.08-1.55, p<0.00001; Tibia coronal: mean 1.56, 95% CI 1.32-1.81, p<0.00001). Three studies reported using different alignment and balancing techniques between mTKA and RATKA, two studies used the same for both group and two studies did not state the methods used in their RATKA groups. RATKA resulted in better Knee Society Score compared to mTKA in the short-to-mid-term follow up (95%CI [- 1.23, - 0.51], p=0.004). There was no difference in arthrofibrosis, superficial and deep infection, wound dehiscence, or overall complication rates. RATKA demonstrated improved accuracy of component positioning and patient-reported outcomes. The learning curve of RATKA for operating time was between 7 and 11 cases. Future well-powered studies on RATKAs should report on the knee alignment and balancing techniques utilised to enable better comparisons on which techniques maximise patient outcomes.Level of evidence III.

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Cotter EJ, Wang J, Illgen RL. Comparative Cost Analysis of Robotic-Assisted and Jig-Based Manual Primary Total Knee Arthroplasty. J Knee Surg 2022;35:176-184. [PMID: 32659815 DOI: 10.1055/s-0040-1713895] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

Excellent durability with traditional jig-based manual total knee arthroplasty (mTKA) has been noted, but substantial rates of dissatisfaction remain. Robotic-assisted TKA (raTKA) was introduced to improve clinical outcomes, but associated costs have not been well studied. The purpose of our study is to compare 90-day episode-of-care (EOC) costs for mTKA and raTKA. A retrospective review of an institutional database from 4/2015 to 9/2017 identified consecutive mTKAs and raTKAs using a single implant system performed by one surgeon. The raTKA platform became available at our institution in October 2016. Prior to this date, all TKAs were performed with mTKA technique. After this date, all TKAs were performed using robotic-assistance without exception. Sequential cases were included for both mTKA and raTKA with no patients excluded. Clinical and financial data were obtained from medical and billing records. Ninety-day EOC costs were compared. Statistical analysis was performed by departmental statistician. One hundred and thirty nine mTKAs and 147 raTKAs were identified. No significant differences in patient characteristics were noted. Total intraoperative costs were higher ($10,295.17 vs. 9,998.78, respectively, p < 0.001) and inpatient costs were lower ($3,893.90 vs. 5,587.40, respectively, p < 0.001) comparing raTKA and mTKA. Length of stay (LOS) was reduced 25% (1.2 vs. 1.6 days, respectively, p < 0.0001) and prescribed opioids were reduced 57% (984.2 versus 2240.4 morphine milligram equivalents, respectively, p < 0.0001) comparing raTKA with mTKA. Ninety-day EOC costs were $2,090.70 lower for raTKA compared with mTKA ($15,629.94 vs. 17,720.64, respectively; p < 0.001). The higher intraoperative costs associated with raTKA were offset by greater savings in postoperative costs for the 90-day EOC compared with mTKA. Higher intraoperative costs were driven by the cost of the robot, maintenance fees, and robot-specific disposables. Cost savings with raTKA were primarily driven by reduced instrument pan reprocessing fees, shorter LOS, and reduced prescribed opioids compared with mTKA technique. raTKA demonstrated improved value compared with mTKA based on significantly lower average 90-day EOC costs and superior quality exemplified by reduced LOS, less postoperative opioid requirements, and reduced postdischarge resource utilization.

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King CA, Jordan M, Bradley AT, Wlodarski C, Tauchen A, Puri L. Transitioning a Practice to Robotic Total Knee Arthroplasty Is Correlated with Favorable Short-Term Clinical Outcomes-A Single Surgeon Experience. J Knee Surg 2022;35:78-82. [PMID: 32544972 DOI: 10.1055/s-0040-1712984] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

BACKGROUND

This study sought to evaluate the patient experience and short-term clinical outcomes associated with the hospital stay of patients who underwent robotic arm-assisted total knee arthroplasty (TKA). These results were compared with a cohort of patients who underwent TKA without robotic assistance performed by the same surgeon prior to the introduction of this technology.

MATERIALS AND METHODS

A cohort of consecutive patients undergoing primary TKA for the diagnosis of osteoarthritis by a single fellowship trained orthopaedic surgeon over a 39-month period was identified. Patients who underwent TKA during the year that this surgeon transitioned his entire knee arthroplasty practice to robotic assistance were excluded to eliminate selection bias and control for the learning curve. All patients received the same prosthesis and postoperative pain protocol. Patients that required intubation for failed spinal anesthetic were excluded. A final population of 492 TKAs was identified. Of these, 290 underwent TKA without robotic assistance and 202 underwent robotic arm-assisted TKA. Patient demographic characteristics and short-term clinical data were analyzed.

RESULTS

Robotic arm-assisted TKA was associated with shorter length of stay (2.3 vs. 2.6 days, p < 0.001), a 50% reduction in morphine milligram equivalent utilization (from 214 to 103, p < 0.001), and a mean increase in procedure time of 9.3 minutes (p < 0.001). There was one superficial infection in the nonrobotic cohort and there were no deep postoperative infections in either cohort. There were no manipulations under anesthesia in the robotic cohort while there were six in the nonrobotic cohort. Additionally, there were no significant differences in emergency department visits, readmissions, or return to the operating room.

CONCLUSION

This analysis corroborates existing literature suggesting that robotic arm-assisted TKA can be correlated with improved short-term clinical outcomes. This study reports on a single surgeon's experience with regard to analgesic requirements, length of stay, pain scores, and procedure time following a complete transition to robotic arm-assisted TKA. These results underscore the importance of continued evaluation of clinical outcomes as robotic arthroplasty technology continues to grow.

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Fang CJ, Mazzocco JC, Sun DC, Shaker JM, Talmo CT, Mattingly DA, Smith EL. Total Knee Arthroplasty Hospital Costs by Time-Driven Activity-Based Costing: Robotic vs Conventional. Arthroplast Today 2021;13:43-47. [PMID: 34917720 PMCID: PMC8666607 DOI: 10.1016/j.artd.2021.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/15/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open

The MAKO robotic-arm knee arthroplasty system. Arch Orthop Trauma Surg 2021;141:2043-2047. [PMID: 34757462 DOI: 10.1007/s00402-021-04208-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]