Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty

2018 ◽  
Vol 27 (4) ◽  
pp. 1232-1240 ◽  
Author(s):  
Cécile Batailler ◽  
Nathan White ◽  
Filippo Maria Ranaldi ◽  
Philippe Neyret ◽  
Elvire Servien ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Implant Position ◽  
Robotic Assisted ◽  
Unicompartmental Knee

scholarly journals High usage of medial unicompartmental knee arthroplasty negatively influences total knee arthroplasty revision rate

2021 ◽  
Author(s):  
Antonio Klasan ◽  
Mei Lin Tay ◽  
Chris Frampton ◽  
Simon William Young
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Oxford Knee Score ◽  
High Volume ◽  
Unicompartmental Knee ◽  
Patient Reported ◽  
Medial Unicompartmental Knee Arthroplasty ◽  
Total Knee

Abstract Purpose Surgeons with higher medial unicompartmental knee arthroplasty (UKA) usage have lower UKA revision rates. However, an increase in UKA usage may cause a decrease of total knee arthroplasty (TKA) usage. The purpose of this study was to investigate the influence of UKA usage on revision rates and patient-reported outcomes (PROMs) of UKA, TKA, and combined UKA + TKA results. Methods Using the New Zealand Registry Database, surgeons were divided into six groups based on their medial UKA usage: < 1%, 1–5%, 5–10%, 10–20%, 20–30% and > 30%. A comparison of UKA, TKA and UKA + TKA revision rates and PROMs using the Oxford Knee Score (OKS) was performed. Results A total of 91,895 knee arthroplasties were identified, of which 8,271 were UKA (9.0%). Surgeons with higher UKA usage had lower UKA revision rates, but higher TKA revision rates. The lowest TKA and combined UKA + TKA revision rates were observed for surgeons performing 1–5% UKA, compared to the highest TKA and UKA + TKA revision rates which were seen for surgeons using > 30% UKA (p < 0.001 TKA; p < 0.001 UKA + TKA). No clinically important differences in UKA + TKA OKS scores were seen between UKA usage groups at 6 months, 5 years, or 10 years. Conclusion Surgeons with higher medial UKA usage have lower UKA revision rates; however, this comes at the cost of a higher combined UKA + TKA revision rate that is proportionate to the UKA usage. There was no difference in TKA + UKA OKS scores between UKA usage groups. A small increase in TKA revision rate was observed for high-volume UKA users (> 30%), when compared to other UKA usage clusters. A significant decrease in UKA revision rate observed in high-volume UKA surgeons offsets the slight increase in TKA revision rate, suggesting that UKA should be performed by specialist UKA surgeons. Level of evidence III, Retrospective therapeutic study.

Progression of osteoarthritis and reoperation in unicompartmental knee arthroplasty: A comparison of national joint registries

2019 ◽  
Vol 43 (3) ◽  
pp. 203-207
Author(s):  
Emanuela Castiello ◽  
Saverio Affatato
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Current Data ◽  
Knee Prostheses ◽  
Unicompartmental Knee ◽  
International Joint ◽  
Osteoarthritis Progression ◽  
History Of ◽  
Total Knee

Unicompartmental knee arthroplasty remains a challenge for orthopaedic surgeons because of its higher revision rate compare with the total knee arthroplasty. The hypothesis of this work is that the progression of osteoarthritis in unicompartmental knee prostheses is the natural history of the degenerative disease and a reason for reoperation. Most international joint registries consider this fact as a failure of the implant and a cause of revision. Annual joint registries were searched for progression of osteoarthritis in unicompartmental knee arthroplasty and reasons for their revisions. Current data from registries for unicompartmental knee indicate that the revision rate of such prostheses is overestimated. Considering osteoarthritis progression as the development of the existing disease and not as a failure of the implant, revision rate will be reduced. Registries, reports, and studies are needed to evaluate the progression of osteoarthritis as a cause of reoperation instead of a reason for revision, reducing unicompartmental revision rate and encouraging surgeons to implant more of them.

A systematic review of robotic-assisted unicompartmental knee arthroplasty

2019 ◽  
Vol 101-B (7) ◽  
pp. 838-847 ◽  
Author(s):  
P. G. Robinson ◽  
N. D. Clement ◽  
D. Hamilton ◽  
M. J. G. Blyth ◽  
F. S. Haddad ◽  
...  
Keyword(s):  
Systematic Review ◽  
United Kingdom ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Outcomes ◽  
Implant Design ◽  
Current Evidence ◽  
Robotic Assisted ◽  
Implant Positioning ◽  
Unicompartmental Knee

AimsRobotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used.Materials and MethodsA search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “knee”, and “surgery”. The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies.ResultsA total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001).ConclusionThere is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838–847.

scholarly journals Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Xiao Wei Sun ◽  
Fei Fan Lu ◽  
Kun Zou ◽  
Mao Hong ◽  
Qi Dong Zhang ◽  
...  
Keyword(s):  
Femoral Component ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Phase Iii ◽  
Cochrane Library ◽  
Radiological Assessment ◽  
Short Term ◽  
Unicompartmental Knee

Abstract Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.

Metal-Backed Tibial Components Do Not Reduce Risk of Early Aseptic Loosening in Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 33 (02) ◽  
pp. 180-189 ◽  
Author(s):  
Giuseppe Gianluca Costa ◽  
Mirco Lo Presti ◽  
Alberto Grassi ◽  
Giuseppe Agrò ◽  
Sergio Cialdella ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Component ◽  
Revision Rate ◽  
Meta Analysis ◽  
Female Patients ◽  
Unicompartmental Knee

AbstractLong-term results of unicompartmental knee arthroplasty (UKA) have shown a slightly higher revision rate than total knee arthroplasty (TKA), and implant fixation geometry seems to affect prosthetic survivorship. Whether metal-backed tibial component leads to superior performance over the all-polyethylene design is unclear, and a lack of evidence exists in literature. Our purpose was to demonstrate which implant design of UKA (all-polyethylene or metal-backed tibial component) is clinically superior regarding revision rates and clinical functioning, and investigate the role of potential factors that could affect the revision rate. A systematic review was conducted for clinical studies comparing all-polyethylene and metal-backed tibial components used in primary UKAs in terms of revision rates and clinical scores. Meta-regression techniques were used to explore factors modifying the observed effect. All causes of revision were extracted and analyzed, to find statistically significant differences between the two groups. Our research strategy generated a systematic review of nine studies comprising 1,101 UKAs in 1,088 patients with 87 revisions for any reason. Meta-analysis showed a higher, but not statistically significant, risk of aseptic revision in the all-polyethylene group. Studies with a smaller sample size and higher percentage of female patients were correlated to a higher relative risk of revision in favor of all-polyethylene UKAs. Differently, patients' age and duration of follow-up did not influence the risk ratio. The main cause for revision was aseptic loosening in both implants' component, with no statistically differences in the two groups examined. Our results do not show a superiority of the metal-backed tibial component in UKAs in terms of survivorship, although extreme care must be given for patients with high risk of early failure, such as female patients. However, surgical experience, in combination with careful patient selection, remains paramount and may lead to better long-term outcomes in patients requiring UKA. This is a Level III, therapeutic study.

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