Component Placement Accuracy in Unicompartmental Knee Arthroplasty Is Improved with Robotic-Assisted Surgery: Will It Have an Effect on Outcomes?

Background. For over fifty years, unicompartmental knee arthroplasty (UKA) has been used to treat single-compartment osteoarthritis of the knee and is considered a safe alternative to total knee arthroplasty (TKA). The development and use of robotic-assisted surgery (r-UKA) have made the execution of the procedure more precise, and various studies have reported improved radiographic outcomes and implant survival rates; however, its cost-effectiveness is unknown. This study aimed at assessing the cost-effectiveness of noncomputerized tomography (non-CT) r-UKA compared to the traditional unicompartmental knee arthroplasty (t-UKA) method in patients with unicompartmental knee osteoarthritis from the UK payer’s perspective. Methods. We developed a 5-year four-state Markov model to evaluate the expected costs and outcomes of the two strategies in patients aged 65 years. Failure rates for t-UKA were taken from the British National Joint Registry while data for non-CT r-UKA were obtained from a 2-year observational study. Cost was obtained from the NHS reference cost valued at 2018/19 GBP£, and a discount rate of 3.5% was applied to both costs and benefits. Results. For a high-volume orthopaedic centre that performs 100 UKA operations per year, non-CT r-UKA was more costly than t-UKA but offered better clinical outcomes, and the estimated cost per QALY was £2,831. The results were more favourable in younger patients aged less than 55 and sensitive to case volumes and follow-up period. Conclusion. Non-CT r-UKA is cost-effective compared with t-UKA over a 5-year period. Results are dependent on case volumes and follow-up period and favour younger age groups.

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Robotic-assisted surgery in medial unicompartmental knee arthroplasty: does it improve the precision of the surgery and its clinical outcomes? Systematic review

Journal of Robotic Surgery ◽

10.1007/s11701-020-01162-8 ◽

2020 ◽

Author(s):

Roberto Negrín ◽

Gonzalo Ferrer ◽

Magaly Iñiguez ◽

Jaime Duboy ◽

Manuel Saavedra ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Robotic Assisted ◽

Robotic Assisted Surgery ◽

Unicompartmental Knee ◽

Medial Unicompartmental Knee Arthroplasty

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Stiffness after unicompartmental knee arthroplasty: Risk factors and arthroscopic treatment

SICOT-J ◽

10.1051/sicotj/2021034 ◽

2021 ◽

Vol 7 ◽

pp. 35

Author(s):

Gaspard Fournier ◽

Romain Gaillard ◽

John Swan ◽

Cécile Batailler ◽

Sébastien Lustig ◽

...

Keyword(s):

Risk Factors ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Flexion Contracture ◽

Arthroscopic Treatment ◽

Level Of Evidence ◽

Robotic Assisted ◽

Arthroscopic Arthrolysis ◽

Robotic Assisted Surgery ◽

Unicompartmental Knee

Introduction: One of the principal complications after total knee arthroplasty (TKA) is stiffness. There are no publications concerning stiffness after unicompartmental knee arthroplasty (UKA). Study objectives were to describe the incidence of stiffness after UKA, to look for risk factors, and to describe safe and effective arthroscopic treatment. Methods: There were 240 UKA performed between March 2016 and January 2019 included. Robotic-assisted surgery was performed in 164 patients and mechanical instrumentation in 76 patients. Stiffness was defined as flexion < 90° or a flexion contracture > 10° during the first 45 post-operative days. Patients with stiffness were treated with arthroscopic arthrolysis. Several factors were studied to look for risk factors of stiffness: body mass index, gender, age, mechanical or robotic instrumentation, preoperative flexion, previous meniscectomy, and anticoagulant treatment. Arthrolysis effectiveness was evaluated by flexion improvement and UKA revision rate. Results: 22 patients (9%) developed stiffness. Mechanical instrumentation significantly increased the risk of stiffness with OR = 0.26 and p = 0.005. Robotic-assisted surgery decreased the risk of stiffness by five-fold. Before arthrolysis, mean knee flexion was 79°, versus 121° (53% improvement) after arthroscopic arthrolysis. Only 2 patients (9%) underwent UKA revision after arthrolysis. Discussion: Stiffness after UKA is an important complication with an incidence of 9% in this study. Arthroscopic arthrolysis is a safe and effective treatment with a range of motion improvement of > 50%. Robotic-assisted surgery significantly decreases the risk of postoperative stiffness. Level of evidence: Level III, therapeutic study, retrospective cohort study

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Comparing clinical and radiographic outcomes of robotic-assisted, computer-navigated and conventional unicompartmental knee arthroplasty: A network meta-analysis of randomized controlled trials

Journal of Orthopaedics ◽

10.1016/j.jor.2021.05.012 ◽

2021 ◽

Author(s):

Kyle N. Kunze ◽

Daniel Farivar ◽

Ajay Premkumar ◽

Michael B. Cross ◽

Alejandro Gonzalez Della Valle ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Meta Analysis ◽

Controlled Trials ◽

Robotic Assisted ◽

Randomized Controlled ◽

Radiographic Outcomes ◽

Unicompartmental Knee

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Is robotic-assisted unicompartmental knee arthroplasty a safe procedure? A case control study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06051-z ◽

2020 ◽

Cited By ~ 3

Author(s):

Guillaume Mergenthaler ◽

Cécile Batailler ◽

Timothy Lording ◽

Elvire Servien ◽

Sébastien Lustig

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Case Control Study ◽

Case Control ◽

Safe Procedure ◽

Robotic Assisted ◽

Unicompartmental Knee ◽

Control Study

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A systematic review of robotic-assisted unicompartmental knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b7.bjj-2018-1317.r1 ◽

2019 ◽

Vol 101-B (7) ◽

pp. 838-847 ◽

Cited By ~ 22

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.

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