No difference in PROMs between robotic-assisted CR versus PS total knee arthroplasty: a preliminary study

AbstractSagittal deformity of the knee is commonly corrected to neutral biomechanical axis (±3 degrees) during total knee arthroplasty (TKA), which is a widely accepted goal. Recent advances in surgical technology have made it possible to accurately plan and fulfill these goals. One of these is robotic-assisted TKA, which has been noted to help increase accuracy and precision of restoring a neutral mechanical axis. While there are data confirming the ability of robotic devices to better correct knee alignment than the manual technique, there is a lack of data concerning the use of the robotic devices in more complex cases, such as those in patients with severe varus or valgus deformity, as well as in flexion contractures. Therefore, the purpose of this case study is to present three cases in which the robotic-assisted TKA device was used to correct a severe varus and severe valgus deformities. Based on this case series, it should be noted that the robotic device can also help correct severe varus/valgus deformities and flexion contractures.

Download Full-text

The Learning Curve Associated with Robotic Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0037-1608809 ◽

2017 ◽

Vol 31 (01) ◽

pp. 017-021 ◽

Cited By ~ 28

Author(s):

Nipun Sodhi ◽

Anton Khlopas ◽

Nicolas Piuzzi ◽

Assem Sultan ◽

Robert Marchand ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Learning Curve ◽

Knee Arthroplasty ◽

Joint Arthroplasty ◽

Ease Of Use ◽

Similar Time ◽

Robotic Assisted ◽

Total Knee ◽

The Times ◽

Time Frames

AbstractAs with most new surgical technologies, there is an associated learning curve with robotic-assisted total knee arthroplasty (TKA) before surgeons can expect ease of use to be similar to that of manual cases. Therefore, the purpose of this study was to (1) assess robotic-assisted versus manual operative times of two joint reconstructive surgeons separately as well as (2) find an overall learning curve. A total of 240 robotic-assisted TKAs performed by two board-certified surgeons were analyzed. The cases were sequentially grouped into 20 cases and a learning curve was created based on mean operative times. For each surgeon, mean operative times for their first 20 and last 20 robotic-assisted cases were compared with 20 randomly selected manual cases performed by that surgeon as controls prior to the initiation of the robotic-assisted cases. Each of the surgeons first 20 robotic assisted, last 20 robotic assisted, and 20 controls were then combined to create 3 cohorts of 40 cases for analysis. Surgeon 1: First and last robotic cohort operative times were 81 and 70 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 81 versus 68 minutes (p < 0.05). Mean operative times for the last 20 robotic-assisted cases and manual cases were 70 versus 68 minutes (p > 0.05). Surgeon 2: First and last robotic cohort operative times were 117 and 98 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 117 versus 95 (p < 0.05). Mean operative times for the last 20 robotic-cohort cases and manual cases were 98 versus 95 (p > 0.05). A similar trend occurred when the times of two surgeons were combined. The data from this study effectively create a learning curve for the use of robotic-assisted TKA. As both surgeons completed their total cases numbers within similar time frames, these data imply that within a few months, a board-certified orthopaedic joint arthroplasty surgeon should be able to adequately perform robotic TKA without adding any operative times.

Download Full-text

Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0041-1731349 ◽

2021 ◽

Author(s):

Kevin B. Marchand ◽

Rachel Moody ◽

Laura Y. Scholl ◽

Manoshi Bhowmik-Stoker ◽

Kelly B. Taylor ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Physical Function ◽

Knee Arthroplasty ◽

Postoperative Outcomes ◽

Medical Complications ◽

Womac Pain ◽

Robotic Assisted ◽

Surgical Data ◽

Total Knee

AbstractRobotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) radiographic assessments for progressive radiolucencies. We compared 80 consecutive cementless robotic-assisted to 80 consecutive cementless manual TKAs. Patient preoperative r-WOMAC and demographics (e.g., age, sex, and body mass index) were not found to be statistically different. Surgical data and medical records were reviewed for aseptic survivorship, medical, and surgical complications. Patients were administered an r-WOMAC survey preoperatively and at 2-year postoperatively. Mean r-WOMAC pain, physical function, and total scores were tabulated and compared using Student's t-tests. Radiographs were reviewed serially throughout patient's postoperative follow-up. A p < 0.05 was considered significant. The aseptic failure rates were 1.25 and 5.0% for the robotic-assisted and manual cohorts, respectively. Patients in the robotic-assisted cohort had significantly improved 2-year postoperative r-WOMAC mean pain (1 ± 2 vs. 2 ± 3 points, p = 0.02), mean physical function (2 ± 3 vs. 4 ± 5 points, p = 0.009), and mean total scores (4 ± 5 vs, 6 ± 7 points, p = 0.009) compared with the manual TKA. Surgical and medical complications were similar in the two cohorts. Only one patient in the manual cohort had progressive radiolucencies on radiographic assessment. Robotic-assisted TKA patients demonstrated improved 2-year postoperative outcomes when compared with manual patients. Further studies could include multiple surgeons and centers to increase the generalizability of these results. The results of this study indicate that patients who undergo robotic-assisted TKA may have improved 2-year postoperative outcomes.

Download Full-text

Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach

Bone and Joint Research ◽

10.1302/2046-3758.810.bjr-2019-0129.r1 ◽

2019 ◽

Vol 8 (10) ◽

pp. 495-501 ◽

Cited By ~ 15

Author(s):

Emily L. Hampp ◽

Nipun Sodhi ◽

Laura Scholl ◽

Matthew E. Deren ◽

Zachary Yenna ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Tissue Damage ◽

Soft Tissues ◽

Soft Tissue Damage ◽

Anatomical Structures ◽

Cruciate Retaining ◽

Robotic Assisted ◽

Total Knee

Objectives The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach. Methods A total of 12 fresh-frozen pelvis-to-toe cadaver specimens were included. Four surgeons each prepared three RATKA and three MTKA specimens for cruciate-retaining TKAs. A RATKA was performed on one knee and a MTKA on the other. Postoperatively, two additional surgeons assessed and graded damage to 14 key anatomical structures in a blinded manner. Kruskal–Wallis hypothesis tests were performed to assess statistical differences in soft-tissue damage between RATKA and MTKA cases. Results Significantly less damage occurred to the PCLs in the RATKA versus the MTKA specimens (p < 0.001). RATKA specimens had non-significantly less damage to the deep medial collateral ligaments (p = 0.149), iliotibial bands (p = 0.580), poplitei (p = 0.248), and patellar ligaments (p = 0.317). The remaining anatomical structures had minimal soft-tissue damage in all MTKA and RATKA specimens. Conclusion The results of this study indicate that less soft-tissue damage may occur when utilizing RATKA compared with MTKA. These findings are likely due to the enhanced preoperative planning with the robotic software, the real-time intraoperative feedback, and the haptically bounded saw blade, all of which may help protect the surrounding soft tissues and ligaments. Cite this article: Bone Joint Res 2019;8:495–501. DOI: 10.1302/2046-3758.810.BJR-2019-0129.R1.

Download Full-text

Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03512-5 ◽

2020 ◽

Vol 140 (10) ◽

pp. 1533-1549 ◽

Cited By ~ 2

Author(s):

James Randolph Onggo ◽

Jason Derry Onggo ◽

Richard De Steiger ◽

Raphael Hau

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Robotic Assisted ◽

Total Knee ◽

Conventional Total Knee Arthroplasty

Download Full-text

Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136190 ◽

2019 ◽

Vol 95 (1121) ◽

pp. 125-133 ◽

Cited By ~ 13

Author(s):

Yi Ren ◽

Shiliang Cao ◽

Jinxuan Wu ◽

Xisheng Weng ◽

Bin Feng

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cochrane Library ◽

Functional Score ◽

Time Range ◽

Mechanical Alignment ◽

Conventional Surgery ◽

Implant Position ◽

Robotic Assisted ◽

Total Knee

BackgroundIn the field of prosthetics, the ultimate goal is to improve the clinical outcome by using a technique that prolongs the longevity of prosthesis. Active robotic-assisted total knee arthroplasty (TKA) is one such technique that is capable of providing accurate implant position and restoring mechanical alignment. Although relevant studies have been carried out, the differences in the efficacy and reliability between active robotic-assisted TKA and conventional arthroplasty have not yet been adequately discussed.MethodsWe referenced articles, including randomised controlled trials and comparative retrospective research, from PubMed, Embase, Cochrane Library and Web of Science, in order to compare active robotic-assisted TKA with the conventional technique. Data extraction and quality assessment were conducted for each study. Statistical analysis was performed using Revman V. 5.3.ResultsSeven studies with a total of 517 knees undergoing TKA were included. Compared with conventional surgery, active robotic TKA showed better outcomes in precise mechanical alignment (mean difference, MD: − 0.82, 95% CI: −1.15 to − 0.49, p < 0.05) and implant position, with lower outliers (p < 0.05), better functional score (Western Ontario and McMaster University, Knee Society Score functional score) and less drainage (MD: − 293.28, 95% CI: − 417.77 to − 168.79, p < 0.05). No significant differences were observed when comparing the operation time, range of motion and complication rates.ConclusionThe current research demonstrates that active robotic-assisted TKA surgeries are more capable of improving mechanical alignment and prosthesis implantation when compared with conventional surgery. Further studies are required to investigate the potential benefits and long-term clinical outcomes of active robotic-assisted TKA.

Download Full-text