Patient reported and clinical outcomes of robotic-arm assisted unicondylar knee arthroplasty: Minimum two year follow-up

Introduction:Robotic-arm assisted (RAA) total knee arthroplasty (TKA) has been shown to potentially have certain pre- and intra-operative advantages over manual techniques. Although there are many studies on the alignment advantages when using the robotic-arm assisted (RAA) system for total knee arthroplasty (TKA), there have been questions regarding patient-reported outcomes. Therefore, the purpose of this study was to use this index to compare: 1) total; 2) physical function; and 3) pain scores for manual vs. RAA patients.Methods:We compared 53 consecutive robotic-arm assisted to 53 consecutive manual TKAs. No differences in pre-operative scores were found between the cohorts. Patients were administered a modified WOMAC satisfaction survey pre-operatively, and at 1-year post-operatively. Univariate analyses and multivariate models with stepwise backward linear regression were utilized to evaluate the associations between outcome scores and surgical technique, age, sex, as well as body mass index (BMI).Results:The RAA cohort had significantly improved mean total (6±6 vs. 9±8 points, p=0.03) and physical function scores (4±4 vs. 6±5 points, p=0.02) when compared to the manual cohort. The mean pain score for the RAA cohort [2±3 points (range, 0 to 14 points)], was also lower than that for the manual cohort [3±4 points (range, 0 to 11 points) (p=0.06)].On backward linear regression analyses, RAA was found to be significantly associated with more improved total (beta coefficient [β]-0.208, SE [standard error] 1.401, p<0.05), function (β=0.216, SE=0.829, p<0.05), and pain scores (β-0.181, SE=0.623, p=0.063). The RAA technique was found to have the strongest association with improved scores.Conclusion:With newer surgical technologies constantly being introduced, it is imperative to continue to evaluate these new modalities, particularly in their abilities to improve patient satisfaction outcomes. This study suggests that RAA patients may have short term improvements at minimum 1-year post-operative. However, longer-term follow up with greater sample sizes are needed to further validate these findings.

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Efficacy of a Second-Generation Rotating Bearing Tibial Platform in Total Knee Arthroplasty: A Prospective Observational Cohort Study with Registry Analysis

The Journal of Knee Surgery ◽

10.1055/s-0039-1678679 ◽

2019 ◽

Vol 33 (05) ◽

pp. 513-524 ◽

Cited By ~ 1

Author(s):

Corey Scholes ◽

Milad Ebrahimi ◽

Nalan Ektas ◽

John Ireland

Keyword(s):

Total Knee Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Second Generation ◽

Oxford Knee Score ◽

Consecutive Series ◽

Rotating Platform ◽

Patient Reported ◽

Total Knee

AbstractThere is a lack of clinical outcomes reported for the rotating bearing knee (RBK) total knee arthroplasty (TKA), which is a second-generation rotating platform knee, with purported benefits over earlier versions. The purpose of the study was to report the complications, short-term (minimum 1 year) patient-reported outcomes and long-term (up to 15 years) procedure survival in a consecutive series of patients receiving a rotating platform TKA (RBK) from an independent clinic. A retrospective analysis of a single-surgeon, private/public practice, with prospectively collected data in a subset of patients were performed. A total of 1,130 procedures (primary, revision from unicompartmental knee arthroplasty (UKA) to TKA) were crossmatched with manufacturer records. Clinical outcomes (complications, reoperations) were summarized and linked to patient-reported outcome measures (Eq. 5D, KSS-function, Oxford knee score [OKS]). OKS results were classified using minimally clinical important difference (MCID) and patient acceptable symptom state (PASS). PROMs were summarized and regression models used to determine relationships between patient factors and outcomes in this cohort. Cumulative percent revision was reported by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) and compared between the senior author and national data using Kaplan–Meier survival analysis. We report a complication rate of 19.7% with the majority (> 60%) being thromboembolic events and complaints of stiffness. Significant improvements were observed in general health, knee pain, and function with > 89% exceeding the MCID for the OKS and > 65% exceeding the PASS for the OKS at an average follow-up of 3.2 years. We report a cumulative revision rate of 4.3% at 5 years and 4.8% at 14 years, with significantly lower revision rates in females and patients aged 55 to 64 years compared with AOANJRR data for fixed bearing designs. The RBK rotating platform TKA provides good functional outcomes, with relatively low revision and complications rates at up to 14 years follow-up. This design in conjunction with a gap balancing technique may be advantageous in certain patient subgroups.

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Robotic arm-assisted versus conventional medial unicompartmental knee arthroplasty: five-year clinical outcomes of a randomized controlled trial

The Bone & Joint Journal ◽

10.1302/0301-620x.103b6.bjj-2020-1355.r2 ◽

2021 ◽

Vol 103-B (6) ◽

pp. 1088-1095 ◽

Cited By ~ 1

Author(s):

Matthew Banger ◽

James Doonan ◽

Philip Rowe ◽

Bryn Jones ◽

Angus MacLean ◽

...

Keyword(s):

Clinical Outcomes ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Controlled Trial ◽

Patient Reported Outcome Measures ◽

Primary Outcome Measure ◽

Patient Reported Outcome ◽

Robotic Arm ◽

Unicompartmental Knee ◽

Patient Reported

Aims Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarthritis localized to a single compartment in the knee. The success of the procedure is sensitive to patient selection and alignment errors. Robotic arm-assisted UKA provides technological assistance to intraoperative bony resection accuracy, which is thought to improve ligament balancing. This paper presents the five-year outcomes of a comparison between manual and robotically assisted UKAs. Methods The trial design was a prospective, randomized, parallel, single-centre study comparing surgical alignment in patients undergoing UKA for the treatment of medial compartment osteoarthritis (ISRCTN77119437). Participants underwent surgery using either robotic arm-assisted surgery or conventional manual instrumentation. The primary outcome measure (surgical accuracy) has previously been reported, and, along with secondary outcomes, were collected at one-, two-, and five-year timepoints. Analysis of five-year results and longitudinal analysis for all timepoints was performed to compare the two groups. Results Overall, 104 (80%) patients of the original 130 who received surgery were available at five years (55 robotic, 49 manual). Both procedures reported successful results over all outcomes. At five years, there were no statistical differences between the groups in any of the patient reported or clinical outcomes. There was a lower reintervention rate in the robotic arm-assisted group with 0% requiring further surgery compared with six (9%) of the manual group requiring additional surgical intervention (p < 0.001). Conclusion This study has shown excellent clinical outcomes in both groups with no statistical or clinical differences in the patient-reported outcome measures. The notable difference was the lower reintervention rate at five years for roboticarm-assisted UKA when compared with a manual approach. Cite this article: Bone Joint J 2021;103-B(6):1088–1095.

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Patient-reported outcome after patient-specific unicondylar knee arthroplasty for unicompartmental knee osteoarthritis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03776-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Viola Freigang ◽

Markus Rupp ◽

Christian Pfeifer ◽

Michael Worlicek ◽

Stefan Radke ◽

...

Keyword(s):

Patient Satisfaction ◽

Knee Arthroplasty ◽

Patient Reported Outcome ◽

Unicondylar Knee Arthroplasty ◽

Patient Specific ◽

Function Score ◽

Leg Axis ◽

Custom Made ◽

Patient Reported

Abstract Background Unicondylar knee arthroplasty was introduced in the late 1960s and remains a topic of controversial discussion. Patient-specific instruments and patient-specific implants are not yet the standard of care. The question remains whether this time-consuming and costly technique can be beneficial for the patient. The aim of this study was to evaluate whether a custom-made unicondylar knee arthroplasty leads to improved patient-reported outcome. Methods This retrospective study evaluates the patient-reported outcome after custom-made unicondylar knee arthroplasty (CM-UKA, ConforMIS™ iUni® G2, ConforMIS Inc., Billerica, MA, USA). We evaluated 29 patients (31 knees) at an average of 2.4 years (range 1.2–3.6 years) after operation for unicondylar osteoarthritis of the knee. The target zone for the postoperative leg axis was a slight under-correction of 0–2° varus. Follow-up evaluation included the Forgotten Joint Score (FJS), the Knee Society Score (KSS), a Visual Analogue Scale (VAS) and a radiographic evaluation including a long-leg radiograph. Primary outcome measure was patient satisfaction based on the Forgotten Joint Score. Results We found an excellent postoperative health-related quality of life with a mean FJS of 76.8 (SD 17.9) indicating a low level of joint awareness after CM-UKA. The mean preoperative KSS was 66.0 (SD 13.71) and 59.4 (17.9) for the KSS function score. The increase was 22.8 points for the KSS knee score (p < 0.0001) and 34.8 points for the KSS function score (p < 0.0001). The VAS for pain decreased from a mean of 5.4 (SD 1.8) to 1.1 (SD 1.2) (p < 0.0001). The malalignment rate with a postoperative deviation of more than 2° in the leg axis was 29%. There was no evidence of component loosening after a mean follow-up of 2.4 years. Conclusions Custom-made unicondylar knee arthroplasty (CM-UKA) can provide improved clinical and functional outcomes for patients with isolated knee osteoarthritis of the medial compartment. We found excellent results regarding patient satisfaction and a low malalignment rate for CM-UKA. Further studies are needed to investigate long-term survivorship of the implant. Level of evidence Level IV. Trial registration Trial Registration number: Z-2014-0389-10 Regensburg Clinical Studies Center (REGCSC) 09/07/2014.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04205-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jake von Hintze ◽

Mika Niemeläinen ◽

Harri Sintonen ◽

Jyrki Nieminen ◽

Antti Eskelinen

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Survival Rate ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Patient Reported ◽

Total Knee ◽

Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

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Midterm results of a new personalized knee implant for total knee arthroplasty: implant survivorship and patient-reported outcome after five years’ follow-up

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02959-5 ◽

2021 ◽

Author(s):

Cristina Dauder Gallego ◽

Irene Blanca Moreno Fenoll ◽

José Luis Patiño Contreras ◽

Francisco Javier Moreno Coronas ◽

María del Carmen Torrejón de la Cal ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcome ◽

Midterm Results ◽

Implant Survivorship ◽

Patient Reported ◽

Total Knee

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Correction to: Robotic‑arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta‑analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06522-x ◽

2021 ◽

Author(s):

Junren Zhang ◽

Wofhatwa Solomon Ndou ◽

Nathan Ng ◽

Paul Gaston ◽

Philip M. Simpson ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Meta Analysis ◽

Robotic Arm ◽

Patient Reported ◽

Total Knee ◽

Improved Accuracy

A correction to this paper has been published: https://doi.org/10.1007/s00167-021-06522-x

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Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119888173 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711988817 ◽

Cited By ~ 1

Author(s):

Darby A. Houck ◽

John W. Belk ◽

Armando F. Vidal ◽

Eric C. McCarty ◽

Jonathan T. Bravman ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Cochrane Library ◽

Recurrence Rates ◽

Capsular Release ◽

Arthroscopic Capsular Release ◽

Patient Reported ◽

Lateral Decubitus ◽

Beach Chair

Background: Arthroscopic capsular release (ACR) for the treatment of adhesive capsulitis of the shoulder can be performed in either the beach-chair (BC) or lateral decubitus (LD) position. Purpose: To determine the clinical outcomes and recurrence rates after ACR in the BC versus LD position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library databases for studies reporting clinical outcomes of patients undergoing ACR in either the BC or LD position. All English-language literature from 1990 through 2017 reporting on clinical outcomes after ACR with a minimum 3-month follow-up were reviewed by 2 independent reviewers. Recurrence rates, range of motion (ROM) results, and patient-reported outcome (PRO) scores were collected. Study methodological quality was evaluated using the modified Coleman Methodology Score (MCMS). Results: A total of 30 studies (3 level 1 evidence, 2 level 2 evidence, 4 level 3 evidence, 21 level 4 evidence) including 665 shoulders undergoing ACR in the BC position (38.1% male; mean age, 52.0 ± 3.9 years; mean follow-up, 35.4 ± 18.4 months) and 603 shoulders in the LD position (41.8% male; mean age, 53.0 ± 2.3 years; mean follow-up, 37.2 ± 16.8 months) were included. There were no significant differences in overall mean recurrence rates between groups (BC, 2.5%; LD, 2.4%; P = .81) or in any PRO scores between groups ( P > .05). There were no significant differences in improvement in ROM between groups, including external rotation at the side (BC, 36.4°; LD, 42.8°; P = .91), forward flexion (BC, 64.4°; LD, 79.3°; P = .73), abduction (BC, 77.8°; LD, 81.5°; P = .82), or internal rotation in 90° of abduction (BC, 40.8°; LD, 45.5°; P = .70). Significantly more patients in the BC group (91.6%) underwent concomitant manipulation than in the LD group (63%) ( P < .0001). There were significantly more patients with diabetes in the LD group (22.4%) versus the BC group (9.6%) ( P < .0001). Conclusion: Low rates of recurrent shoulder stiffness and excellent improvements in ROM can be achieved after ACR in either the LD or BC position. Concomitant manipulation under anesthesia is performed more frequently in the BC position compared with the LD position.

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Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies

Children ◽

10.3390/children8070587 ◽

2021 ◽

Vol 8 (7) ◽

pp. 587

Author(s):

Isabel I. Sreeram ◽

Chantal A. ten Kate ◽

Joost van Rosmalen ◽

Johannes M. Schnater ◽

Saskia J. Gischler ◽

...

Keyword(s):

Linear Regression ◽

Clinical Outcomes ◽

Outcome Measures ◽

Clinical Decision Making ◽

Linear Regression Analysis ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Added Value ◽

Patient Reported

Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.

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