Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

AbstractRobotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, gender, comorbidities, Charlson-Comorbidity Index, and geographic region) were compared between cohorts. Annual primary and revision utilization rates as well as risk factors for revision procedures were also compared. Kaplan–Meier survivorship was also calculated. The Pearson χ2 test was used to test for significance in patient demographics, whereas the Welch t-test was used to compare the incidence of revisions as well as the revision burden (proportion of revisions to total sum of primary and revision procedures). Multivariate binomial logistic regression analysis was performed to compare risk factors for revision procedures. There were statistically significant differences in RAUKA versus MUKA patients with respect to age (p < 0.001), gender (p < 0.001), and region (p < 0.001). RAUKA procedures performed increased over 12-fold compared with manual, which increased only 4.5-fold. RAUKA procedures had significantly lower revision incidence (0.99 vs. 4.24%, p = 0.003) and revision burden (0.91 vs. 4.23%, p = 0.005) compared with manuals. For patients undergoing RAUKA, normal (19–24 kg/m2) and obese (30–39 kg/m2) body mass index (p < 0.05), congestive heart failure (p = 0.004), hypothyroidism (p < 0.001), opioid dependency (p = 0.002), and rheumatoid arthritis (p < 0.001) were risk factors for a revision procedure. Kaplan–Meier survival curve 3 years following the index procedure to all-cause revisions demonstrated that RAUKA patients maintained nearly 100% survivorship compared with manual patients who had 97.5% survivorship. The data demonstrate increased utilization of RAUKA in the United States. The current data indicated that RAUKA has significantly lower revision rates and improved survivorship compared with patients undergoing non-RAUKA within Medicare patients.

Download Full-text

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

Download Full-text

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

Download Full-text

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

Download Full-text

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.

Download Full-text