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

2019 ◽  
Vol 95 (1121) ◽  
pp. 125-133 ◽  
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.

Residual Mild Varus Alignment and Neutral Mechanical Alignment Have Similar Outcome after Total Knee Arthroplasty for Varus Osteoarthritis in Five-Year Follow-Up

2019 ◽  
Vol 33 (02) ◽  
pp. 200-205 ◽  
Author(s):  
Zhiqi Zhang ◽  
Can Liu ◽  
Zhiwen Li ◽  
Peihui Wu ◽  
Shu Hu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Weight Bearing ◽  
Primary Total Knee Arthroplasty ◽  
Functional Score ◽  
Mechanical Alignment ◽  
Knee Score ◽  
Neutral Group ◽  
Total Knee

AbstractThe effect of residual varus on survival rate and function in patients with varus knee osteoarthritis (OA) was considered an important issue for successful primary total knee arthroplasty (TKA). In this study, we compared the midterm clinical and functional outcomes in patients with different residual varus. A retrospective review of 175 patients (219 knees) with varus OA was > 3° for the hip-knee-ankle (HKA) who underwent primary TKA after exclusions and loss to follow-up from 237 patients (281 knees). The mean follow-up period was 5.2 ( ±  1.1) years. Patients were divided into four groups according to the first postoperative HKA angle from weight-bearing full-leg radiographs: “valgus” group (HKA angle > 0°, n = 44), “neutral” group (–3° ≤ HKA angle < 0°, n = 86), “mild varus” group (–6° ≤ HKA angle < –3°, n = 62), and “severe varus” group (HKA angle < –6°, n = 27). Survival analysis, Knee Society Score (KSS, including knee score and functional score), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared among the four groups. No knee required revision surgery during follow-up. For the KSS knee score and functional score at the last follow-up, the neutral and mild varus groups were better compared with the valgus and severe varus groups (p < 0.05), and there were no significant differences between the neutral and mild varus groups (p > 0.05). WOMAC scores of the neutral and mild varus groups were also better compared with the valgus and severe varus groups (p < 0.05), and there were no significant differences between the neutral and mild varus groups at the last follow-up. The postoperative HKA angle was significantly changed in valgus group between first and at the last follow-up when compared with the other three groups (p < 0.05). Leaving an HKA angle at < 6° varus had the same excellent functional outcome as neutral mechanical alignment after TKA for varus-type OA in the 5-year follow-up, using mechanically aligned technique. Caution is advised when leaving valgus or leaving severe varus after TKA.

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

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.

scholarly journals The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199822
Author(s):  
Youguang Zhuo ◽  
Rongguo Yu ◽  
Chunling Wu ◽  
Yuting Huang ◽  
Jie Ye ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Low Dose ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Postoperative Rehabilitation ◽  
Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

scholarly journals Reporting of post-operative rehabilitation interventions for Total knee arthroplasty: a scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nora Bakaa ◽  
Lu Hsi Chen ◽  
Lisa Carlesso ◽  
Julie Richardson ◽  
Luciana Macedo
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Scoping Review ◽  
Literature Search ◽  
Exercise Adherence ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Quality Of Reporting ◽  
Exercise Interventions ◽  
Total Knee

Abstract Objective The aim of this study was to evaluate the completeness of reporting of exercise adherence and exercise interventions delivered as part of clinical trials of post-operative total knee replacement (TKA) rehabilitation. Design: Scoping review Literature search A literature search was conducted in PubMed, EMBASE, AMED, CINAHL, SPORTDiscus and Cochrane Library. Study selection criteria All randomized controlled trials (RCT) that examined post-operative exercise-based interventions for total knee arthroplasty were eligible for inclusion. Studies that were multifactorial or contained exercise interventions for both hip and knee arthroplasty were also included. Data synthesis The definition, type of measurement used and outcome for exercise adherence were collected and analyzed descreptively. Quality of reporting of exercise interventions were assessed using the Consensus for Exercise Reporting Tool (CERT) and the Cochrane Risk of Bias Tool. Results There were a total of 112 RCTs included in this review. The majority of RCTs (63%, n = 71) did not report exercise adherence. Only 23% (n = 15) of studies provided a definition of adherence. RCTs were of poor quality, with 85% (n = 95) of studies having high or unclear risk of bias. Reporting of exercise interventions was poor, with only 4 items (of 19) (21%) of the CERT adequately reported (88–99%), with other items not fulfilled on at least 60% of the RCTs. There were no RCTs that had fulfilled all the criteria for the CERT. Conclusion The RCTs included in this study poorly reported exercise adherence, as well as description of the post-operative TKA rehabilitation intervention. Future RCTs should use valid and reliable measures of adherence and a proper tool for reporting of exercise interventions (e.g., CERT, TiDER). Pre-registration OSF:https://osf.io/9ku8a/

A cautionary case: osteoporotic femur fracture after robotic-assisted total knee arthroplasty

2021 ◽  
Author(s):  
H. E. Skibicki ◽  
D. Y. Ponzio ◽  
J. A. Brustein ◽  
Z. D. Post ◽  
A. C. Ong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femur Fracture ◽  
Robotic Assisted ◽  
Total Knee

Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position

2021 ◽  
Author(s):  
Pablo Besa ◽  
Rafael Vega ◽  
Gerardo Ledermann ◽  
Claudio Calvo ◽  
Manuela Angulo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Anatomical Landmark ◽  
Mechanical Alignment ◽  
Longus Tendon ◽  
Extensor Hallucis Longus ◽  
Tibial Cut ◽  
Total Knee

AbstractThis study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.

Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements

The Knee ◽  
2021 ◽  
Vol 31 ◽  
pp. 64-76
Author(s):  
Takao Kaneko ◽  
Tadashi Igarashi ◽  
Kazutaka Takada ◽  
Shu Yoshizawa ◽  
Hiroyasu Ikegami ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rotational Alignment ◽  
Robotic Assisted ◽  
Total Knee

scholarly journals Bone Cement Solidifiliation Influence the Limb Alignment and Gap Balance during TKA

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Dongquan Shi ◽  
Xingquan Xu ◽  
Anyun Guo ◽  
Jin Dai ◽  
Zhihong Xu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Mechanical Axis ◽  
Statistical Significance ◽  
Mechanical Alignment ◽  
Early Loosening ◽  
Flexion Extension ◽  
Before And After ◽  
Total Knee

Introduction. Mechanical alignment deviation after total knee arthroplasty is a major reason for early loosening of the prosthesis. Achieving optimum cement penetration during fixation of the femoral and tibial component is an essential step in performing a successful total knee arthroplasty. Bone cement is used to solidify the bone and prosthesis. Thickness imbalance of bone cement leads to the deviation of mechanical alignment. To estimate the influence of bone cement, a retrospective study was conducted.Materials and Methods. A total of 36 subjects were studied. All the TKA were performed following the standard surgical protocol for navigated surgery by medial approach with general anaesthesia. Prostheses were fixed by bone cement.Results. We compared the mechanical axis, flexion/extension, and gap balance before and after cementation. All the factors were different compared with those before and after cementation. Internal rotation was reached with statistical significance (P=0.03).Conclusion. Bone cement can influence the mechanical axis, flexion/extension, and gap balance. It also can prompt us to make a change when poor knee kinematics were detected before cementation.

scholarly journals Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Costas Papakostidis ◽  
Peter V. Giannoudis ◽  
J. Tracy Watson ◽  
Robert Zura ◽  
R. Grant Steen
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Readmission Rate ◽  
Meta Analysis ◽  
Deep Infection ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Serious Adverse Events ◽  
Surgical Methods ◽  
Total Knee

Abstract Background Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved. Methods To obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA with patient N > 1000, and the SAE or 30-dRR rate could be calculated. SAEs included return to operating room, death or coma, venous thromboembolism (VTE), deep infection or sepsis, myocardial infarction, heart failure or cardiac arrest, stroke or cerebrovascular accident, or pneumonia. Results Of 248 references reviewed, 28 are included, involving 10,153,503 patients; this includes 9,483,387 patients with primary TKA (pTKA), and 670,116 patients with revision TKA (rTKA). For pTKA, the SAE rate was 5.7% (95% CI 4.4−7.2%, I2 = 100%), and the 30-dRR was 4.8% (95% CI 4.3−5.4%, I2 = 100%). For rTKA, the SAE rate was 8.5% (95% CI 8.3−8.7%, I2 = 77%), while the 30-dRR was 7.2% (95% CI 6.4−8.0%, I2 = 81%). Odds of 30-dRR following pTKA were about half that of rTKA (OR 0.57, 95% CI 0.53−0.62%, p < 0.001, I2 = 45%). Of patients who received pTKA, the commonest SAEs were VTE (1.22%; 95% CI 0.83−1.70%) and genitourinary complications including renal insufficiency or renal failure (1.22%; 95% CI 0.83−1.67%). There has been significant improvement in SAE rate and 30-dRR since 2010 (χ2 test < 0.001). Conclusions TKA procedures have a relatively low complication rate, and there has been a significant improvement in SAE rate and 30-dRR over the past decade.

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