scholarly journals Early Economic Evaluation Demonstrates That Noncomputerized Tomography Robotic-Assisted Surgery Is Cost-Effective in Patients Undergoing Unicompartmental Knee Arthroplasty at High-Volume Orthopaedic Centres

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Leo M. Nherera ◽  
Sanjay Verma ◽  
Paul Trueman ◽  
Simon Jennings
Keyword(s):  
Cost Effectiveness ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Cost Effective ◽  
High Volume ◽  
Osteoarthritis Of The Knee ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Unicompartmental Knee

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.

scholarly journals Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre

2021 ◽  
Author(s):  
D. M. Moore ◽  
G. A. Sheridan ◽  
A. Welch-Phillips ◽  
J. M. O’Byrne ◽  
P. Kenny
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Womac Score ◽  
Long Term Results ◽  
Secondary Outcome ◽  
Osteoarthritis Of The Knee ◽  
Phase 3 ◽  
Unicompartmental Knee ◽  
Aseptic Revision

Abstract Purpose Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution. Methods This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years. Results A total of 64 cemented Oxford phase 3 UKAs were performed between January 2006 and November 2009. Fifteen-year follow-up data were available for 51 patients, of these 12 required revision. Survival rates, adjusting for patients that were either lost to follow-up or deceased, were 87.5% at 5 years, 81.4% at 10 years and 76.4% at 15 years. The overall aseptic revision rate at the time of review was 18.75% (n = 12). The only significant predictor of postoperative WOMAC score at 15 years was the preoperative WOMAC score (p = 0.03). Conclusion The Oxford Phase 3 UKA for medial tibio-femoral arthritis has promising outcomes at 15-year follow-up with a survival rate of 76.4% in a non-designer centre. Level of Evidence III.

Robotic-Assisted versus Manual Unicompartmental Knee Arthroplasty: Contemporary Systematic Review and Meta-analysis of Early Functional Outcomes

2020 ◽  
Author(s):  
Michael A. Gaudiani ◽  
Linsen T. Samuel ◽  
Atul F. Kamath ◽  
P. Maxwell Courtney ◽  
Gwo-Chin Lee
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Forest Plot ◽  
Robotic Assisted ◽  
Unicompartmental Knee ◽  
Surgeon Experience

AbstractRobotic-assisted unicompartmental knee arthroplasty (RA-UKA) aims to improve accuracy of component placement. Studies have shown improvement in radiographic positioning/alignment with RA-UKA but have not addressed clinical outcome measures (COMs). The purpose of this study was to determine if RA-UKA is associated with improved early revision rates and functional outcome scores (FOS) compared with manual UKA. A systematic review of all English language articles from 1999 to 2019 on RA-UKA using Medline, EMBASE, Scopus, and Web of Science databases identified 277 studies. Seven (three randomized controlled trials) met inclusion criteria. Revision rates/FOS were aggregated for RA-UKA and manual UKA; a forest plot was constructed utilizing inverse variance/Mantel–Haenszel fixed-effects meta-analysis. The seven articles included a total of 363 RA-UKA patients and 425 manual UKA patients. Mean age was 66 ± 3.5 and 65 ± 4.0 years, and mean body mass index (BMI) was 26.8 ± 2.1 and 27.1 ± 1.5 kg/m2, respectively. Mean follow-up was 25.5 months (4.5–48) and 29.1 months (4.5–48) for RA-UKA and manual UKA, respectively. At latest follow-up, RA-UKA patients showed a 26% ± 12 improvement in COMs versus 24% ± 12 improvement for manual UKA patients (p = 0.6). The revision rate was 3% for both groups (p = 0.8); however, a meta-analysis of RCTs showed no difference. Robotic and manual UKAs offer comparable improvements in pain, FOS, and revision rates. The effects of follow-up duration, ceiling effects of COMs, and surgeon experience remain unknown. Future studies comparing robotic versus manual UKAs with longer term follow-up may inform further benefits of each, with respect to component durability, alignment, and functional improvement.

scholarly journals O 017 - A five-year follow up of gait in robotic assisted vs conventional unicompartmental knee arthroplasty

2018 ◽  
Vol 65 ◽  
pp. 31-32 ◽  
Author(s):  
Lindsay Jane Millar ◽  
Matthew Banger ◽  
Philip John Rowe ◽  
Mark Blyth ◽  
Bryn Jones ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Robotic Assisted ◽  
Unicompartmental Knee

Robot-assisted unicompartmental knee arthroplasty for patients with isolated medial compartment osteoarthritis is cost-effective

2019 ◽  
Vol 101-B (9) ◽  
pp. 1063-1070 ◽  
Author(s):  
Nick D. Clement ◽  
David J. Deehan ◽  
James T. Patton
Keyword(s):  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
High Volume ◽  
Medial Compartment ◽  
Case Volume ◽  
Unicompartmental Knee ◽  
The Cost

Aims The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY. Patients and Methods A Markov decision analysis was performed, using known parameters for costs, outcomes, implant survival, and mortality, to assess the cost-effectiveness of rUKA relative to manual TKA and UKA for patients with isolated medial compartment OA of the knee with a mean age of 65 years. The influence of case volume and shorter hospital stay were assessed. Results Using a model with an annual case volume of 100 patients, the cost per QALY of rUKA was £1395 and £1170 relative to TKA and UKA, respectively. The cost per QALY was influenced by case volume: a low-volume centre performing ten cases per year would achieve a cost per QALY of £7170 and £8604 relative to TKA and UKA. For a high-volume centre performing 200 rUKAs per year with a mean two-day length of stay, the cost per QALY would be £648; if performed as day-cases, the cost would be reduced to £364 relative to TKA. For a high-volume centre performing 200 rUKAs per year with a shorter length of stay of one day relative to manual UKA, the cost per QALY would be £574. Conclusion rUKA is a cost-effective alternative to manual TKA and UKA for patients with isolated medial compartment OA of the knee. The cost per QALY of rUKA decreased with reducing length of hospital stay and with increasing case volume, compared with TKA and UKA. Cite this article: Bone Joint J 2019;101-B:1063–1070.

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