The Accuracy and Clinical Success of Robotic-Assisted Total Knee Arthroplasty

Background: Robotic-assisted total knee arthroplasty (rTKA) has emerged as a patient-specific customizable tool that enables 3-dimensional preoperative planning, intraoperative adjustment, robotic-assisted bone preparation, and soft-tissue protection. Haptic rTKA may enhance component positioning, but only a few small studies have examined patient satisfaction and clinical outcomes after haptic rTKA. Purpose: In patients who underwent haptic rTKA, we sought to evaluate (1) the discrepancy in alignment between the executed surgical plan and implanted alignment in the coronal and sagittal planes 1 year postoperatively and (2) patient-reported outcomes 2 years postoperatively. Methods: From a prospectively collected database, we reviewed 105 patients who underwent haptic rTKA from August 2016 to May 2017. Two fellowship-trained arthroplasty surgeons independently reviewed hip-to-ankle standing biplanar radiographs to measure overall limb alignment and individual tibial and femoral component alignment relative to the mechanical axis and compared this to the executed surgical plan. Patient-reported outcomes were collected preoperatively and at 2 years postoperatively using the Lower Activity Extremity Score (LEAS), Knee Injury and Osteoarthritis Outcome Score Junior (KOOS Jr.), and Numeric Pain Rating Scale (NPRS). Results: Mean patient age was 62.4 years, and mean body mass index was 30.6 kg/m2. Interobserver reliability was significant with a κ of 0.89. Absolute mean deviations in postoperative coronal alignment compared to intraoperative alignment were 0.625° ± 0.70° and 0.45° ± 0.50° for the tibia and femur, respectively. Absolute mean deviations in postoperative tibial sagittal alignment were 0.47° ± 0.76°. Overall mechanical alignment was 0.97° ± 1.79°. Outcomes in LEAS, KOOS Jr., and NPRS changed from 8 to 10, 78 to 88.3, and 8 to 1, respectively. Conclusions: Haptic rTKA demonstrated high reliability and accuracy (less than 1°) of tibial coronal, femoral coronal, and tibial sagittal component alignment postoperatively compared to the surgical plan. Patient-reported outcomes improved, as well. A more rigorous study on long-term outcomes is warranted.

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Patient-Specific Simulated Dynamics After Total Knee Arthroplasty Correlate With Patient-Reported Outcomes

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.04.035 ◽

2018 ◽

Vol 33 (9) ◽

pp. 2843-2850 ◽

Cited By ~ 3

Author(s):

Joshua G. Twiggs ◽

Edgar A. Wakelin ◽

Justin P. Roe ◽

David M. Dickison ◽

Brett A. Fritsch ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Patient Specific ◽

Patient Reported ◽

Total Knee

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One and Two Year Postoperative Patient Reported Outcomes of Robotic-Assisted Total Knee Arthroplasty

10.29007/n4qv ◽

2019 ◽

Author(s):

Christopher Blum ◽

Christopher Plaskos ◽

Adil Hussein ◽

Jan A Koenig

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Computer Assisted ◽

Robotic Assisted ◽

Post Surgery ◽

Patient Reported ◽

National Cohort ◽

Total Knee ◽

And Function

Total knee arthroplasty is a successful procedure. However, there is still area for improvement as up to 15-20% of patients remain unsatisfied. Robotic-assisted surgery (RAS) may improve patient outcomes by providing a reproducible way of obtaining neutral mechanical alignment of the limb, which has been shown to reduce early revisions and correlate with patient reported outcomes after surgery.We prospectively enrolled 106 patients undergoing robotic-assisted TKA by a single surgeon performing a measured-resection femur-first technique using the OMNIBotic system. Patients completed a KOOS and New Knee Society Score (KSS) pre-operatively and at 3, 6, 12, and 24 months (M) postoperatively. Changes in the five KOOS sub-scales were compared to available literature data from the FORCE – TJR cohort, as well as to individual studies reporting on conventional and computer-assisted TKA.When compared to FORCE-TJR 6-month (M) and 2-year (Y) data, the RAS cohort had significantly higher improvements at 6M for pain (40.5 vs. 31.1, p<.001) and at 2Y for all five KOOS sub-scores. The larger improvement was due to the RAS cohort having lower baseline KOOS scores than the FORCE-TJR cohort, except for the Sports-Recreation sub-score, which was similar pre- operatively but significantly higher post-operatively for the robotic cohort. Rates of dissatisfaction with knee pain level and function using the KSS after RAS were 3.0%, 1.0%, and 2.7% at 6, 12, and 24M postoperatively, respectively.Despite having poorer joint function and higher pain pre-operatively, robotic-assisted TKA patients achieved excellent self-reported outcomes, with significantly higher levels of improvement through two years post-surgery when compared with large national cohort studies. Further controlled clinical studies are warranted to determine if these results translate to other groups of surgeons, centers and patients.

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Relative Clinical Outcomes Comparing Manual and Robotic-Assisted Total Knee Arthroplasty at Minimum 1-Year Follow-up

HSS Journal ® ◽

10.1177/15563316211028568 ◽

2021 ◽

pp. 155633162110285

Author(s):

Joseph Mitchell ◽

Jesse Wang ◽

Brett Bukowski ◽

Justin Greiner ◽

Brianna Wolford ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Complication Rates ◽

Readmission Rates ◽

Robotic Assisted ◽

Primary Tkas ◽

Patient Reported ◽

Total Knee

Background: Total knee arthroplasty (TKA) demonstrates excellent durability using jig-based manual techniques (manual TKA [mTKA]), but significant rates of dissatisfaction remain. Modifications of mTKA techniques and TKA implant designs to improve outcomes have had minimal success. Studies comparing relative outcomes of mTKA and robotic-assisted TKA (raTKA) are limited. Purpose: This study sought to compare outcomes of mTKA and raTKA in patients at a single institution. Methods: We retrospectively reviewed all primary TKAs performed by 1 surgeon from 2015 to 2017. In all, 139 consecutive mTKAs (2015–2016) and 148 consecutive raTKAs (2016–2017) were included. No cases were excluded. Patient demographics, complications, readmission rates, and clinical and patient-reported outcomes were compared at a minimum of 1-year follow-up. A post hoc student t test and Pearson χ2 test were used for continuous and categorical data. Results: We found that mTKA patients compared with raTKA patients required significantly longer length of stay (LOS) (1.73 vs 1.18 days, respectively), greater morphine milligram equivalents consumption (89.6 vs 65.2, respectively), and increased physical therapy (PT) visits (13.0 vs 11.0, respectively) with increased 30-day readmission rates (4.3 vs 0.7%, respectively) that approached significance. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and the University of California at Los Angeles activity score did not differ significantly comparing raTKA with mTKA patients at 1 year. There were no differences in complication rates. Conclusion: Significant early clinical benefits were noted with raTKA, including lower opioid requirements, shorter LOS, and fewer PT visits when compared with mTKA. A reduction in 30-day readmission rates was noted with raTKA that was not significant. Excellent clinical results with similar patient-reported outcomes were noted in both groups at 1-year follow-up. Further prospective investigations at longer follow-up intervals comparing these techniques are warranted.

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Mid-term Patient Reported Outcomes and Survivorship Following Robotic Assisted Total Knee Replacement: A Cohort Study

10.29007/m8xk ◽

2019 ◽

Author(s):

Eric Chen ◽

Adil Husain ◽

Nicholas Billow ◽

Jan Koenig ◽

Christopher Plaskos

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

The United States ◽

Robotic Assisted ◽

Cutting Guide ◽

Patient Reported ◽

Total Knee ◽

Navigated Tka

Despite the advantages of real time alignment assessment and visual feedback while balancing offered by robotic assisted total knee arthroplasty, few clinical studies have reported patient outcomes. The purpose of this study is to report the midterm patient reported outcomes and survivorship of a computer-navigated TKA system with a robotic cutting guide. This patient cohort is the first IRB approved series of patients treated in the United States with this robotic knee system. This study serves as a midterm follow-up study on for this cohort, upon which learning curve, intra-operative efficiency, and deformity management were previously reportedRecipients of 152 consecutive total knee arthroplasties using a computer- navigated TKA system performed by a single surgeon between June 2010 and January 2012 were surveyed between 5-7 years post-operatively. 94 patients were reachable for outcome measures and survivorship data was obtained in 98 patients. Mean patient age at follow up was 74.6 +/- 8.6 years. Implant survivorship was 99.0% at an average of 6.5 years. Mean patient reported knee outcome scores were 62.7 (KSS-SF) and 79.5 (KOOS-JR). Overall satisfaction rate was reported as “satisfied or very satisfied” in 80.2%, “neutral” in 11.0%, and “dissatisfied or very dissatisfied” in 7.7% of patients.Robotic assisted total knee arthroplasty using a computer-navigated TKA system with a robotic cutting guide appears to provide a durable outcome with sustainable midterm patient reported outcomes and excellent survivorship. Further follow up is required to determine if there are long term outcome and survivorship benefits of robotic assisted total knee arthroplasty.

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The Use of Customized Total Knee Arthroplasty Implants to Increase Efficiency in the Operating Room and Improve Patient Outc

Medical Research Archives ◽

10.18103/mra.v9i7.2474 ◽

2021 ◽

Vol 9 (7) ◽

Author(s):

Raj Sinha

Keyword(s):

Total Knee Arthroplasty ◽

Operating Room ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Knee Kinematics ◽

Anatomic Reconstruction ◽

Patient Specific ◽

Patient Specific Implants ◽

Patient Reported ◽

Total Knee

Operating room efficiency during surgical procedures saves time and money, reduces waste of hospital resources and improves staff morale. Surgical efficiency in orthopaedic surgery can decrease medical complications, such as periprosthetic infection and venous thromboembolic disease, but also must be associated with equivalent or improved longer term patient reported outcomes. In total knee arthroplasty, the instruments used for bone preparation are excessive in number, are frequently redundant, and rely upon achieving average alignment and rotational parameters. As a result, approximately 15-25% of patients report dissatisfaction with their knee reconstructions. Patient specific customized instruments and patient specific implants improve intraoperative efficiency by reducing surgical steps and eliminating redundant steps. Further, because the customized instruments and implants provide anatomic reconstruction of each individual patient, patient reported outcomes have been higher. Additional demonstrated benefits include improved knee alignment and knee kinematics. This paper addresses the various sources of operating room inefficiency, provides suggestions to overcome them, and discusses the first decade of experience with the customized guides for customized implants as a method to improve efficiency.

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Should we abandon the patient-specific instrumentation ship in total knee arthroplasty? Not quite yet!

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04581-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

László Török ◽

Péter Jávor ◽

Petra Hartmann ◽

László Bánki ◽

Endre Varga

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Patient Specific ◽

Transfusion Rate ◽

Component Alignment ◽

Patient Specific Instrumentation ◽

Patient Reported ◽

Total Knee

AbstractPatient-specific Instrumentation (PSI) is an innovative technique aiding the precise implementation of the preoperative plan during total knee arthroplasty (TKA) by using patient-specific guides and cutting blocks. Despite of the theoretical advantages, studies have reported contradictory results, thus there is no consensus regarding the overall effectiveness of PSI. Through the critical assessment of a meta-analysis published lately, this correspondence aims to highlight the complexity of comparing the efficacy of PSI to standard instrumentation (SI). The accuracy of component alignment, patient-reported outcome measures (PROMs), surgery time, blood loss, transfusion rate, and postoperative complications are commonly used outcomes for investigating the efficacy of PSI-aided TKA. By assessing component alignment, the expertise of the surgeon(s) should be taken into consideration, since PSI may not provide benefits for expert surgeons but might improve accuracy and patient safety during the learning curve of novice surgeons. With respect to PROMs and postoperative complications, PSI may not improve short-term results; however, long-term follow up data is missing. Regarding transfusion rates, favorable trends can be observed, but further studies utilizing recent data are needed for a clear conclusion. When assessing surgery time, we suggest focusing on operating room turnover instead of procedure time.

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Impact of Preoperative Opioid Use on Patient-Reported Outcomes after Revision Total Knee Arthroplasty: A Propensity Matched Analysis

The Journal of Knee Surgery ◽

10.1055/s-0041-1729966 ◽

2021 ◽

Author(s):

Eitan Ingall ◽

Christian Klemt ◽

Christopher M. Melnic ◽

Wayne B. Cohen-Levy ◽

Venkatsaiakhil Tirumala ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Propensity Score ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Opioid Use ◽

Absolute Increase ◽

Patient Reported ◽

Total Knee ◽

Opioid Users ◽

Revision Tka

AbstractThis is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre- and postoperative PROMs was identified. Due to differences in baseline characteristics, 99 opioid users were matched to 198 nonusers using the nearest-neighbor propensity score matching. Pre- and postoperative knee disability and osteoarthritis outcome score physical function (KOOS-PS), patient reported outcomes measurement information system short form (PROMIS SF) physical, PROMIS SF mental, and physical SF 10A scores were evaluated. Opioid use was identified by the medication reconciliation on the day of surgery. Propensity score–matched opioid users had significantly lower preoperative PROMs than the nonuser for KOOS-PS (45.2 vs. 53.8, p < 0.01), PROMIS SF physical (37.2 vs. 42.5, p < 0.01), PROMIS SF mental (44.2 vs. 51.3, p < 0.01), and physical SF 10A (34.1 vs. 36.8, p < 0.01). Postoperatively, opioid-users demonstrated significantly lower scores across all PROMs: KOOS-PS (59.2 vs. 67.2, p < 0.001), PROMIS SF physical (43.2 vs. 52.4, p < 0.001), PROMIS SF mental (47.5 vs. 58.9, p < 0.001), and physical SF 10A (40.5 vs. 49.4, p < 0.001). Propensity score–matched opioid-users demonstrated a significantly smaller absolute increase in scores for PROMIS SF Physical (p = 0.03) and Physical SF 10A (p < 0.01), as well as an increased hospital length of stay (p = 0.04). Patients who are actively taking opioids at the time of revision TKA report significantly lower preoperative and postoperative outcome scores. These patients are more likely to have longer hospital stays. The apparent negative effect on patient reported outcomes after revision TKA provides clinically useful data for surgeons in engaging patients in a preoperative counseling regarding narcotic use prior to revision TKA to optimize outcomes.

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