Robotic-assisted Unicompartmental knee Arthroplasty optimizes joint line restitution better than conventional surgery

Abstract Purpose To compare joint line restoration after unicompartmental knee arthroplasty (UKA) between conventional and robotic-assisted surgery. Previous studies have shown that joint line distalization can lead to higher failure rates. The hypothesis was that robotic-assisted UKA is associated with less femoral component distalization and a precise tibial cut, which allows a more anatomical restitution of the knee joint line. Methods Retrospective cohort study of patients undergoing medial or lateral UKA between May 2018 and March 2020. Preoperative and postoperative radiologic assessment of the joint line was performed by two observers, using three different methods, one for tibial slope and one for tibial resection. Robotic assisted UKA and conventional UKA groups were compared. Results Sixty UKA were included, of which 48 (77.42%) were medial. Robotic-assisted UKA were 40 (64.52%) and 22(35.48%) were conventional The distalization of the femoral component was higher in the conventional group despite the method of measurement used In both Weber methods, the difference was statistically different: Conventional 2.3 (0.9 to 5.6) v/s Robotic 1.5 (− 1.1 to 4.1) (p =0.0025*). A higher proportion of patients achieved a femoral component position ≤ two millimeters from the joint line using robotic-assisted UKA compared to the conventional technique . No statistical difference between robotic-assisted and conventional UKA was found in tibial resection and slope. Conclusion Robotic-assisted UKA shows a better rate of joint line restoration due to less femoral component distalization than conventional UKA. No difference was found in the amount of tibial resection between groups in this study. Level of evidence III

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Improved joint-line restitution in unicompartmental knee arthroplasty using a robotic-assisted surgical technique

International Orthopaedics ◽

10.1007/s00264-017-3633-9 ◽

2017 ◽

Vol 41 (11) ◽

pp. 2265-2271 ◽

Cited By ~ 39

Author(s):

Yannick Herry ◽

Cécile Batailler ◽

Timothy Lording ◽

Elvire Servien ◽

Philippe Neyret ◽

...

Keyword(s):

Surgical Technique ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Joint Line ◽

Robotic Assisted ◽

Unicompartmental Knee

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Robot-Assisted Unicompartmental Knee Arthroplasty: Increasing Surgical Accuracy? A Cadaveric Study

The Journal of Knee Surgery ◽

10.1055/s-0039-1698771 ◽

2019 ◽

Cited By ~ 4

Author(s):

Magaly Iñiguez ◽

Roberto Negrín ◽

Jaime Duboy ◽

Nicolás O. Reyes ◽

Rodrigo Díaz

Keyword(s):

Femoral Component ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Functional Results ◽

Tibial Slope ◽

Clinical Results ◽

Robot Assisted ◽

Post Surgery ◽

Unicompartmental Knee ◽

Significant Difference

AbstractUnicompartmental knee arthroplasty (UKA) represents 10% of knee arthroplasties. Advantages are better functional results, quicker recovery, shorter hospitalization time, and lower blood loss, among others. However, revision rates are larger than total knee arthroplasty. Among the most important factors that explain this are the implant position and alignment, and the correct surgical indication. Greater accuracy in the implant placement may improve clinical results and increase the rate of implant survival. The objective of this study is to evaluate the precision of the Navio robot-assisted system in the position and alignment of medial UKA compared with the conventional technique. This is an experimental pilot study. Twenty-six cadaveric models were randomized into 2 groups: Robot-Assisted surgery (R) and Conventional Surgery (C). Radiological study was performed pre- and post-surgery, evaluating the medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), tibial slope, tibiofemoral angle (TFA), sagittal femoral angle (SFA), and size of the femoral and tibial components. The main result measurement was the change in postoperative angulation. The results of this study are MDFA median of 1.07° (0.19–4.5) for group R and 0.12° (0.03–10.4) with a significant difference in variances; a Welch t-test of p = 0.013; and an MPTA of 1.28° (0.05–5.87) for R and 1.3°(0.08–14.1) for C with significantly different variances (p = 0.0064). Size of the femoral component has a difference of p < 0.05 between groups. No differences for dispersion of TFA nor for the size of the tibial component were observed. In conclusion, using robot-assisted UKA allows for greater accuracy in the positioning of the implants and in the prediction of the size of the femoral component.

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Radiological outcomes following manual and robotic-assisted unicompartmental knee arthroplasty

Bone & Joint Open ◽

10.1302/2633-1462.23.bjo-2020-0205.r1 ◽

2021 ◽

Vol 2 (3) ◽

pp. 191-197

Author(s):

Gregory S. Kazarian ◽

Robert L. Barrack ◽

Toby N. Barrack ◽

Charles M. Lawrie ◽

Ryan M. Nunley

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Robotic System ◽

Target Range ◽

Implant Survival ◽

Level Of Evidence ◽

Robotic Assisted ◽

Unicompartmental Knee ◽

Medial Unicompartmental Knee Arthroplasty ◽

Survival Level

Aims The purpose of this study was to compare the radiological outcomes of manual versus robotic-assisted medial unicompartmental knee arthroplasty (UKA). Methods Postoperative radiological outcomes from 86 consecutive robotic-assisted UKAs (RAUKA group) from a single academic centre were retrospectively reviewed and compared to 253 manual UKAs (MUKA group) drawn from a prior study at our institution. Femoral coronal and sagittal angles (FCA, FSA), tibial coronal and sagittal angles (TCA, TSA), and implant overhang were radiologically measured to identify outliers. Results When assessing the accuracy of RAUKAs, 91.6% of all alignment measurements and 99.2% of all overhang measurements were within the target range. All alignment and overhang targets were simultaneously met in 68.6% of RAUKAs. When comparing radiological outcomes between the RAUKA and MUKA groups, statistically significant differences were identified for combined outliers in FCA (2.3% vs 12.6%; p = 0.006), FSA (17.4% vs 50.2%; p < 0.001), TCA (5.8% vs 41.5%; p < 0.001), and TSA (8.1% vs 18.6%; p = 0.023), as well as anterior (0.0% vs 4.7%; p = 0.042), posterior (1.2% vs 13.4%; p = 0.001), and medial (1.2% vs 14.2%; p < 0.001) overhang outliers. Conclusion Robotic system navigation decreases alignment and overhang outliers compared to manual UKA. Given the association between component placement errors and revision in UKA, this strong significant improvement in accuracy may improve implant survival. Level of Evidence: III Cite this article: Bone Jt Open 2021;2-3:191–197.

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Radiographic and Clinical Evolution of the Oxford Unicompartmental Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1731718 ◽

2021 ◽

Author(s):

Riccardo D'Ambrosi ◽

Manuel J. de S.V. da Silva ◽

João L. M. Moura ◽

Ilaria Mariani ◽

Luca D. Serrao ◽

...

Keyword(s):

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Oxford Knee Score ◽

Tibial Slope ◽

Phase Iii ◽

Positive Correlation ◽

Tibial Resection ◽

Unicompartmental Knee ◽

Significant Difference ◽

Oxford Unicompartmental Knee Arthroplasty

AbstractThe aim of the study is to evaluate whether the use of the new instrumentation Microplasty (MP) improves component positioning and the reliability of the surgical technique, reducing the implant outliers from the recommended range and providing a more accurate resection, while avoiding insufficient or excessive tibial resection and clinical scores. We prospectively analyzed clinical and radiographic outcomes of three consecutive cohorts for a total of 227 implants at a minimum follow-up of 36 months. The first cohort consisted of 67 Oxford unicompartmental knee arthroplasty (OUKA), using the phase III (Ph-III). The second cohort consisted of 136 OUKA, with the MP instrumentation. The third cohort consisted of 24 hypoallergenic OUKA, using the MP instrumentation (TiNbN). Postoperative alignment of the knee in the coronal and sagittal plane was measured using radiographs. No clinical differences were found among the three groups (p > 0.05). A significant difference was found on the slope between Ph-III and MP (p = 0.0005). Moreover, a significant difference was found in tibial angle and in tibial slope in arthroplasty with femoral size small (S), compared with size medium (M) or large (Ly) (tibia varus/valugs angle: p = 0.0484; tibial slope: p = 0.04). Similar results were found between small (AA, A, B) tibial size and large (C, D, E, F) tibial size for tibial varus/valgus (p = 0.03) angle and tibial slope (p = 0.003). A significant difference was found between Ph-III and MP in tibial slope in patients with body mass index (BMI) ≥25 kg/m2 (p = 0.0003). A positive correlation was noted between the femoral and tibial sizes and the tibial angle and the slope, and a negative correlation between weight and the tibial slope; furthermore, a positive correlation was found between Oxford knee score and radiographic angles. The MP instrumentation seems to be effective in determining the tibial cut and, particularly, improving the tibial slope, compared with Ph-III. The tibial slope is directly affected by the weight and measurements of the components, regardless of the instruments or the number of pegs, while clinical outcomes are correlated with implant position. This prospective comparative study reflects level of evidence II.

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Improved sizing with image-based robotic-assisted system compared to image-free and conventional techniques in medial unicompartmental knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b4.bjj-2020-1453.r1 ◽

2021 ◽

Vol 103-B (4) ◽

pp. 610-618

Author(s):

Cecile Batailler ◽

Maxence Bordes ◽

Timothy Lording ◽

Ana Nigues ◽

Elvire Servien ◽

...

Keyword(s):

Ct Scan ◽

Free Group ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Surgical Techniques ◽

Conventional Technique ◽

Conventional Group ◽

Robotic Assisted ◽

Unicompartmental Knee ◽

Preoperative Ct

Aims Ideal component sizing may be difficult to achieve in unicompartmental knee arthroplasty (UKA). Anatomical variants, incremental implant size, and a reduced surgical exposure may lead to over- or under-sizing of the components. The purpose of this study was to compare the accuracy of UKA sizing with robotic-assisted techniques versus a conventional surgical technique. Methods Three groups of 93 medial UKAs were assessed. The first group was performed by a conventional technique, the second group with an image-free robotic-assisted system (Image-Free group), and the last group with an image-based robotic arm-assisted system, using a preoperative CT scan (Image-Based group). There were no demographic differences between groups. We compared six parameters on postoperative radiographs to assess UKA sizing. Incorrect sizing was defined by an over- or under-sizing greater than 3 mm. Results There was a higher rate of tibial under-sizing posteriorly in the conventional group compared to robotic-assisted groups (47.3% (n = 44) in conventional group, 29% (n = 27) in Image-Free group, 6.5% (n = 6) in Image-Based group; p < 0.001), as well as a higher rate of femoral under-sizing posteriorly (30.1% (n = 28) in conventional group, 7.5% (n = 7) in Image-Free group, 12.9% (n = 12) in Image-Based group; p < 0.001). The posterior femoral offset was more often increased in the conventional group, especially in comparison to the Image-Based group (43% (n = 40) in conventional group, 30.1% (n = 28) in Image-Free group, 8.6% (n = 8) in Image-Based group; p < 0.001). There was no significant overhang of the femoral or tibial implant in any groups. Conclusion Robotic-assisted surgical techniques for medial UKA decrease the risk of tibial and femoral under-sizing, particularly with an image-based system using a preoperative CT scan. Cite this article: Bone Joint J 2021;103-B(4):610–618.

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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

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