scholarly journals Robotic technology: current concepts, operative techniques and emerging uses in unicompartmental knee arthroplasty

2020 ◽  
Vol 5 (5) ◽  
pp. 312-318
Author(s):  
Fahima A. Begum ◽  
Babar Kayani ◽  
Samuel D. J. Morgan ◽  
Syed S. Ahmed ◽  
Sandeep Singh ◽  
...  
Keyword(s):  
Learning Curve ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Outcomes ◽  
Inpatient Rehabilitation ◽  
Case Volume ◽  
Implant Positioning ◽  
Unicompartmental Knee ◽  
Implant Survivorship

Unicompartmental knee arthroplasty (UKA) is associated with improved functional outcomes but reduced implant survivorship compared to total knee arthroplasty (TKA). Surgeon-controlled errors in component positioning are the most common reason for implant failure in UKA, and low UKA case-volume is associated with poor implant survivorship and earlier time to revision surgery. Robotic UKA is associated with improved accuracy of achieving the planned femoral and tibial component positioning compared to conventional manual UKA. Robotic UKA has a learning curve of six operative cases for achieving operative times and surgical team comfort levels comparable to conventional manual UKA, but there is no learning curve effect for accuracy of implant positioning or limb alignment. Robotic UKA is associated with reduced postoperative pain, decreased opiate analgesia requirements, faster inpatient rehabilitation, and earlier time to hospital discharge compared to conventional manual UKA. Limitations of robotic UKA include high installation costs, additional radiation exposure with image-based systems, and paucity of studies showing any long-term differences in functional outcomes or implant survivorship compared to conventional manual UKA. Further clinical studies are required to establish how statistical differences in accuracy of implant positioning between conventional manual UKA and robotic UKA translate to long-term differences in functional outcomes, implant survivorship, complications, and cost-effectiveness. Cite this article: EFORT Open Rev 2020;5:312-318. DOI: 10.1302/2058-5241.5.190089

A systematic review of robotic-assisted unicompartmental knee arthroplasty

2019 ◽  
Vol 101-B (7) ◽  
pp. 838-847 ◽  
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.

scholarly journals Patient Satisfaction, Functional Outcomes, and Implant Survivorship in Patients Undergoing Customized Unicompartmental Knee Arthroplasty

2021 ◽  
Vol 11 (8) ◽  
pp. 753
Author(s):  
Cyrus Anthony Pumilia ◽  
Lennart Schroeder ◽  
Nana O. Sarpong ◽  
Gregory Martin
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Functional Outcomes ◽  
Phone Call ◽  
Survivorship Analysis ◽  
Computed Tomography Images ◽  
Unicompartmental Knee ◽  
Implant Survivorship ◽  
Patient Reported

Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m2. Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1–3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1–8.7) and 97.9% at an average of 4.8 years (range: 2.0–8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were “very satisfied,” 26% were “satisfied,” 4% were “neutral,” 2% were “dissatisfied,” and 1% were “very dissatisfied.” When asked if the knee felt “natural,” 60% responded with “always,” 35% responded with “sometimes,” and 5% responded with “never.” After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.

scholarly journals Robotic technology in total knee arthroplasty: a systematic review

2019 ◽  
Vol 4 (10) ◽  
pp. 611-617 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Atif Ayuob ◽  
Elliot Onochie ◽  
Talal Al-Jabri ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Learning Curves ◽  
Robotic Technology ◽  
Soft Tissue Envelope ◽  
Implant Positioning ◽  
Total Knee

Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA. Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7–20 robotic TKA cases. Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA. Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA. Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022

scholarly journals All-Polyethylene Tibial Component Does Not Affect Survivorship of Medial Unicompartmental Knee Arthroplasty at Mid-Term Follow-Up

2020 ◽  
Author(s):  
Michele Gagliardi ◽  
Francesco Zambianchi ◽  
Alois Franz ◽  
Vitantonio Digennaro ◽  
Fabio Catani
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Tibial Component ◽  
Varus Deformity ◽  
Implant Positioning ◽  
Unicompartmental Knee ◽  
Kaplan Meier ◽  
Medial Unicompartmental Knee Arthroplasty

AbstractThe present study's primary aim was to determine the survivorship of a large cohort of patients implanted with a single design all-polyethylene tibial component medial unicompartmental knee arthroplasty (UKA). Its secondary purpose was to investigate the reasons underlying implant failure, with specific attention to component positioning and limb alignment. Between 2007 and 2013, 166 patients underwent medial UKA with a single design all-polyethylene tibial component at two centers. Preoperatively and postoperatively, patients were administered clinical outcome scores and radiographic information were collected. Postoperative complications and causes of revision were recorded. A total of 140 patients (80 in Center A and 60 in Center B) who underwent all-polyethylene tibial component medial UKA (82 cases in Center A and 60 in Center B) were taken into account. Kaplan–Meier cumulative survivorship of implants was 96.5% (confidence interval [CI]: 91.7–98.6%) at an average follow-up of 61.1 months. Tibial aseptic loosening was accounted for failure in one case, while no correlation was found between implant positioning and failure. Two revisions were performed in Center A and three in Center B. Slight correction of the preoperative varus deformity was performed at both centers. All-polyethylene tibial component UKA provided satisfactory clinical and functional outcome, with excellent survival rate in the early and mid-term follow-up. Continued patient follow-up is needed to determine long-term survivorship of the examined UKA model.

scholarly journals A systematic review of imageless hand-held robotic-assisted knee arthroplasty: learning curve, accuracy, functional outcome and survivorship

2020 ◽  
Vol 5 (5) ◽  
pp. 319-326
Author(s):  
Nicholas D. Clement ◽  
Marwan Al-Zibari ◽  
Irrum Afzal ◽  
David J. Deehan ◽  
Deiary Kader
Keyword(s):  
Systematic Review ◽  
Learning Curve ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Reporting Accuracy ◽  
Robotic Assisted ◽  
Implant Positioning ◽  
Implant Survivorship

The aim of this systematic review was to present and assess the quality of evidence for learning curve, component positioning, functional outcomes and implant survivorship for image-free hand-held robotic-assisted knee arthroplasty. Searches of PubMed and Google Scholar were performed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The criteria for inclusion was any published full-text article or abstract assessing image-free hand-held robotic knee arthroplasty and reporting learning curve, implant positioning, functional outcome or implant survival for clinical or non-clinical studies. There were 22 studies included. Five studies reported the learning curve: all were for unicompartmental knee arthroplasty (UKA) – no learning curve for accuracy, operative time was reduced after five to 10 cases and a steady surgical time was achieved after eight cases. There were 16 studies reporting accuracy: rate of outliers was halved, higher rate of joint line and mechanical axis restoration, supported by low root mean square error values. Six studies reported functional outcome: all for UKA, improvement at six to 52 weeks, no difference from manual UKA except when assessed for lateral UKA which showed improved clinical outcomes. Two studies reported survivorship: one reported an unadjusted revision rate of 7% at 20 months for medial UKA and the other found a 99% two-year survival rate for UKA. There was evidence to support more accurate implant positioning for UKA, but whether this is related to superior functional outcomes or improved implant survivorship was not clear and further studies are required. Cite this article: EFORT Open Rev 2020;5:319-326. DOI: 10.1302/2058-5241.5.190065

scholarly journals Efficacy and mid/long-term survivorship of mobile-bearing unicompartmental knee arthroplasty for medial compartment knee osteoarthritis combined patellofemoral joint arthritis: a prospective cohort study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038448
Author(s):  
Jingbo Cheng ◽  
Mingli Feng ◽  
Guanglei Cao ◽  
Shibao Lu
Keyword(s):  
Cohort Study ◽  
Knee Osteoarthritis ◽  
Prospective Cohort Study ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Prospective Cohort ◽  
Patellofemoral Joint ◽  
Medial Compartment ◽  
Unicompartmental Knee

IntroductionUnicompartmental knee arthroplasty (UKA) is one of the most effective surgical procedures for treating isolated medial compartment knee osteoarthritis. However, previous studies have regarded patellofemoral osteoarthritis as a contraindication for UKA. In contrast, most current research shows that damage to the articular cartilage of the patellofemoral joint, even to the extent of full-thickness cartilage loss, has no influence on the outcome of UKA.Methods and analysisStudy settings: This study is a prospective cohort study that will compare the Forgotten Joint Score and Lonner patellofemoral joint score of patients who have undergone UKA; the patients will be divided into two groups (with and without patellofemoral joint osteoarthritis (PFJOA)). Primary objective: Long-term follow-up will be used to evaluate the effect of the operation on the above-mentioned scores in both the groups. Secondary objective: We will divide the patients from the with PFJOA group into three subgroups according to the localisation of patellofemoral cartilage lesions (medial zone, lateral zone and central zone). We aim to compare knee joint scores among these groups and clarify the impact of different wear sites on clinical efficacy. We will use CT to explore the potential mechanism through which UKA affects patellofemoral joint-related parameters (lateral patellar tilt, lateral patellar shift and tibia tuberosity-trochlear groove distance). We will also record mid-term/long-term post-surgery complications.Ethics and disseminationThis study’s protocol is in accordance with the Declaration of Helsinki. This study was approved by the Ethics Committee of Xuanwu Hospital. The results of this study will be disseminated in international peer-reviewed journals.Trial registration numberChiCTR2000030310.

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