Minimally Invasive Robotic-Arm-Guided Unicompartmental Knee Arthroplasty

Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511–1518.

Download Full-text

Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-4404-7 ◽

2016 ◽

Vol 26 (5) ◽

pp. 1455-1464 ◽

Cited By ~ 41

Author(s):

Edward Burn ◽

Maria T. Sanchez-Santos ◽

Hemant G. Pandit ◽

Thomas W. Hamilton ◽

Alexander D. Liddle ◽

...

Keyword(s):

Propensity Score ◽

Minimally Invasive ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Cohort Analysis ◽

Matched Cohort ◽

Unicompartmental Knee ◽

Patient Reported

Download Full-text

Effect of minimally-invasive implantation of unicompartmental knee arthroplasty on cement penetration and biomechanical stability. An experimental study in human tibiae

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2017.11.006 ◽

2018 ◽

Vol 51 ◽

pp. 34-39 ◽

Cited By ~ 3

Author(s):

C. Scheele ◽

M.F. Pietschmann ◽

C. Schröder ◽

T. Grupp ◽

M. Holderied ◽

...

Keyword(s):

Experimental Study ◽

Minimally Invasive ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Biomechanical Stability ◽

Unicompartmental Knee ◽

Cement Penetration

Download Full-text

Does component placement affect short-term clinical outcome in robotic-arm assisted unicompartmental knee arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.101b4.bjj-2018-0753.r1 ◽

2019 ◽

Vol 101-B (4) ◽

pp. 435-442 ◽

Cited By ~ 11

Author(s):

F. Zambianchi ◽

G. Franceschi ◽

E. Rivi ◽

F. Banchelli ◽

A. Marcovigi ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Outcome ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Robotic Arm ◽

Short Term ◽

Soft Tissue Balancing ◽

Unicompartmental Knee ◽

Post Implantation

Aims The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA). Patients and Methods Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded. Results Following exclusions and losses to follow-up, 334 medial robotic-arm assisted UKAs were assessed at a mean follow-up of 30.0 months (8.0 to 54.9). None of the measured parameters were associated with overall KOOS outcome. Correlations were described between specific KOOS subscales and intraoperative, post-implantation robotic data, and between FJS-12 and femoral component sagittal alignment. Three UKAs were revised, resulting in 99.0% survival at two years (95% confidence interval (CI) 97.9 to 100.0). Conclusion Although little correlation was found between intraoperative robotic data and overall clinical outcome, surgeons should consider information regarding 3D component placement and soft-tissue balancing to improve patient satisfaction. Reproducible and precise placement of components has been confirmed as essential for satisfactory clinical outcome. Cite this article: Bone Joint J 2019;101-B:435–442.

Download Full-text