“Standard” Versus “Challenging” Patients - Early Outcomes using Computer-Assisted Total Knee Arthroplasty

This study investigated if CAOS TKA cases complicated by challenging patient conditions would negatively impact the perioperative outcomes of surgery. Early outcome data on 51 TKA’s from a multicenter, consecutive series were analyzed. The patients were separated into challenging and standard case groups according to the criteria of age, BMI, and severity of deformity. The two groups did not exhibit significant differences in any of the early outcomes. Our study demonstrates consistent early results using CAOS TKA irrespective of patient conditions.

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The Learning Curve of Reaching the Planned Limb Alignment in Robotic-Arm-Assisted Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0041-1741001 ◽

2021 ◽

Author(s):

Tejbir S. Pannu ◽

Jesus M. Villa ◽

Isaac Schultz ◽

Wael K. Barsoum ◽

Carlos A. Higuera ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Learning Curve ◽

Knee Arthroplasty ◽

Operative Time ◽

Robotic Arm ◽

Perioperative Outcomes ◽

Second Phase ◽

Consecutive Series ◽

Limb Alignment ◽

Total Knee

AbstractEvidence on the learning curve associated with robotic-arm-assisted total knee arthroplasty (ra-TKA) is scarce and mostly based on operative time. Thus, the objective of this study was to assess a surgeon's learning experience based on accuracy to reach planned limb alignment and its impact on surgical-characteristics, limb-alignment, and perioperative-outcomes. A retrospective chart review was conducted on a consecutive series of 204 primary ra-TKAs (patients), performed by a single surgeon in a single institution (3/7/2018-to-6/18/2019). Cumulative summation control sequential analysis was used for the assessment of the learning curve using accuracy of reaching the planned limb alignment establishing that surgeries had an initial-learning-phase, followed by a second-consolidation-phase. Baseline demographics, operative/tourniquet times, prosthesis type, and limb alignment were compared between these two phases. Length of stay, discharge disposition, complications, reoperation/readmission (90 days), and total morphine equivalents (TMEs) prescribed were compared between phases. Independent sample t-tests, and chi-squared analyses were performed. ra-TKA demonstrated a learning curve of 110 cases for reaching planned limb alignment (p = 0.012). Robotic experience resulted in significantly more proportion of knees in neutral-axis postoperatively (p = 0.035) and significant reduction in TMEs prescribed (p = 0.04). The mean operative and tourniquet time were found to be significantly lower in second-phase versus the first-phase (p for both < 0.0001). ra-TKA has a significant learning curve in clinical practice. A surgeon can reach the planned limb alignment with increased accuracy over time (110-cases). Progressive robotic learning and associated operative time efficiency can lead to significantly lower opioid consumption in patients undergoing TKA.

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Computer and robotic – assisted total knee arthroplasty: a review of outcomes

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00278-y ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Jobe Shatrov ◽

David Parker

Keyword(s):

Total Knee Arthroplasty ◽

Survival Analysis ◽

Knee Arthroplasty ◽

Computer Assisted ◽

Implant Survival ◽

Robotic Assisted ◽

Early Results ◽

Patient Reported ◽

Total Knee ◽

Term Data

Abstract Background Total knee arthroplasty (TKA) is a successful treatment for tricompartmental knee arthritis. Computer navigation and robotic-assisted-surgery (RAS) have emerged as tools that aim to help plan and execute surgery with greater precision and consistency. We reviewed the most current literature to describe the historical background and outcomes compared to conventional TKA. Methods A review and synthesis of the literature comparing the patient reported outcomes (PROM’s) of RA TKA and computer-assisted (CA) TKA to conventional TKA was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results CAS TKA improves accuracy and consistency of implant position, and appears to provide a small improvement in PROMs and implant survival compared to conventional TKA. RTKA similarly improves implant accuracy compared to conventional techniques and early results suggest a similar small benefit in PROMs compared to conventional TKA. A strengthening trend is emerging showing CAS TKA has greatest benefit to implant survival in people under 65. RTKA survival analysis data is more limited and early results do not allow strong conclusions, however early trends are similar to CAS TKA. Conclusion Results for CAS-TKA show improvement in alignment, and early clinical outcomes have revealed promising results, with longer-term data and medium-term survival analysis recently emerging showing small benefits over conventional TKA. RTKA represents another phase of development. Early results show similar trends to that of CAS TKA with longer-term data still to come.

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The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain

The Journal of Knee Surgery ◽

10.1055/s-0041-1735313 ◽

2021 ◽

Author(s):

Stephen Gerard Zak ◽

David Yeroushalmi ◽

Alex Tang ◽

Morteza Meftah ◽

Erik Schnaser ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Opioid Consumption ◽

Perioperative Outcomes ◽

Computer Assisted ◽

Surgical Time ◽

Pain Scores ◽

Pain Outcomes ◽

Total Knee

AbstractThe use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.

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“Standard” Versus “Challenging” Patients - Perioperative Outcomes using Computer-Assisted Total Knee Arthroplasty

10.29007/fdnt ◽

2018 ◽

Author(s):

Yifei Dai ◽

Quanjun Cui ◽

Michael Bolognesi ◽

Samuel Wellman ◽

Thorsten Seyler ◽

...

Keyword(s):

General Trend ◽

Perioperative Outcomes ◽

Computer Assisted ◽

Consecutive Series ◽

Surgical Time ◽

Discharge Data ◽

Standard Case ◽

Loss Recovery ◽

Risk Patients ◽

Total Knee

This study investigated if CAOS TKA cases in higher risk patients would impact the perioperative outcomes of surgery. Intraoperative and recovery/discharge data on 70 patients (72 knees) from a multicenter, consecutive series were analyzed. The patients were grouped into challenging and standard case groups according to the criteria of age, BMI, and degree of deformity. Despite a general trend observed between the challenging and standard cases, the two groups did not exhibit significant differences in terms of surgical time, blood loss, recovery and time to discharge. The data demonstrated consistent perioperative results by CAOS TKA irrespective of patient conditions.

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