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

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.

Download Full-text

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

10.29007/3vpn ◽

2018 ◽

Author(s):

Yifei Dai ◽

Michael Bolognesi ◽

Samuel Wellman ◽

Thorsten Seyler ◽

Quanjun Cui ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Outcome Data ◽

Perioperative Outcomes ◽

Computer Assisted ◽

Consecutive Series ◽

Standard Case ◽

Early Outcome ◽

Early Results ◽

Total Knee

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.

Download Full-text

What to Expect in Short-term Outcomes of “Challenging” Patients with Computer-Assisted Total Knee Arthroplasty?

10.29007/w2t9 ◽

2019 ◽

Author(s):

Yifei Dai ◽

Quanjun Cui ◽

Michael Bolognesi ◽

Samuel Wellman ◽

Thorsten Seyler ◽

...

Keyword(s):

Outcome Measures ◽

Postoperative Outcomes ◽

Computer Assisted ◽

Short Term ◽

Prospective Multicenter Study ◽

Postoperative Results ◽

Standard Case ◽

Risk Patients ◽

Total Knee ◽

Postoperative Improvement

This study investigated if CAOS TKA cases in higher risk patients would impact the outcomes of surgery. An average of 14-month postoperative outcomes on 58 TKAs from a prospective multicenter study were analyzed. The patients were grouped into challenging and standard case groups according to the criteria of age, BMI, comorbidities, and alignment deformity. Both groups demonstrated significant postoperative improvement in all outcome measures. Compared to the standard patients, the challenging patients achieved significantly higher improvement after TKA in KSS Knee score, while demonstrating the same level of improvements in all other outcome measures. Similarly, the two groups generally exhibit equivalent postoperative outcomes. The data demonstrated consistent postoperative results by CAOS TKA irrespective of patient conditions.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Accuracy of Coronal Plane Mechanical Alignment in a Customized, Individually Made Total Knee Replacement with Patient-Specific Instrumentation

The Journal of Knee Surgery ◽

10.1055/s-0037-1608946 ◽

2017 ◽

Vol 31 (08) ◽

pp. 792-796 ◽

Cited By ~ 6

Author(s):

Gary Levengood ◽

Jack Dupee

Keyword(s):

Mechanical Axis ◽

Computer Assisted Surgery ◽

Coronal Plane ◽

Patient Specific ◽

Computer Assisted ◽

Consecutive Series ◽

Mechanical Alignment ◽

Patient Specific Instrumentation ◽

Patient Specific Instruments ◽

Total Knee

AbstractThe objective of this study was to evaluate the accuracy of a customized individually made total knee implant used in conjunction with patient-specific cutting guides in restoring coronal plane mechanical axis alignment using computer-assisted surgery (CAS). A consecutive series of 63 total knee arthroplasty (TKA) patients were prospectively measured with intraoperative CAS. The patient-specific instruments and implants were created utilizing a preoperative CT scan. CAS system was used for all patients, to determine mechanical alignment. Bone cuts were made using the patient-specific instruments. Both bone cuts and final coronal mechanical alignment were recorded utilizing the navigation system for the assessment.The patient-specific instruments and implants provided perfect neutral coronal mechanical alignment (0°) in 53 patients. The remaining 10 patients had a postoperative alignment within ± 2° of neutral. The average preoperative deformity was 5.57° versus 0.18° postoperatively (p < 0.0001). The mean correction angle was 5.68°. No patients had postoperative extension deficits as measured with CAS (7.50° pre-op for 40/63 patients). Customized, individually made total knee implant with patient-specific cutting jigs showed results that are comparable to those of CAS systems in this study. This technology restores the neutral coronal mechanical axis very accurately, while offering unique benefits such as improved implant fit and restoration of the patient's J-curves, which require further investigation.

Download Full-text

Adjustable cutting blocks improve alignment and surgical time in computer-assisted total knee replacement

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-011-1752-1 ◽

2011 ◽

Vol 20 (9) ◽

pp. 1736-1741 ◽

Cited By ~ 16

Author(s):

Eduardo M. Suero ◽

Christopher Plaskos ◽

Peter L. Dixon ◽

Andrew D. Pearle

Keyword(s):

Total Knee Replacement ◽

Knee Replacement ◽

Computer Assisted ◽

Surgical Time ◽

Total Knee

Download Full-text

CAOS Augmented Mechanical Instrumentation Provides Versatility and Improved Accuracy During Total Knee Arthroplasty

10.29007/mq2k ◽

2020 ◽

Author(s):

Jefferson Craig Morrison ◽

Erika Frazier ◽

Mary Denton Stumb

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Weight Bearing ◽

Computer Assisted ◽

Surgical Time ◽

Surgical Workflow ◽

Leg Alignment ◽

Total Knee ◽

The Impact

This study assessed the impact of adding computer-assisted orthopedic surgery (CAOS) augmentation to conventional mechanical instrumentation with regard to the enablement of both mechanical and natural alignment surgical philosophies and accuracy of postoperative alignment for total knee arthroplasty (TKA). Fifty CAOS augmented TKA cases were compared to 101 conventional cases. Data on surgical time, length of stay, and postoperative weight-bearing long leg alignment were collected. The results reported no significant impact on surgical time with incorporation of CAOS augmentation into the conventional surgical workflow, as well as a shorter length of stay and substantial decrease in alignment outliers compared to the conventional TKA cases. The study revealed the advantages of CAOS augmentation in providing a non-disruptive tool to enhance surgical accuracy and offer versatility in accommodating different surgical philosophies during TKA.

Download Full-text

Learning of A CAOS Enhanced Mechanical Instrument System for Total Knee Arthroplasty: A CUSUM Analysis

10.29007/k12h ◽

2018 ◽

Author(s):

Yifei Dai ◽

James Huddleston ◽

Matt Rueff ◽

Laurent Angibaud ◽

Derek Amanatullah

Keyword(s):

Orthopaedic Surgery ◽

Computer Assisted ◽

Surgical Time ◽

Experience Levels ◽

Computer Assisted Orthopaedic Surgery ◽

Cusum Analysis ◽

Total Knee ◽

Conventional Instrument ◽

Cumulative Sum Control ◽

Case Number

This study employed an advanced method (Cumulative sum control chart, CUSUM) to analyze the learning curve regarding surgical efficiency (time) in four surgeons from different experience levels upon their adoption of a mechanical instrument enhanced by computer-assisted orthopaedic surgery (CAOS). The first six CAOS-TKA cases of each surgeon were analyzed to identify the case number when their learning process was stabilized (cases to proficiency). The surgical time increase during the learning phase were compared between senior and fellow surgeons. The data demonstrated a short learning duration (2-3 cases) both senior and fellow surgeons and a mild impact from learning compared to cases performed using conventional instrument system.

Download Full-text

Application-Specific Learning Curve in Computer-Assisted Total Knee Arthroplasty

10.29007/nrzj ◽

2020 ◽

Author(s):

Yifei Dai ◽

Laurent Angibaud ◽

Guillaume Bras ◽

Cyril Hamad ◽

Jefferson Craig Morrison

Keyword(s):

Learning Curve ◽

Learning Process ◽

Computer Assisted ◽

Surgical Time ◽

Experience Level ◽

Total Knee ◽

The Impact ◽

Application Specific ◽

Different Levels ◽

Specific Learning

This study employed an advanced method (CUSUM) to analyze the learning curve regarding surgical efficiency (time) using two CAOS applications, which were designed to address user needs with different levels of comprehensiveness in term of offered guidance and instrumentation requirements. Two group of surgeons, each used either CAOS applications were included in the study. The first 50 CAOS TKA cases from each surgeon were analyzed to identify the learning curve. The duration of learning, as well as the impact of learning based on surgical time, were assessed with regard to the specific CAOS application and surgeon’s previous CAOS experience level. The data demonstrated differences in term of pattern of adoption during learning process between the two CAOS applications. However, the learning process was not sensitive to surgeon’s experience level.

Download Full-text