Dataset Information

Robotic-assisted Total Knee Arthroplasty Reduces Radiographic Outliers for Low-volume Total Knee Arthroplasty Surgeons.

ABSTRACT:

Background

Most studies evaluating robotic-assisted total knee arthroplasty (RA TKA) analyzed the advantages offered to high-volume surgeons. This study aims to determine if RA TKA improves radiographic or clinical outcomes for low-volume, non-arthroplasty-trained surgeons.

Methods

Radiographic and early clinical outcomes of 19 RA TKAs and 41 conventional TKAs, all performed by a single, non-arthroplasty-trained orthopaedic surgeon, were compared. Radiographic outliers were based on surgeon targets and defined as tibial posterior slope outside of 0°-5°, tibial tray varus outside of 0°-3°, and the presence of notching. Clinical outcomes included inpatient narcotic usage, length of stay, range of motion, and Patient-Reported Outcome Measurement Information System scores.

Results

There was a significant decrease in tibial slope outliers (RA TKA 0% vs non-RA TKA 22%, P = .024) and notching incidence (RA TKA 0% vs non-RA TKA 19.5%, P = .044) in the RA group. Tibial tray varus/valgus outliers trended lower in the RA TKA group (10.0% vs 26.8%, P = .189). Length of stay was significantly shorter in RA patients (48.0 hours [standard deviation: 25.5] vs 67.7 hours [34.3], P = .038). RA patients trended toward lower in postoperative inpatient total mean morphine equivalents usage (79.9 [89.2] vs 140.1 [169.3], P = .142) and inpatient mean morphine equivalents usage per day (30.36 [26.9] vs 45.6 [36.7], P = .105). There was no significant difference in Patient-Reported Outcome Measurement Information System scores or range of motion at first and second postoperative follow-up within 3 months.

Conclusions

RA TKA reduced the incidence of radiographic outliers when compared to conventional TKA for a low-volume arthroplasty surgeon.

SUBMITTER: Byrne C

PROVIDER: S-EPMC10834457 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Robotic-assisted Total Knee Arthroplasty Reduces Radiographic Outliers for Low-volume Total Knee Arthroplasty Surgeons.

Byrne Connor C Durst Caleb C Rezzadeh Kevin K Rockov Zachary Z Moon Charles C Rajaee Sean S

Arthroplasty today 20240123

<h4>Background</h4>Most studies evaluating robotic-assisted total knee arthroplasty (RA TKA) analyzed the advantages offered to high-volume surgeons. This study aims to determine if RA TKA improves radiographic or clinical outcomes for low-volume, non-arthroplasty-trained surgeons.<h4>Methods</h4>Radiographic and early clinical outcomes of 19 RA TKAs and 41 conventional TKAs, all performed by a single, non-arthroplasty-trained orthopaedic surgeon, were compared. Radiographic outliers were based ...[more]

PMID: 38313190

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Project description:BackgroundTotal knee arthroplasty (TKA) with mechanical alignment (MA) aims to achieve neutral limb alignment in all patients, whereas TKA with functional alignment (FA) aims to restore native, patient-specific anatomy and knee kinematics by manipulating bone resections and fine-tuning implant positioning. The objective of this study is to determine the optimal alignment technique in TKA by comparing patient satisfaction, functional outcomes, implant survivorship, complications, and cost-effectiveness in MA TKA versus FA TKA. Robotic technology will be used to execute the planned implant positioning and limb alignment with high-levels of accuracy in all study patients.Methods and analysisThis prospective double-blinded randomised control trial will include 100 patients with symptomatic knee osteoarthritis undergoing primary robotic arm-assisted TKA. Following informed consent, patients will be randomised to MA TKA (the control group) or FA TKA (the investigation group) at a ratio of 1:1 using an online random number generator. Blinded observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes relating to postoperative rehabilitation, clinical progress, functional outcomes, accuracy of implant positioning and limb alignment, gait, implant stability, cost-effectiveness, and complications. A superiority study design will be used to evaluate whether FA TKA provides superior outcomes compared to MA TKA. Primary and secondary objectives will be used to quantify and draw inferences on differences in the efficacy of treatment between the two groups. Intention-to-treat and per-protocol population analysis will be undertaken. The following statistical methods will be employed to analyse the data: descriptive statistics, independent t test, paired t test, analysis of variance, Fisher exact test, chi-square test, and graphical displays. Ethical approval was obtained from the London-Surrey Research Ethics Committee, UK. The study is sponsored by University College London, UK.DiscussionThis is the first study to describe the use of robotic technology to achieve FA TKA, and the only existing clinical trial comparing robotic MA TKA versus robotic FA TKA. The findings of this study will enable an improved understanding of the optimal alignment technique in TKA for achieving high-levels of patient satisfaction, improving functional outcomes, increasing implant survivorship, improving cost-effectiveness, and reducing complications.RegistrationClinical Trials.gov, NCT04092153. Registered on 17 September 2019.

Project description:Purpose Total knee arthroplasty (TKA) is widely recognized as an effective treatment for end-stage knee osteoarthritis (OA). Compared with conventional TKA, robotic-arm assisted TKA may improve patients’ functionality and resulting quality of life by more accurate and precise component placement. Currently, the literature on cost-effectiveness of robotic-arm assisted TKA in the US is limited. The objective of this study was to assess the cost-effectiveness of robotic-arm assisted TKA relative to TKA in the Medicare-aged population including exploring the impact of hospital volume on cost-effectiveness outcomes. Methods We developed a decision-analytic model to evaluate the costs, health outcomes, and incremental cost-effectiveness ratio (ICER) of robotic-arm assisted TKA vs TKA in Medicare population with OA. We evaluated cost-effectiveness at a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life-year (QALY). We sourced costs from the literature including episode-of-care (EOC) costs from a Medicare study. We assessed cost-effectiveness of robotic-arm assisted TKA by hospital procedure volume and conducted deterministic (DSA) and probabilistic sensitivity analysis (PSA). Results For the average patient treated in a hospital with an annual volume of 50 procedures, robotic-arm assisted TKA resulted in a total QALY of 6.18 relative to 6.17 under conventional TKA. Total discounted costs per patient were $32,535 and $31,917 for robotic-arm assisted TKA and conventional TKA, respectively. Robotic-arm assisted TKA was cost-effective in the base case with an ICER of $41,331/QALY. In univariate DSA, cost-effectiveness outcomes were most sensitive to the annual hospital procedure volume. Robotic-arm assisted TKA was cost-effective at a WTP of $50,000/QALY only when hospital volume exceeded 49 procedures per year. In PSA, robotic-arm assisted TKA was cost-effective at a $50,000/QALY WTP threshold in 50.4% of 10,000 simulations. Conclusions Despite high robotic purchase costs, robotic-arm assisted TKA is likely to be cost-effective relative to TKA in the Medicare population with knee OA in high-volume hospitals through lowering revision rates and decreasing post-acute care costs. Higher-volume hospitals may deliver higher value in performing in robotic-arm assisted TKA.

Dataset Information

Robotic-assisted Total Knee Arthroplasty Reduces Radiographic Outliers for Low-volume Total Knee Arthroplasty Surgeons.

Background

Methods

Results

Conclusions

Publications

Robotic-assisted Total Knee Arthroplasty Reduces Radiographic Outliers for Low-volume Total Knee Arthroplasty Surgeons.

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