Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve.
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ABSTRACT:
SUBMITTER: Grau L
PROVIDER: S-EPMC6921119 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Total 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 ANALYSIS:This 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. DISCUSSION:This 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. REGISTRATION:Clinical Trials.gov, NCT04092153. Registered on 17 September 2019.
| S-EPMC7027302 | biostudies-literature
Project description:BackgroundRobotic arm-assisted total knee arthroplasty (RATKA) has demonstrated improved patient-reported outcome measures. Less evidence has been reported on how frequently patients return to complex activities of daily living. Our purposes were to investigate (1) hospital lengths of stay (LOSs) (2) discharge dispositions and (3) the rates and postoperative time intervals at which patients returned to driving and working.MethodsA total of 50 RATKA patients who were employed prior to surgery were included. Outcomes included hospital LOS, discharge dispositions, return to driving, and return to work.ResultsA total of 48 patients (96%) were discharged home with self-care or health aid discharge after a mean LOS of 1.2 ± 0.6 days. Twelve patients (24%) returned to driving within 3 weeks of surgery. In our study, 100% of patients who underwent RATKA returned to driving after a mean of 29 days (range, 4 to 62 days). Forty-five patients (90%) returned to their preoperative level of work after a mean of 46 days (range, 2 to 96 days). Nineteen patients (38%) returned to work within 3 weeks.ConclusionsThis study showed fast recovery after RATKA, with >90% returning to driving and working at full capacity within 2 months. Many (38%) returned to work within 3 weeks. Further studies to demonstrate the value of RATKA with respect to recovery of complex activities are needed. Compared to controls from previously published literature on manual total knee arthroplasties, it appears that patients who undergo RATKA have similar or better outcomes in reference to return to driving.
| S-EPMC9307493 | biostudies-literature
Project description:BackgroundTotal knee arthroplasty (TKA) serves as a reliable treatment option for patients with end-stage arthritis, but patient dissatisfaction rate remains high. With the projected increase in the volume of arthroplasty operations, surgeons have aimed for methods in which to improve the patient outcomes. Robotic-assisted TKA has become increasingly popular. The learning curve for such technology has been investigated, but these prior studies have only been performed by fellowship-trained arthroplasty surgeons. The goal of this study was to investigate the learning curve for non-fellowship-trained orthopedic surgeons to ameliorate any concerns about increased operative time.MethodsRetrospective analysis of robotic-assisted TKAs and manual TKAs, performed by two non-fellowship-trained orthopedic surgeons, was conducted on a total of 160 patients. For each individual surgeon, the robotic-assisted TKAs were divided into 3 cohorts of 20 consecutive patients. Data from 20 consecutive manual TKAs were also gathered for each surgeon. The mean operative times were compared. Cohorts were then grouped together for both surgeons and compared in a similar fashion.ResultsFor surgeon 1, mean operative times were significantly increased for robotic-assisted cohorts compared with those for the manual cohort. For surgeon 2, the first robotic-assisted cohort was significantly longer. However, there were no significant differences for the second and third robotic-assisted cohorts. In the combined surgeon group, there was no significant difference between operative times for the third robotic cohort and the manual cohort.ConclusionThis study demonstrates that the general orthopedic surgeon in a community hospital may be able to adequately perform robotic-assisted surgery in a similar timeframe to their manual TKA within their first 40 robotic-arm-assisted TKA.
| S-EPMC8791856 | biostudies-literature
Project description:Robotic arm-assisted arthroplasty was introduced in 2006 and has expanded its applications into unicompartmental knee, total knee, and total hip replacement. The first case of a revision surgery from conventional unicompartmental to total knee arthroplasty with the utilization of the robotic arm-assisted MAKO system is presented. An 87-year-old female presented with deteriorating left knee pain due to failure of medial unicompartmental knee arthroplasty at the outpatient clinic. The patient was advised to undergo revision surgery. Through medial parapatellar arthrotomy, the joint was exposed. With the use of the MAKO system, the estimated depth of the medial plateau according to CT planning was found to be 10?mm more distal than the lateral. The resection line of the remaining plateau was placed deliberately 2?mm more distal in order to achieve satisfactory replacement of the bony gap of the medial tibial condyle by a 10?mm augment. The patient had an uneventful recovery. A plethora of additional applications in the future, such as total shoulder or reverse total shoulder arthroplasty, megaprosthesis placement in oncological patients, and total hip or knee revision surgeries, may improve patient-related outcomes.
| S-EPMC7037895 | biostudies-literature
Project description:AimThe objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan.Patients and methodsThis was a prospective observational study conducted in a tertiary care centre between August 2018 and January 2020. 143 consecutive RATKA(105 patients) and 151 consecutive MTKA(111 patients) performed by two experienced arthroplasty surgeons were included. Two independent observers evaluated the accuracy of implant positioning by measuring the radiological parameters according to the Knee-Society-Roentgenographic-Evaluation-System and limb alignment from postoperative weight-bearing scanogram. Outcomes were defined, based on the degree of deviation of measurements from the planned position and alignment, as excellent(0-1.99°), acceptable(2.00-2.99°) and outlier(≥ 3.00°).ResultsThere were no systematic differences in the demographic and baseline characteristics between RATKA and MTKA. Statistically significant outcomes were observed favouring robotic group for postoperative mechanical axis (p < .001), coronal inclination of the femoral component (p < 0.001), coronal inclination of tibial component (p < 0.001), and sagittal inclination of tibial component (p < 0.001). There was no significant difference in the sagittal inclination of the femoral component (p = 0.566). The percentage of knees in the 'excellent' group were higher in RATKA compared to MTKA. There was absolutely no outlier in terms of limb alignment in the RATKA group versus 23.8% (p < 0.001) in the MTKA group. All the measurements showed high interobserver and intraobserver reliability.ConclusionRobotic-arm assisted TKA executed the preoperative plan more accurately with respect to limb alignment and implant positioning compared to manual TKA, even when the surgeons were more experienced in the latter.Graphic abstractSupplementary informationThe online version contains supplementary material available at 10.1007/s43465-020-00324-y.
| S-EPMC8192671 | biostudies-literature
Project description:Total knee arthroplasty (TKA) is a highly successful operation for the treatment of end-stage osteoarthritis of the knee. Increasing use of computer-assisted and robotic-assisted total joint arthroplasty has been shown to improve component position, with short-term studies demonstrating improved survivability in unicompartmental knee arthroplasty. Robotic-assisted technology has been shown to be helpful in revising unicompartmental knee arthroplasty to TKA, as well as hip fusion to total hip arthroplasty, but few have described revision of a primary TKA. This case report describes the use of robotic-assisted technology in revision TKA. Robotic assistance during revision TKA may improve component alignment and increase prosthesis longevity. Future research is needed to investigate the effects on survivorship and cost.
| S-EPMC8666608 | biostudies-literature
Project description: Not available
| S-EPMC9867950 | biostudies-literature
Project description:BACKGROUND:There remains a paucity of clinical studies assessing how any differences in accuracy of implant positioning between robotic-arm assisted unicompartmental knee arthroplasty (RO UKA) and conventional jig-based unicompartmental knee arthroplasty (CO UKA) translate to patient satisfaction, functional outcomes, and implant survivorship. The objectives of this study are to compare accuracy of implant positioning, limb alignment, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications in CO UKA versus RO UKA. Computer navigation will be used to assess intraoperative knee kinematics in all patients undergoing CO UKA. METHODS AND ANALYSIS:This prospective randomised controlled trial will include 140 patients with symptomatic medial compartment knee arthritis undergoing primary UKA. Following informed consent, patients will be randomised to CO UKA (control group) or RO UKA (investigation group) at a ratio of 1:1 using an online random number generator. The primary objective of this study is to compare accuracy of implant positioning in CO UKA versus RO UKA. The secondary objectives are to compare the following outcomes between the two treatment groups: limb alignment, surgical efficiency, postoperative functional rehabilitation, functional outcomes, quality of life, range of motion, resource use, cost effectivness, and complications. Observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes pertaining to these objectives. Ethical approval was obtained from the London-Bloomsbury Research Ethics Committee, UK. The study is sponsored by University College London, UK. DISCUSSION:This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in CO UKA versus RO UKA. The findings of this study will provide an improved understanding of the differences in CO UKA versus RO UKA with respect to accuracy of implant positioning, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications. TRIAL REGISTRATION:ClinicalTrials.gov NCT04095637 . Registered on 19 September 2019.
| S-EPMC7430022 | biostudies-literature
Project description:Background:Unicompartmental knee arthroplasty (UKA) originated in the 1950's. There have been many enhancements to the implants and the technique, improving the precision and accuracy of this challenging operation. Specifically for Robotic Arm Interactive Orthopedic System (Rio; Mako Stryker, Fort Lauderdale, FL), there are many studies reporting clinical outcomes, but our search offered nothing regarding patient reported outcomes using validated surveys. Methods:Patients with onlay tibial components presenting for routine follow-up of robotic-arm assisted UKA performed between May 2009 and September 2013 were invited to participate. Four joints had simultaneous patella femoral resurfacing. Knee Injury and Osteoarthritis Outcomes Score (KOOS) and the 2011 Knee Society Scores were collected. Radiographic evidence of osteoarthritis in the non-operative knee compartments was documented. Results:Eighty-one patients presented for follow-up and consented to participate. Mean follow up was 54 months. Mean patient reported KOOS activities of daily living and pain scores were each 90. Knee Society 2011 mean objective score was 96 and mean function score 81. There was one revision to total knee at 40 months post-op for pain after injury. Seventy-seven percent reported their knee always felt "Normal", 20% sometimes, and only 3% reported that it never felt normal. Conclusion:Literature on UKA failure rates suggests that UKA may be a less forgiving procedure than total knee arthroplasty. Robotic-arm assisted surgery is reported to improve the accuracy of implant placement. Based on our prospectively collected positive patient outcomes, the authors have achieved good results from performing robotic-arm assisted UKA on select patients.
| S-EPMC6104461 | biostudies-literature
Project description: Not available
| S-EPMC9947954 | biostudies-literature