Dataset Information

Improved Compartment Balancing Using a Robot-Assisted Total Knee Arthroplasty.

ABSTRACT:

Background

Robot-assisted surgery was developed to improve accuracy and outcomes in total knee arthroplasty (TKA). One important determinant of TKA success is a well-balanced knee throughout the range of motion. The purpose of this study is to determine if robot-assisted TKA (RA-TKA) results in improved intracompartmental ligament balance compared with conventional jig-based instrumentation (CM-TKA).

Methods

This retrospective cohort study included 2 cohorts-a CM-TKA (n = 49) vs RA-TKA (n = 37) cohort. Demographic and intraoperative data, including intraoperative compartment loads, were measured after final implant implantation in extension (10°), mid-flexion (45°), and full flexion (90°), using an intraoperative compartment pressure sensor. An a priori power analysis revealed our study exhibited >80% power in detecting a 5-pound (lb) difference in compartment loads in the 2 cohorts.

Results

There was no difference between medial and lateral compartment loads in extension, mid-flexion, and full flexion for the conventional (15.1 lbs, 15.9 lbs, and 13.4 lbs, respectively) vs RA-TKA (14.2 lbs, 15.1 lbs, and 10.3 lbs, respectively). The percentage of patients with high load compartment pressure in flexion (>40 lbs) by the conclusion of the surgery was significantly greater for the conventional (18%) vs the robotic TKA cohort (3%, P = .025). The percentage of patients with unbalanced knees (>20 lbs differential between medial and lateral compartments) in flexion was significantly greater in the conventional (24%) vs robotic TKA cohort (5%, P = .018).

Conclusions

In this series, RA-TKA resulted in improved intraoperative compartment balancing in flexion with no observed difference in mid-flexion and extension compared with CM-TKA.

SUBMITTER: Held MB

PROVIDER: S-EPMC7850935 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Improved Compartment Balancing Using a Robot-Assisted Total Knee Arthroplasty.

Held Michael B MB Grosso Matthew J MJ Gazgalis Anastasia A Sarpong Nana O NO Boddapati Venkat V Neuwirth Alexander A Geller Jeffrey A JA

Arthroplasty today 20210130

<h4>Background</h4>Robot-assisted surgery was developed to improve accuracy and outcomes in total knee arthroplasty (TKA). One important determinant of TKA success is a well-balanced knee throughout the range of motion. The purpose of this study is to determine if robot-assisted TKA (RA-TKA) results in improved intracompartmental ligament balance compared with conventional jig-based instrumentation (CM-TKA).<h4>Methods</h4>This retrospective cohort study included 2 cohorts-a CM-TKA (n = 49) vs R ...[more]

PMID: 33553538

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Project description:Background:Interest in bicompartmental knee arthroplasty (BKA) for the treatment of medial patellofemoral osteoarthritis (MPFOA) has grown in recent years because BKA offers a bone and ligament-preserving alternative to total knee arthroplasty (TKA). BKA only resurfaces the diseased compartments, while preserving proprioception and native knee kinematics. Therefore, the objective of this study is to assess knee function, perioperative morbidity, and implant survivability in patients undergoing BKA vs TKA for MPFOA. Methods:The databases MEDLINE, PUBMED, and EMBASE were systematically searched. Randomized controlled trials and nonrandomized comparative studies comparing BKA with TKA for the treatment of MPFOA were included for further analysis. The primary outcome of interest was knee function. Secondary outcomes included range of movement, operation length, intraoperative blood loss, hospital length of stay, postoperative complications, and rate of revision length. The quality of evidence was evaluated using the GRADE approach. Meta-analysis was performed by pooling the results of the selected studies when possible. Results:Six studies were selected for inclusion (4 prospective studies and 2 retrospective cohort studies). In total, 274 patients and 277 knees were included for analysis. There were no significant differences between the 2 groups at any time points in terms of knee function, length of stay, complication rate, or revision rate, when monolithic BKA designs were controlled for. BKA did result in significantly decreased intraoperative blood loss, at the expense of increased operative length compared with TKA. Conclusions:The use of modular BKA for MPFOA is comparable with TKA in terms of short-term function, complication rate, and revision rate. BKA reduces intraoperative blood losses, but it is also more technically demanding, resulting in increased operation length. The use of modular BKA has acceptable short-term outcomes, but more long-term data are needed before it can be recommended for routine use in the treatment of MPFOA. The selection of modular BKA should be determined on a patient-specific basis. Currently, there is no evidence to suggest the use of monolithic BKA designs because of their high revision and failure rate.

Project description:Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures.A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction.Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years.Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

Dataset Information

Improved Compartment Balancing Using a Robot-Assisted Total Knee Arthroplasty.

Background

Methods

Results

Conclusions

Publications

Improved Compartment Balancing Using a Robot-Assisted Total Knee Arthroplasty.

Similar Datasets

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