Dataset Information

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

ABSTRACT:

Background

Robotic-assisted total knee arthroplasty (TKA) is a growing technique in adult reconstruction. The variations between robotic-assisted and conventional TKA could lead to changes in immediate postoperative outcomes. We aimed to evaluate for differences in postoperative pain, discharge day, as well as post-hospital disposition (home vs subacute rehabilitation facility [SAR]) between robotic-assisted and conventional TKA.

Methods

We retrospectively identified 2 cohorts of patients who underwent either conventional or robotic-assisted TKA between January 2019 and July 2019. Their average pain scores from postoperative day 0, day 1, and day 2 were recorded. Their postoperative discharge day was recorded, as well as their disposition to either home or a SAR. Preoperatively, all patients are offered robotic-assisted TKA, and only those who want the procedure and undergo a preoperative CT scan receive the robotic-assisted surgery. Statistical analysis was conducted using SPSS.

Results

One hundred sixty-six patients were identified with 83 in each cohort. No differences between age, race, and gender were found. Despite minor variations in pain levels, the overall postoperative pain score analysis did not strongly favor one technique over the other. The robotic-assisted group had a significantly higher amount of patients discharged to home instead of a SAR and also had a shorter time to discharge than the conventional group.

Conclusions

Robotic-assisted TKA has similar postoperative pain scores compared with conventional TKA. The robotic-assisted cohort demonstrated other benefits including earlier discharge and are more likely to be discharged home instead of a SAR.

SUBMITTER: Hamilton DA

PROVIDER: S-EPMC7921755 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

Hamilton David Alex DA Ononuju Ucheze U Nowak Caden C Chen Chaoyang C Darwiche Hussein H

Arthroplasty today 20210227

<h4>Background</h4>Robotic-assisted total knee arthroplasty (TKA) is a growing technique in adult reconstruction. The variations between robotic-assisted and conventional TKA could lead to changes in immediate postoperative outcomes. We aimed to evaluate for differences in postoperative pain, discharge day, as well as post-hospital disposition (home vs subacute rehabilitation facility [SAR]) between robotic-assisted and conventional TKA.<h4>Methods</h4>We retrospectively identified 2 cohorts of ...[more]

PMID: 33718557

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Project description:BackgroundProlonged wound drainage after TKA is associated with increased risk of infection. To decrease wound drainage, tissue adhesive has been suggested as an adjunct to wound closure after TKA; however, no studies of which we are aware have investigated the effect of tissue adhesive in a modern fast-track TKA setting.Questions/purposesThe purpose of this study was to evaluate the effect of wound closure using a high-viscosity tissue adhesive in simultaneous bilateral TKA with respect to (1) postoperative wound drainage, measured as number of dressing changes in the first 72 hours postoperatively; and (2) wound healing assessed using the ASEPSIS score.MethodsThirty patients undergoing simultaneous bilateral TKA were included in the study. The left knee was randomized to receive either standard three-layer closure with staples or the same closure supplemented with tissue adhesive with the opposite treatment used on the contralateral knee. One patient underwent a constrained TKA and underwent revision 2 days after the index procedure and was therefore excluded leaving 29 patients (58 knees) for analysis. Sixty-two percent (n = 18) were female. Mean age was 64 years (range, 42-78 years). Mean body mass index was 28 kg/m (range, 21-38 kg/m). Postoperative wound drainage was evaluated as drainage resulting in a dressing change. The wound dressing was changed if it was soaked to the borders of the absorbable dressing at any point. The nurses changing the dressing were blinded to treatment allocation up to the first dressing change. The number of dressing changes during the first 72 hours postoperatively was recorded. The secondary study endpoint was the ASEPSIS score, which is a clinical score assessing wound healing. ASEPSIS score, measured by a nurse not involved in the treatment, was compared between the groups at 3 weeks followup.ResultsKnees with tissue adhesive underwent fewer dressing changes (median, 0; interquartile range [IQR], 0-1) compared with the contralateral knee (IQR, 1-2; difference of medians, one dressing change; p = 0.001). A total of 59% of knees in the intervention group did not undergo any dressing changes before discharge, whereas 24% of knees in the control group did not undergo any dressing changes before discharge (p = 0.02). The knees in the intervention group and the control group did not differ with respect to ASEPSIS score at 3 weeks.ConclusionsTissue adhesive as an adjunct to standard wound closure after primary TKA reduced the number of dressing changes after surgery, but did not change the appearance or healing of the wound at 3 weeks based on the ASEPSIS scores. Whether the small differences observed here in terms of the number of dressing changes performed will justify the additional costs associated with using this product or whether there are other differences associated with the use of tissue adhesive that may prove important such as patient preferences or longer term differences in wound healing or infection should be studied in the future.Level of evidenceLevel I, therapeutic study.

Project description:BackgroundThis study assessed surgical accuracy and functional outcomes using hand-held accelerometer-based navigation following total knee arthroplasty (TKA).Question(1) Does hand-held navigation (the iAssist system) improve surgical accuracy (assessed with five parameters commonly used to evaluate surgical alignment: the hip-knee-ankle angle (HKA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), and tibial slope angle (TSA)) compared to conventional instruments in TKA? (2) Which surgical alignment parameters among HKA, FCA, TCA, FSA, and TSA can obtain the most advantage from the iAssist system? (3) Does the iAssist system lead to better functional outcomes at two years of follow-up after TKA?MethodsThis parallel-group double-blinded randomized controlled trial recruited 60 patients (30 patients each in the iAssist and conventional group) with osteoarthritis who underwent primary TKA by a single surgeon at Siriraj Hospital. There was no loss to follow-up in the study. All procedures in both groups were performed using similar surgical exposure, prosthesis implant, perioperative and postoperative protocols. Participants in the iAssist group received the iAssist system as an assistive technique, while those in the conventional group only had conventional instruments. Surgical alignments (HKA, FCA, TCA, FSA, and TSA) were recorded using CT scan at six weeks post-operation. Functional outcomes were assessed with knee ROM, KSS, and EQ-5D at 6 months, 1 year and 2 years post-operation. Baseline characteristics including age, sex, the affected knee side, and body mass index were comparable between the two groups, similar to preoperative ROM, KSS, and EQ-5D.ResultsThe mean operative time was relatively longer in the iAssist than the conventional group, although not statistically significant (88.1 ± 13.7 versus 83.4 ± 21.3; p = 0.314). Among the surgical alignment parameters evaluated, FCA was the only radiographic parameter with a statistically significant difference between the two groups and was closer to 90º in the iAssist group (89.4 ± 2.2 in the iAssist versus 87.2 ± 2.1 in the conventional group; p = 0.003). Also, there was a higher proportion of outliers in the conventional than the iAssist group (23.3% versus 10%; p = 0.086). Nonetheless, HKA and TCA did not differ between the two groups (p = 0.25 and 0.096, respectively), although the percentages of outliers were higher in the conventional than the iAssist group (HKA: 26.7% vs. 13.3%; p = 0.101 and TCA: 6.7% versus 0%; p = 0.078). Likewise, we observed other radiographic parameters had no significant group differences, including FSA and TSA. Furthermore, at two years post-operation, we found no differences between the iAssist and the conventional group in knee ROM (106.7 ± 14.6 versus 108.2 ± 12.7; p = 0.324), KSS (82.5 ± 6.4 versus 83.8 ± 3.4; p = 0.324), and EQ-5D (0.9 ± 0.2 versus 1.0 ± 0.1; p = 0.217). All functional outcomes were also comparable at 6 months and 12 months of follow-up postoperatively.ConclusionThe iAssist technology increase surgical precision by allowing for a more precise FCA with fewer outliers than conventional equipment. iAssist had longer operative time. Functional outcomes and quality of life were not different.Level of evidenceI.

Project description:PurposeTo compare 60-day complication rates, radiographic outcomes, and clinical outcomes following primary THA with conventional versus shortened stems, in a large cohort study.MethodsThe authors reviewed a consecutive series of 800 primary THAs, of which 781 met the inclusion/exclusion criteria: 395 received a conventional stem and 386 received a shortened stem. Intraoperative and postoperative complications were noted. Radiographic and clinical assessments were performed preoperatively and 60 days after surgery.ResultsCompared to conventional stems, shortened stems had significantly less intraoperative complications (2.8% vs 0.3%, p = 0.006), but no significant differences in complications that did not require reoperation (1.0% vs 1.3%, p = 0.620), complications that required reoperation without stem revision (2.0% vs 1.0%, p = 0.384), and complications that required stem revision (0.5% vs 0.5%, p = 1.000). Four hips (two from each group) required stem revision and were thus excluded from 60-day assessment. There were no significant differences between groups in subsidence ≥ 3 mm (1.0% vs 0.5%, p = 0.686), alignment (90.3%vs 86.7%, p = 0.192), net change in offset (within 3 mm, 32.3% vs 30.5%, p = 0.097), and limb length discrepancy (3.0 ± 2.6 mm vs 2.9 ± 2.4 mm, p = 0.695). Compared to conventional stems, shortened stems had significantly better preoperative mHHS (56.5 ± 18.5 vs 64.5 ± 13.5, p < 0.001), and significantly lower net improvement in mHHS (29.9 ± 17.1 vs 24.4 ± 15.0, p < 0.001), but no significant differences in postoperative mHHS (87.3 ± 11.9 vs 89.4 ± 9.6, p = 0.109).ConclusionsThere were no significant differences between conventional and shortened stems in terms of postoperative complication rates, radiographic outcomes, and postoperative mHHS. However, patients implanted with shortened stems had less intraoperative complications, but lower net improvement in mHHS.Level of evidenceLevel IV, Retrospective comparative cohort study.

Project description:INTRODUCTION:Robotic-assisted bariatric surgery is increasingly performed. There remains controversy about the overall benefit of robotic-assisted (RBS) compared to conventional laparoscopic (LBS) bariatric surgery. In this study, we used a large national risk-stratified bariatric clinical database to compare outcomes between robotic and laparoscopic gastric bypass (RNYGB) and sleeve gastrectomy (SG). METHODS:A retrospective analysis of the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Data File (PUF) was performed. Primary robotic and laparoscopic RYNGB and SG were analyzed. Descriptive analysis was performed of the unmatched cohorts, followed by 1:3 case-controlled matching. Cases and controls were matched by patient demographics and pre-operative comorbidities, and peri-operative outcomes compared. RESULTS:77,991 Roux-en-Y gastric bypass (RnYGB) (7.5% robotic-assisted) and 189,503 SG (6.8% robotic-assisted) cases were identified. Operative length was significantly higher in both the robotic-assisted RnYGB and SG cohorts (p?<?0.0001). Outcomes were similar between the robotic-assisted and laparoscopic RnYGB cohorts, except a lower mortality rate (p?=?0.05), transfusion requirement (p?=?0.005), aggregate bleeding (p?=?0.04), and surgical site infections (SSI) (p?=?0.006) in the robotic-assisted cohort. Outcomes were also similar between robotic-assisted and laparoscopic SG, except for a longer length of stay (p?<?0.0001) and higher rates of conversion (p?<?0.0001), 30-day intervention (p?=?0.01), operative drain present (p?<?0.0001), sepsis (p?=?0.01), and organ space SSI (p?=?0.0002) in the robotic cohort. Bleeding was lower in the robotic SG cohort and mortality was similar. CONCLUSION:Both robotic-assisted and laparoscopic RnYGB and SG are overall very safe. Robotic-assisted gastric bypass is associated with a lower mortality and morbidity; however, a clear benefit for robotic-assisted SG compared to laparoscopic SG was not seen. Given the longer operative and hospital duration, robotic SG is not cost-effective.

Dataset Information

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

Background

Methods

Results

Conclusions

Publications

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

Similar Datasets

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