Robotic-Assisted Lateral Unicompartmental Knee Arthroplasty in a Patient With Nail-Patella Syndrome.
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SUBMITTER: Vakharia RM
PROVIDER: S-EPMC8049876 | biostudies-literature |
REPOSITORIES: biostudies-literature
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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:Many studies have found associations between unicompartmental knee arthroplasty (UKA) and implant survival, but controversy still exists regarding the relative survival of medial versus lateral UKA over mid-to long-term follow-up. The purpose of this study was to compare survival and clinical outcomes of medial and lateral UKAs. In this meta-analysis, we reviewed studies that assessed implant survival in patients who underwent medial or lateral UKA with short- to mid-term (<10years) or long-term (>10years) follow-up, and that used assessments, such as pain and function scores, to compare postoperative scores on knee outcome scales. A total of eight studies (33,999 knees with medial UKA and 2,853 with lateral UKA) met the inclusion criteria and was analyzed in detail. There were no significant differences between medial and lateral UKA in pain score (95% CI: -0.37 to 0.88; P = 0.42), function score (95% CI: -0.19 to 0.60; P = 0.31), short- to mid-term survival (medial, 32,083/33,483; lateral, 2,636/2,726; OR 0.98, 95% CI: 0.64 to 1.48;P = 0.91), or long-term survival (medial, 479/516; lateral, 110/127; OR 2.51, 95% CI:0.67 to 9.43; P = 0.17). In addition, both groups had substantial proportions of knees with short- to mid-term survival (95.6% by medial UKA and 94.6% by lateral UKA) and long-term survival (92.8% by medial UKA and 86.6% by lateral UKA). This meta-analysis found no significant differences in short- to mid-term and long-term survival of medial and lateral UKAs. Similarly, patients treated with medial UKA showed no difference in pain relief or functional improvement compared to patients treated with lateral UKA. These results suggest that both UKA techniques are viable treatment options for patients with unicompartmental knee osteoarthritis over long-term follow-up, although further high-quality studies are needed to address some remaining uncertainties regarding the clinical benefits of these procedures.
| S-EPMC6980580 | biostudies-literature
Project description:Bell et al.'s "Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty: Data from a Prospective, Randomized Controlled Study" compared the accuracy of a robotic-assisted unicompartmental knee arthroplasty (UKA) using the MAKO Robotic Interactive Orthopedic Arm (RIO) system to a conventional UKA using standardized instrumentation. This review examines the authors' findings and their relevance to clinical practice. Bell et al. conclude that the MAKO RIO system leads to more accurate implantation of both the tibial and femoral components in UKA in the sagittal, coronal, and axial planes. This well-designed, level I study suggests what many arthroplasty surgeons assume about robotic assistance, which admittedly is of unknown clinical significance at this time. Evaluating this article in the context of the current literature provides valuable insight into areas in need of future investigation. The effect of implant positioning on long-term clinical outcomes and implant survivorship remains unclear. Long-term follow-up studies are needed to determine the role of robotic-assisted arthroplasty in the future.
| S-EPMC6031529 | biostudies-literature
Project description:BackgroundUnicompartmental knee arthroplasty (UKA) is an increasingly popular option for the treatment of single-compartment knee osteoarthritis (OA) in adults. Two options for tibial resurfacing during UKA are (1) all-polyethylene inlays and (2) metal-backed onlays.Questions/purposesThe aim of this study was to determine whether there are any differences in clinical outcomes with inlay versus onlay tibial components.Patients and methodsWe identified 39 inlays and 45 onlays, with average 2.7- and 2.3-year follow-up, respectively, from a prospective robotic-assisted surgery database. The primary outcome was the Western Ontario and McMaster University Arthritis Index (WOMAC), subcategorized by the pain, stiffness, and function subscores, at 2 years postoperatively. The secondary outcome was the need for secondary or revision surgery.ResultsPostoperative WOMAC pain score was 3.1 for inlays and 1.6 for onlays (p?=?0.03). For 25 inlays and 30 onlays with both preoperative and postoperative WOMAC data, pain score improved from 8.3 to 4.0 for inlays versus from 9.2 to 1.7 for onlays (p?=?0.01). Function score improved from 27.5 to 12.5 for inlays versus from 32.1 to 7.3 for onlays (p?=?0.03). Four inlays and one onlay required a secondary or revision procedure (p?=?0.18).ConclusionsWe advise using metal-backed onlays during UKA to improve postoperative clinical outcomes.
| S-EPMC4342394 | biostudies-literature
Project description:Nail-patella syndrome (NPS) is a pleiotropic autosomal-dominant disorder due to mutations in the gene LMX1B. It has traditionally been characterized by a tetrad of dermatologic and musculoskeletal abnormalities. However, one of the most serious manifestations of NPS is kidney disease, which may be present in up to 40% of affected individuals. Although LMX1B is a developmental LIM-homeodomain transcription factor, it is expressed in post-natal life in the glomerular podocyte, suggesting a regulatory role in that cell. Kidney disease in NPS seems to occur more often in some families with NPS, but it does not segregate with any particular mutation type or location. Two patterns of NPS nephropathy may be distinguished. Most affected individuals manifest only an accelerated age-related loss of filtration function in comparison with unaffected individuals. Development of symptomatic kidney failure is rare in this group, and proteinuria (present in approximately one-third) does not appear to be progressive. A small minority (5-10%) of individuals with NPS develop nephrotic-range proteinuria as early as childhood or young adulthood and progress to end-stage kidney failure over variable periods of time. It is proposed that this latter group reflects the effects of more global podocyte dysfunction, possibly due to the combination of a mutation in LMX1B along with an otherwise innocuous polymorphism or mutation involving any of several genes expressed in podocytes (e.g. NPHS2, CD2AP), the transription of which is regulated by LMX1B.
| S-EPMC2770138 | biostudies-literature
Project description:ObjectiveWe conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA.DesignSystematic review and meta-analysis.Data sourcesThe PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020.Eligibility criteriaCase-control studies comparing robotic-assisted and conventional UKA.Data extraction and synthesisData from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ2 and I2 tests. All analyses were performed using the 'metafor' package of R V.3.6.2 software.ResultsA total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis.ConclusionsThis study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required.Prospero registration numberCRD42021246927.
| S-EPMC8359483 | biostudies-literature
Project description:BackgroundThe aim of this study was to compare the clinical and radiologic outcomes of robot-assisted unicompartmental knee arthroplasty (UKA) to those of conventional UKA in Asian patients.MethodsFifty-five patients underwent robot-assisted UKA and 57 patients underwent conventional UKA were assessed in this study. Preoperative and postoperative range of motion (ROM), American Knee Society (AKS) score, Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC), and patellofemoral (PF) score values were compared between the two groups. The mechanical femorotibial angle (mFTA) and Kennedy zone were also measured. Coronal alignments of the femoral and tibial components and posterior slopes of the tibial component were compared. Additionally, polyethylene (PE) liner thicknesses were compared.ResultsThere was no significant difference between the two groups regarding postoperative ROM, AKS, WOMAC and PF score. Robot group showed fewer radiologic outliers in terms of mFTA and coronal alignment of tibial and femoral components (p = 0.022, 0.037, 0.003). The two groups showed significantly different PE liner thicknesses (8.4 ± 0.8 versus 8.8 ± 0.9, p = 0.035). Robot group was the only influencing factor for reducing radiologic outlier (postoperative mFTA) in multivariate model (odds ratio: 2.833, p = 0.037).ConclusionIn this study, robot-assisted UKA had many advantages over conventional UKA, such as its ability to achieve precise implant insertion and reduce radiologic outliers. Although the clinical outcomes of robot-assisted UKA over a short-term follow-up period were not significantly different compared to those of conventional UKA, longer follow-up period is needed to determine whether the improved radiologic accuracy of the components in robotic-assisted UKA will lead to better clinical outcomes and improved long-term survival.
| S-EPMC6890211 | biostudies-literature
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:Nail-patella syndrome (NPS) is an autosomal dominant disease that typically involves the nails, knees, elbows and the presence of iliac horns. In addition, some patients develop glomerulopathy or adult-onset glaucoma. NPS is caused by loss-of-function mutations in the LMX1B gene. In this study, phenotype-genotype correlation was analyzed in 9 unrelated Korean children with NPS and their affected family members. The probands included 5 boy and 4 girls who were confirmed to have NPS, as well as 6 of their affected parents. All of the patients (100%) had dysplastic nails, while 13 patients (86.7%) had patellar anomalies, 8 (53.3%) had iliac horns, 6 (40.0%) had elbow contracture, and 4 (26.7%) had nephropathy including one patient who developed end-stage renal disease at age 4.2. The genetic study revealed 8 different LMX1B mutations (5 missense mutations, 1 frame-shifting deletion and 2 abnormal splicing mutations), 6 of which were novel. Genotype-phenotype correlation was not identified, but inter- and intrafamilial phenotypic variability was observed. Overall, these findings are similar to the results of previously conducted studies, and the mechanism underlying the phenotypic variations and predisposing factors of the development and progression of nephropathy in NPS patients are still unknown.
| S-EPMC2633198 | biostudies-literature
Project description:BackgroundTwo commonly used tibial designs for unicompartmental knee arthroplasty (UKA) are all-polyethylene "inlay" and metal-backed "onlay" components. Biomechanical studies showed that the metal baseplate in onlay designs better distributes forces over the tibia but studies failed to show differences in functional outcomes between both designs at mid-term follow-up. Furthermore, no studies have compared both designs with total knee arthroplasty (TKA).Questions/purposesThe goal of this study was to compare outcomes of inlay UKA and onlay UKA at mid-term follow-up and compare these with TKA outcomes.MethodsIn this retrospective study, 52 patients undergoing inlay medial UKA, 59 patients undergoing onlay medial UKA, and 59 patients undergoing TKA were included. Western Ontario and McMaster Universities Arthritis Index scores were collected preoperatively and at mean 5.1-year follow-up (range 4.0-7.0 years).ResultsPreoperatively, no differences were observed in patient characteristics or outcome scores. At mid-term follow-up, patients undergoing onlay medial UKA reported significant better functional outcomes than those of inlay medial UKA (92.0 ± 10.4 vs. 82.4 ± 18.7, p = 0.010) and when compared to TKA (92.0 ± 10.4 vs. 79.6 ± 18.5, p < 0.001) while no significant differences between inlay medial UKA and TKA were noted. No significant differences in revision rates were found.ConclusionFunctional outcomes following onlay metal-backed medial UKA were significantly better compared to inlay all-polyethylene medial UKA and to TKA. Based on the results of this study and on biomechanical and survivorship studies in the literature, we recommended using metal-backed onlay tibial components for unicompartmental knee arthroplasty.
| S-EPMC5617820 | biostudies-literature