Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees

Foissey, Constant; Batailler, Cécile; Vahabi, Arman; Fontalis, Andreas; Servien, Elvire; Lustig, Sébastien

doi:10.1007/s00264-022-05640-6

Cited by 28 publications

(17 citation statements)

References 48 publications

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“…The outlier rates for Δ Cartier, Δ MPTA, and Δ MPTA preoperatively-TCA varied in this series between 30.6% and 38.9%, close to the outlier rate found in the series of Foissey et al (Δ Cartier = 45%) with the conventional cutting guides. These authors found a signiicant decrease in outliers under robotic assistance [12]. The Cartier angle, which takes into account the lateral tibial plateau as a reference, was not modeled by the robot, contrary to the MPTA, which would probably allow to improve the accuracy and to decrease the outlier rate [2].…”

Section: Discussionmentioning

confidence: 99%

“…(Δ Cartier = 45%) with the conventional cutting guides. These authors found a significant decrease in outliers under robotic assistance [12]. The Cartier angle, which takes into account the lateral tibial plateau as a reference, was not modeled by the robot, contrary to the MPTA, which would probably allow to improve the accuracy and to decrease the outlier rate [2].…”

Section: Discussionmentioning

confidence: 99%

“…The Cartier angle was measured between the axis passing through the middle of the healthy cartilage externally and parallel to the lateral tibial plateau, to the medial tibial plateau above the UKA or tangent to the femoral implant, and the anatomical axis of the tibia (Fig. 1) [10, 12, 29].…”

Section: Methodsmentioning

confidence: 99%

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Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Micicoi,

Machado,

Ernat

et al. 2023

Knee surg. sports traumatol. arthrosc.

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PurposeThe alignment obtained after unicompartmental knee arthroplasty (UKA) inluences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the inluence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes. Methods This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre-and postoperatively. Outliers were deined as follows: Δ Cartier > 3° (diference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (diference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre-and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coeicient. Results During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was signiicantly correlated with IKS function (R 2 = 0.06, p < 0.001) and FJS (R 2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was signiicantly correlated (p < 0.001) with KOOS (R 2 = 0.38), IKS Knee (R 2 = 0.17), IKS function (R 2 = 0.34), SKV (R 2 = 0.08), and FJS (R 2 = 0.37) scores. In subgroup analysis, nonoutliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients. Conclusion Functional results after medial UKA can be inluenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be conirmed by other controlled studies. Level of evidence IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Micicoi,

Machado,

Ernat

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…A recent prospective study reported an accurate execution of the pre-operative plan with the image-based robotic-assisted system [23]. These systems have also proven their accuracy and satisfying clinical outcomes with unicompartmental knee arthroplasty [11][12][13][14]29].…”

Section: Discussionmentioning

confidence: 99%

“…The evolution of surgical technology had led to the development of robotic arm assistance for knee arthroplasty that has been reported to result in more reproducible, accurate and personalized component positioning [11][12][13][14], in addition to minimizing bone and soft tissue peri-articular trauma [15,16]. Available robotic systems encompass imagefree and image-based systems that use pre-operative computerized tomography scans (CT) to create a computer-aided design model of the patient's knee joint and guide implant positioning and bone resection.…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral Arthroplasty Is an Efficient Strategy for Isolated Patellofemoral Osteoarthritis with or without Robotic-Assisted System

Batailler

Putzeys²,

Lacaze

et al. 2023

JPM

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There is relative paucity in the literature concerning outcomes after robotic-assisted Patellofemoral Arthroplasty (PFA). The aims were (1) to evaluate outcomes in patients undergoing PFA with inlay or onlay components, with or without robotic arm assistance and (2) to identify risk factors of poor outcomes after PFA. This retrospective study included 77 PFA for isolated patellofemoral joint osteoarthritis, assigned to three groups (18 conventional technique, 17 image-free robotic-assisted system and 42 image-based robotic-assisted system). The demographic data were comparable between the three groups. The clinical outcomes assessed were: Visual Analogue Scale, Knee Society Score, Kujala score and satisfaction rate. The radiological measures were: Caton Deschamps index, patellar tilt and frontal alignment of the trochlea. Functional outcomes, satisfaction rate and residual pain were comparable between the three groups. Patellar tilt improvement was superior when a robotic device was used (either image-based or image-free) compared to the conventional technique. There were three revisions (3.9%) at the last follow-up related to femorotibial osteoarthritis progression. Multivariate analysis found no significant risk factors for poor outcomes, with respect to the surgical technique or implant design. Functional outcomes and revisions rate after PFA were comparable between the surgical techniques and implants. Robotic-assisted systems were associated with a superior improvement of the patellar tilt compared to the conventional technique.

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Effect of design and surgical parameters variations in mobile‐bearing versus fixed‐bearing unicompartmental knee arthroplasty: A finite element analysis

Luyckx,

Bori,

Saldari

et al. 2024

J. exp. orthop.

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PurposeUnicompartmental knee arthroplasty (UKAs) are available in the market as fixed‐ and mobile‐bearing (FB and MB) and can be characterised by a different set of design parameters in terms of geometries, materials and surgical approaches, with overall good clinical outcomes. However, clear biomechanical evidence concerning the consequences of variations of these features on knee biomechanics is still lacking; therefore, the present study aims to perform a sensitivity analysis to see which outcomes are affected by these variations.MethodsFor both MB‐UKA and FB‐UKA, five design and surgical parameters were defined (bearing insert thickness, tibial component material, implant components friction coefficient, antero‐posterior slope angle and level of tibial bone resection). Two control models were defined based on standard configurations for both implants. Finite element analysis was chosen to perform this study, and different parameter combinations (216 models in total) were implemented and tested at both 0° and 90° of flexion, using a previously validated finite element knee model. The results were then evaluated in terms of bone and polyethylene Von Mises stress and tibio‐femoral contact area.ResultsBearing thickness, tibial bone cut and slope angle were found to be the most sensitive parameters for both types of UKAs. Specifically, changes in these parameters in the FB‐UKA appeared to induce more significant variations in the polyethylene insert (both in terms of polyethylene stress and contact area), while in the MB‐UKA, these changes influenced bone stress distribution more.ConclusionsSurgical parameters returned to have a more significant influence than material and friction variations; furthermore, the outcomes most affected by parameter variations were the insert‐related ones for FB‐UKA while for the MB‐UKA were the ones regarding tibial bone stresses.Level of EvidenceNot Applicable.

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Better accuracy and implant survival in medial imageless robotic-assisted unicompartmental knee arthroplasty compared to conventional unicompartmental knee arthroplasty: two- to eleven-year follow-up of three hundred fifty-six consecutive knees

Cited by 28 publications

References 48 publications

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Patellofemoral Arthroplasty Is an Efficient Strategy for Isolated Patellofemoral Osteoarthritis with or without Robotic-Assisted System

Effect of design and surgical parameters variations in mobile‐bearing versus fixed‐bearing unicompartmental knee arthroplasty: A finite element analysis

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