HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

Li, Zheng; Chen, Xin; Wang, Xiaoquan; Zhang, Bo; Wang, Wei; Fan, Yu; Yan, Jun; Zhang, Xiaofeng; Zhao, Yu; Lin, Yuan; Liu, Jun; Lin, Jianhao

doi:10.1016/j.jot.2021.12.004

Cited by 31 publications

(27 citation statements)

References 51 publications

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“…The sensitivity analysis with commonly used robotic systems found similar results ( Figure 7 , see Appendix ); however, the analysis excluding a study with high risk of bias found both the point estimate and the 95%CI favoring COTKA ( Figure 6 , see Appendix ), while the result from the analysis employing the fixed-effects model favored RATKA ( Figure 8 , see Appendix ). For HSS score, the combined results from 3 studies ( 23 , 24 , 32 ) of 256 participants with no heterogeneity (I 2 = 0%, p = 1) found an average of 0.67 HSS points higher in the RATKA group (CI –0.99 to 2.3, moderate certainty) ( Figure 3C ). The 3 sensitivity analyses gave similar results ( Figures 6 – 8 , see Appendix ).…”

Section: Resultsmentioning

confidence: 97%

“…All 12 included studies are parallel-group RCTs published during 2007–2020. 10 studies were conducted in Asia: South Korea (n = 4) ( 22 - 24 , 27 ), China (n = 2) ( 31 , 32 ), Singapore (n = 2) ( 25 , 26 ), Thailand (n = 1) ( 29 ), and India (n = 1) ( 30 ), and 2 were from Europe: Russia (n = 1) ( 33 ), and England (n = 1) ( 28 ). Their sample sizes ranged from 30 to 1,406, with participants’ mean age ranging from 60 to 77 years.…”

Section: Resultsmentioning

confidence: 99%

“…The mean follow-up time of the studies with clinical outcomes ranged from 3 months to 13 years. 2 studies received funding from governmental and non-profit organizations ( 29 , 32 ). Another study had a potential financial conflict of interest with the robot manufacturer ( 24 ).…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity analyses found the point estimates to be in the same direction, with the 95% CIs all excluding the MID ( Figures 6 – 8 , see Appendix ). 5 studies, including 1,685 patients, reported the KSS ( 22 , 26 , 27 , 31 , 32 ). Compared with COTKA, RATKA had 0.89 points higher KSS on average (CI –0.18 to 2.0, moderate certainty) as presented in Figure 3B (I 2 = 25%, p = 0.3).…”

Section: Resultsmentioning

confidence: 99%

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Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Ruangsomboon

Pornrattanamaneewong

et al. 2023

ActaO

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Background and purpose: Robotic-assisted total knee arthroplasty (RATKA) is an alternative surgical treatment method to conventional total knee arthroplasty (COTKA) that may deliver better surgical accuracy. However, its impact on patient outcomes is uncertain. The aim of this systematic review of randomized controlled trials (RCTs) is to evaluate whether RATKA could improve functional and radiological outcomes compared with COTKA in adult patients with primary osteoarthritis of the knee.Methods: We searched Ovid MEDLINE, EMBASE, Scopus, and the Cochrane Library to identify published RCTs comparing RATKA with COTKA. 2 reviewers independently screened eligible studies, reviewed the full texts, assessed risk of bias using the Risk of Bias 2.0 tool, and extracted data. Outcomes were patient-reported outcomes, range of motion, and mechanical alignment (MA) deviation and outliers, and complications.Results: We included 12 RCTs involving 2,200 patients. RATKA probably results in little to no effect on patient-reported outcomes (mean difference (MD) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of –0.35 (95% confidence interval [CI] –0.78 to 0.07) and range of motion (MD –0.73°; CI –7.5° to 6.0°) compared with COTKA. However, RATKA likely results in a lower degree of MA outliers (risk ratio 0.43; CI 0.27 to 0.67) and less deviation from neutral MA (MD –0.94°; CI –1.1° to –0.73°). There were no differences in revision rate or major adverse effects associated with RATKA.Conclusion: Although RATKA likely results in higher radiologic accuracy than COTKA, this may not be clinically meaningful. Also, there is probably no clinically important difference in clinical outcomes between RATKA and COTKA, while it is as yet inconclusive regarding the revision and complication rates due to insufficient evidence.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Ruangsomboon

Pornrattanamaneewong

et al. 2023

ActaO

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“…A study published by Marchand et al demonstrated that an RA-TKA system improved postoperative pain and knee joint function compared with conventional methods 28 . Li et al found no signi cant difference in WOMAC, HSS, SF-36, or KSS scores in patients that were operated using robot assistance compared with conventional surgery 29 . In the present study, no signi cant difference was observed in the KSS or VAS scores, or ROM in the RA group compared with conventional surgery (P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Learning curve and short-term clinical outcomes of a new seven-axis robot-assisted total knee arthroplasty system: A propensity-score-matched retrospective cohort study

Duan

Kong

Cao

et al. 2022

Preprint

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Robot-assisted total knee arthroplasty (RA-TKA) requires a lot of training from surgeons to master it. The purpose of the present study was to determine the learning curve for a novel seven-axis RA-TKA system, and to explore whether it could provide superior short-term clinical and radiological outcomes compared with conventional surgery. In the present retrospective study, 180 patients from our hospital with primary unilateral TKA were included, from January 2021 to June 2022. Of these, 90 patients underwent RA-TKA and were included in robot-assisted system (RAS) group, while the remaining 90 patients underwent conventional TKA and were included in the conventional group. The learning curve for the RA-TKA system was evaluated by cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) methods. Depending on the learning curve data, the RAS group patients were categorized as either in a learning or proficiency group. In addition, the proficiency group was compared with the conventional group using propensity score matching. There was no significant difference in postoperative Hip–Knee–Ankle (HKA) angle, or deviations in the postoperative HKA angle, component tibial coronal angle (CTCA), component femoral coronal angle (CFCA), sagittal tibial component angle (STCA), or sagittal femoral component angle (SFCA) between the learning and proficiency phases in RA-TKA group patients. A total of 49 patients in the proficiency group were matched with 49 patients from the conventional group. The indicators representing the accuracy of the prosthetic installation differ between the proficiency group and conventional group. (P < 0.05). From the learning curve data, 20 cases are required for a surgeon using a novel seven-axis RA-TKA system to enter the proficiency phase. In the proficiency group, compared with the conventional group using propensity score matching, the RAS was found to be superior to the conventional group in prosthesis and lower limb alignment.

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Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis

Zheng,

Li,

Yuan

et al. 2024

J. exp. orthop.

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PurposeVarious assistive techniques, such as conventional cutting instruments (CON), computer‐assisted navigation systems (CAS), patient‐specific instruments (PSI) and robot‐assisted systems (RAS), have been developed and applied in primary total knee arthroplasty (TKA). In this study, we aimed to assess the relative accuracy and efficacy of several assistive techniques for TKA through a network meta‐analysis (NMA) based on multiple published randomized controlled trials (RCTs).MethodsThe PubMed, EMBASE and Cochrane databases were searched for RCTs to conduct this NMA from inception to 1 January 2024. We combined direct and indirect comparisons using a Bayesian NMA framework to assess and compare the effects of different assistive techniques on radiological and clinical outcomes. An NMA was conducted, and the study protocol was published online at PROSPERO (CRD42023402882).ResultsOne hundred and twelve RCTs involving 14,968 TKAs with four different assistive techniques (CON, CAS, PSI and RAS) were evaluated. Inconsistency and heterogeneity were acceptable for most outcomes. Based on the surface under the cumulative ranking curve, RAS could be the best technique for accurate mechanical axis alignment and component position, followed by CAS, PSI and CON. We observed no difference in clinical outcome scores. Additionally, CAS was the best intervention for visual analogue scale scores, and PSI had the shortest operative time. No significant differences were observed in postoperative complications, range of motion or total blood loss.ConclusionRAS was most likely to achieve an accurate alignment, followed by CAS, PSI and CON. No differences were observed in clinical outcome scores and postoperative complications among the four assistive techniques.Level of EvidenceLevel I (systematic review of Level‐I randomized controlled studies).

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HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment – A prospective randomized and multicenter study

Cited by 31 publications

References 51 publications

Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Learning curve and short-term clinical outcomes of a new seven-axis robot-assisted total knee arthroplasty system: A propensity-score-matched retrospective cohort study

Comparison of the accuracy and efficacy of different assistive techniques in primary total knee arthroplasty: A network meta‐analysis

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