Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: A systematic review and meta-analysis

Mannan, Ashim; Vun, Shen Hwa; Lodge, Christopher; Eyre-Brook, Alistair; Jones, Simon

doi:10.1016/j.surge.2017.12.003

Cited by 45 publications

(56 citation statements)

References 26 publications

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“…Overall, the MAKO robotic-assisted TKA was able to achieve planned final limb coronal alignment within 1.00 degrees of the preoperative plan 78% of the time and within 3.00 degrees 100% of the time. A systematic review by Mannan et al (2018) 11 included studies utilizing the ROBODOC (Zimmer) and CASPAR (Evolution) systems and found robotic-assisted surgery had increased accuracy of alignment compared with conventional TKA. It is difficult to compare our results with other studies as conventionally studies have focused on the proportion of knees that achieved a neutral alignment of 3 degrees postoperatively; however, the surgeons in this study did not necessarily aim for this.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Bone Resection in MAKO Total Knee Robotic-Assisted Surgery

2019

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Accurate component positioning and planning is vital to prevent malalignment of total knee arthroplasty (TKA) as malalignment is associated with an increased rate of polyethylene wear and revision arthroplasty. The MAKO total knee robotic arm-assisted surgery (Stryker, Kalamazoo, MI) uses a preoperative computed tomography scan of the patient's knee and three-dimensional planning to size and orientate implants prior to bone resection. The aim of this study was to determine the accuracy of the MAKO Total Knee system in achieving the preoperative plan for bone resection and final limb coronal alignment. A series of 45 consecutive cases was performed using the MAKO Total Knee system and Triathlon Total Knee implant (Stryker) between April 2018 and May 2019. The difference between what was planned and what was achieved for bone resection and coronal limb alignment was calculated. A total of 37 patients had their data captured using the MAKO system software. Mean difference from the plan for distal femoral cuts was 0.38mm (0.32) deep/proud, anterior femoral cuts 0.44mm (0.27) deep/proud and tibial cuts 0.37mm (0.30) deep/proud. In total, 99 out of 105 (94.29%) of bone resections were within 1mm of the plan. Mean absolute difference in final limb coronal alignment was 0.78° (0.78), with 78.13% being ≤1.00° of the plan, and 100% being ≤3.00° of the plan. The accuracy in achieving preoperatively planned bone resection and final limb coronal alignment using the MAKO Total Knee system is high. Future research is planned to look at whether this is associated with decreased rates of polyethylene wear and revision arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Bone Resection in MAKO Total Knee Robotic-Assisted Surgery

2019

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“…12 Mannan et al presented a systematic review and meta-analysis of five studies including 181 RA-TKAs and 159 conventional TKAs with the RA group having a better incidence or improved accuracy of ideal mechanical alignment that was statistically significant when comparing the groups. 23 Liow et al present a prospective randomized trial of 31 RA-TKA cases and 29 manual TKA cases and found that the conventional group had a rate of mechanical axis deviation of greater than 3 degree and notching at 19.4% and 10.3% versus 0% for both in the RA-TKA group. Further, joint-line restoration was better in the RA-TKA group with only 3.23% being joint-line outliers of >5 mm versus 20.6% in the conventional group.…”

Section: Discussionmentioning

confidence: 99%

Improved Patient Satisfaction following Robotic-Assisted Total Knee Arthroplasty

et al. 2019

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Approximately 20% of the patients are dissatisfied with their total knee arthroplasty (TKA). Computer technology has been introduced for TKA to provide real time intraoperative information on limb alignment and exact flexion/extension gap measurements. The purpose of this study was to determine if patient satisfaction could be improved with the use of robotic-assisted (RA) technology following primary TKA. A total of 120 consecutive patients undergoing RA-TKA with real time intraoperative alignment and gap balancing information were compared with a prospective cohort of 103 consecutive patients undergoing TKA with manual jig-based instruments during the same time period. There were no differences between groups with age, gender, baseline Knee Society Score (KSS) knee and function scores, follow-up, and ASA scores. TKAs were performed using same technique, implant design, anesthesia, and postoperative treatment protocols. Patient satisfaction survey using KSS and Likert scoring system were obtained at 1-year follow-up. Likert scoring system demonstrated 94% of the patients in the RA group were either very satisfied or satisfied versus 82% in the manual instruments TKA group (p = 0.005). RA-TKA group had better average scores of all five satisfaction questions although not significant. RA-TKA group had a better average overall satisfaction score of 7.1 versus 6.6 in the manual instrument group, p = 0.03. KSS function scores were significantly better at 6 weeks and 1 year postoperatively (p = 0.02, 0.005), and KSS knee scores were significantly better at 1 year postoperatively (p = 0.046). There are multiple reasons for patient dissatisfaction following primary TKA. Using intraoperative computer technology with RA surgery for patients undergoing a primary TKA, a significant improvement in patient satisfaction was demonstrated compared with TKA using conventional manual jig-based instruments. RA surgery provides several advantages in TKA including real time information in millimeters to help obtain balanced gaps, accurate bone cuts, reduced soft tissue injury, and achieve the target alignment which may lead to improved patient satisfaction.

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“…La navegación y los sistemas robóticos en cirugía protésica de rodilla han permitido aumentar la exactitud de los cortes óseos y la precisión del posicionamiento del implante, con un aumento potencial de la seguridad de este procedimiento. [11][12][13][14] Sin embargo, su impacto clínico ha sido cuestionado. Distribución de los tiempos de isquemia quirúrgicas.…”

Section: Discussionunclassified

“…[10][11][12][13] Sin embargo, la repercusión clínica en términos de mejora en la tasa de complicaciones y sobrevida del implante con nuevas revisiones no ha sido demostrada. [10][11][12][13][14] Estudios comparativos recientes entre la cirugía protésica de rodilla con asistencia robótica y la cirugía convencional han evidenciado diferencias significativas en el postoperatorio inmediato. La asistencia robótica ha permitido un postoperatorio con menor dolor y menor pérdida sanguínea, mayor funcionalidad física, una rehabilitación precoz del rango de movilidad articular (ROM), mejor percepción de salud y mayor satisfacción general.…”

Section: Introductionunclassified

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Artroplastía Total de Rodilla con Asistencia de Brazo-Robótico: Resultados Clínicos Postoperatorios Tempranos

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Guiloff

Naranjo

et al. 2019

Rev Chil Ortop Traumatol

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Resumen Objetivo Describir los resultados clínicos postoperatorios tempranos de la primera serie de pacientes operados de artroplastía total de rodilla (ATR) con asistencia de brazo-robótico en Latinoamérica. Materiales y Métodos Estudio prospectivo de 52 pacientes (53 rodillas) con gonartoris tricompartimental sintomática operados de ATR primaria con asistencia de brazo-robótico (RIO-MAKO) de manera consecutiva, con seguimiento a 2 meses postoperados. No se excluyeron pacientes. Se utilizó el mismo protocolo anestésico y de rehabilitación. Se realizó revisión de fichas clínicas para recolectar los siguientes resultados: tiempo de isquemia quirúrgica, estadía hospitalaria, tiempo a marcha, dolor postoperatorio diario [Escala visual análoga (EVA)], uso de opioides, rangos de movilidad articular (ROM), pérdida sanguínea, complicaciones y eje mecánico postoperatorio. Resultados Tiempos de Isquemia: 82 minutos (60–120). Estadía Hospitalaria: 4 días (2–12). Dolor postoperatorio: EVA el mismo día operatorio de 0 (0–10) y previa al alta de 0 (rango 0–4), con 0,3 purgas (0–6,5) de opioides por paciente. Tiempo a marcha (día logrado): 1 día (1–3), cuarenta y cinco pacientes (84,9%) iniciaron la marcha el primer día postoperatorio. ROM (Extensión-Flexión): Aumento progresivo durante el seguimiento. En el control ambulatorio de los dos primeros meses [23 días (13–50)], veintiún pacientes (40%) alcanzaron un ROM mayor o igual a 0–90° y once (20%) presentaron un ROM funcional máximo (0–120°). Pérdida sanguínea: Siete pacientes (13,2%) requirieron transfusión. Complicaciones: un paciente (1,89%) presentó una dehiscencia del cierre de la artrotomía. No hubo otras complicaciones. Eje mecánico postoperatorio: 179,1° (178,2–180). Discusión Los resultados concuerdan con la evidencia descrita en otras regiones, sugiriendo que la asistencia de brazo-robótico permite resultados postquirúrgicos reproducibles. Conclusión Los resultados clínicos postoperatorios tempranos de esta serie de pacientes operados de ATR con asistencia de brazo-robótico, muestran una baja percepción del dolor, con bajo consumo de opioides, una rápida recuperación funcional de la marcha y ROM, y excelentes resultados desde el punto de vista del eje mecánico postoperatorio. Nivel de Evidencia IV.

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Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: A systematic review and meta-analysis

Cited by 45 publications

References 26 publications

Accuracy of Bone Resection in MAKO Total Knee Robotic-Assisted Surgery

Accuracy of Bone Resection in MAKO Total Knee Robotic-Assisted Surgery

Improved Patient Satisfaction following Robotic-Assisted Total Knee Arthroplasty

Artroplastía Total de Rodilla con Asistencia de Brazo-Robótico: Resultados Clínicos Postoperatorios Tempranos

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