Innovations in Total Knee Arthroplasty: Improved Technical Precision, But Unclear Clinical Benefits

Keeney, James A.

doi:10.3928/01477447-20160628-03

Cited by 16 publications

(11 citation statements)

References 40 publications

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“…As the population continues to age, demand for TKA is expected to increase and is projected to reach over 1.5 million cases performed annually by 2050 [4]. Over the last 4 decades, advancements in implant designs, improvement in surgical techniques and instrumentation, and development of rapid recovery protocols have significantly contributed to reducing the length of stay (LOS) and recovery time after TKA [5,6]. In 2018, The Centers for Medicare and Medicaid Services removed TKA from its inpatient-only list, allowing medically and socially optimized patients to discharge home on the same day or next day after TKA [7,8].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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Background: In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA. Methods: A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 oneday length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC. Results: Controlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] ¼ 0.935, P < .001), body mass index !35 (OR ¼ 0.491, P ¼ .002), female (OR ¼ 0.535, P < .001), nonwhite race (OR ¼ 0.456, P ¼ .003), primary hypertension (OR ¼ 0.710, P ¼ .032), !3 comorbidities (OR ¼ 0.507, P ¼ .002), American Society of Anesthesiologists score !3 (OR ¼ 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (c 2 ¼ 12.437, P ¼ .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination. Conclusion: For patients undergoing primary TKA, increased age, body mass index !35, female gender, nonwhite race, primary hypertension, !3 comorbidities, and American Society of Anesthesiologists score !3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

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Section: Introductionmentioning

confidence: 99%

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

et al. 2021

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“…However, this was not the case. Therefore, given these various complexities, our findings regarding stable operative times may suggest that orthopedic surgeons have continually implemented innovative techniques and technologies into their practice in order to maintain a safe procedural duration [29,30]. This is further suggested by our findings regarding the decreased incidences of various complications as well as the overall decrease in LOS.…”

Section: Discussionmentioning

confidence: 55%

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

Acuña

Samuel

Karnuta

et al. 2020

The Journal of Arthroplasty

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“…In this context, the introduction of robotic assisted TKA is supposed to improve the accuracy of component positioning and to adapt more precisely to patient anatomy and biomechanics 8 . Robotic TKA using has been introduced to improve component alignment, stability and proprioception [9][10][11] . The aim of this treatment is a lower pain rate, shorter hospitalisation, and longer implantation survival rates 12; 13 .…”

Section: Introductionmentioning

confidence: 99%

Robotic total knee arthroplasty in clinical practice: protocol for a randomised controlled trial

Migliorini¹,

Maffulli

Schäfer³

et al. 2022

Preprint

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Around 2–20% of patients who undergo total knee arthroplasty (TKA) reported restricted motion and anterior knee pain. Non-optimal implant components alignment represents a common cause for complain. In this context, the introduction of robotic assisted TKA is supposed to improve the accuracy of component positioning and to adapt more precisely to patient anatomy and biomechanics. Robotic TKA using has been introduced to improve component alignment, stability and proprioception. However, the advantages of robotic surgery over the conventional freehand TKA are still unclear and evidence are missing. The present study is a protocol for a single-blind parallel-group randomized controlled trial in which each group of participants is exposed to only one of the study interventions. Patients will be randomly allocated to robotic TKA or standard TKA. The primary outcome of interest is to evaluate the learning curve. The secondary outcome of interest is to compare robotic TKA using CORI versus freehand arthroplasty in patients reported outcome measures (PROMs), length of the hospitalisation, blood values, implant positioning, blood transfusion units, range of motion. The third outcome of interest is to evaluate accuracy of component positioning of robotic TKA compared to the conventional TKA with respect to the pre-operative planning. Level of evidence: Level I, randomised controlled trial Registration: German Registry of Clinical Trials (ID: DRKS00030614)

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Innovations in Total Knee Arthroplasty: Improved Technical Precision, But Unclear Clinical Benefits

Cited by 16 publications

References 40 publications

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample

Robotic total knee arthroplasty in clinical practice: protocol for a randomised controlled trial

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