Is robotic-assisted unicompartmental knee arthroplasty a safe procedure? A case control study

Mergenthaler, Guillaume; Batailler, Cécile; Lording, Timothy; Servien, Elvire; Lustig, Sébastien

doi:10.1007/s00167-020-06051-z

Cited by 31 publications

(16 citation statements)

References 27 publications

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“…Only some minor complications related to the use of navigation pins are described [ 105 , 106 ]. Similar results have been described with the Navio system [ 107 ].…”

Section: Robotic-assisted Knee Arthroplastysupporting

confidence: 87%

New Technologies in Knee Arthroplasty: Current Concepts

Batailler

Swan

Sappey‐Marinier

et al. 2020

JCM

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Total knee arthroplasty (TKA) is an effective treatment for severe osteoarthritis. Despite good survival rates, up to 20% of TKA patients remain dissatisfied. Recently, promising new technologies have been developed in knee arthroplasty, and could improve the functional outcomes. The aim of this paper was to present some new technologies in TKA, their current concepts, their advantages, and limitations. The patient-specific instrumentations can allow an improvement of implant positioning and limb alignment, but no difference is found for functional outcomes. The customized implants are conceived to reproduce the native knee anatomy and to reproduce its biomechanics. The sensors have to aim to give objective data on ligaments balancing during TKA. Few studies are published on the results at mid-term of these two devices currently. The accelerometers are smart tools developed to improve the TKA alignment. Their benefits remain yet controversial. The robotic-assisted systems allow an accurate and reproducible bone preparation due to a robotic interface, with a 3D surgical planning, based on preoperative 3D imaging or not. This promising system, nevertheless, has some limits. The new technologies in TKA are very attractive and have constantly evolved. Nevertheless, some limitations persist and could be improved by artificial intelligence and predictive modeling.

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“…Only some minor complications related to the use of navigation pins are described [ 105 , 106 ]. Similar results have been described with the Navio system [ 107 ].…”

Section: Robotic-assisted Knee Arthroplastysupporting

confidence: 87%

New Technologies in Knee Arthroplasty: Current Concepts

Batailler

Swan

Sappey‐Marinier

et al. 2020

JCM

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“…Then, several studies have shown a decrease in postoperative pain with the use of the robot [ 20 , 21 ]. This may also explain the decrease in the rate of stiffness in patients operated with robotic.…”

Section: Discussionmentioning

confidence: 99%

Stiffness after unicompartmental knee arthroplasty: Risk factors and arthroscopic treatment

Fournier

Gaillard

Swan

et al. 2021

SICOT-J

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Introduction: One of the principal complications after total knee arthroplasty (TKA) is stiffness. There are no publications concerning stiffness after unicompartmental knee arthroplasty (UKA). Study objectives were to describe the incidence of stiffness after UKA, to look for risk factors, and to describe safe and effective arthroscopic treatment. Methods: There were 240 UKA performed between March 2016 and January 2019 included. Robotic-assisted surgery was performed in 164 patients and mechanical instrumentation in 76 patients. Stiffness was defined as flexion < 90° or a flexion contracture > 10° during the first 45 post-operative days. Patients with stiffness were treated with arthroscopic arthrolysis. Several factors were studied to look for risk factors of stiffness: body mass index, gender, age, mechanical or robotic instrumentation, preoperative flexion, previous meniscectomy, and anticoagulant treatment. Arthrolysis effectiveness was evaluated by flexion improvement and UKA revision rate. Results: 22 patients (9%) developed stiffness. Mechanical instrumentation significantly increased the risk of stiffness with OR = 0.26 and p = 0.005. Robotic-assisted surgery decreased the risk of stiffness by five-fold. Before arthrolysis, mean knee flexion was 79°, versus 121° (53% improvement) after arthroscopic arthrolysis. Only 2 patients (9%) underwent UKA revision after arthrolysis. Discussion: Stiffness after UKA is an important complication with an incidence of 9% in this study. Arthroscopic arthrolysis is a safe and effective treatment with a range of motion improvement of > 50%. Robotic-assisted surgery significantly decreases the risk of postoperative stiffness. Level of evidence: Level III, therapeutic study, retrospective cohort study

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“…25 Mergenthaler et al reported no complications related to the use of the robotic system. 26 Pearle et al suggested that no further rigid fixation device is necessary, which reduces potential complications such as infection, iatrogenic fractures or soft tissue injury caused by the weight and movement of the robot. 27 However, there were no significant differences in non-implant-specific complications between the two techniques in our meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis

et al. 2021

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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.

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Is robotic-assisted unicompartmental knee arthroplasty a safe procedure? A case control study

Cited by 31 publications

References 27 publications

New Technologies in Knee Arthroplasty: Current Concepts

New Technologies in Knee Arthroplasty: Current Concepts

Stiffness after unicompartmental knee arthroplasty: Risk factors and arthroscopic treatment

Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis

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