NAVIO RATKA shows similar rates of hemoglobin‐drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study

PurposeThe purpose of this pilot cross‐sectional study was to compare the operating room (OR) efficiency and intraoperative staff task load when performing individualised versus off‐the‐shelf (OTS) total knee arthroplasty (TKA).MethodsA consecutive series of 28 patients randomised (1:1) to receive either OTS TKA or individualised TKA were included. The OR staff workload was assessed with the NASA Task Load Index (TLX), a subjective grading system assessing mental demand, physical demand, temporal demand, performance, effort and frustration on a scale from 0 (very low) to 20 (very high). The time for patient preparation, surgical time, closure and total OR time was recorded to assess OR efficiency. Effect sizes of differences between OTS and individualised TKA were expressed as mean differences (MDs) with 95% confidence intervals (CIs).ResultsPatients in both cohorts were similar in age (OTS vs. individualised TKA (median [IQR]), 67 [63–76] vs. 71 [68–79]; p = 0.207) and body mass index (BMI) (29 [24–33] vs. 29 [26–31]; p = 0.807), and there were no significant differences in other preoperative characteristics. The OR staff perceived individualised TKA as less demanding than OTS TKA: Individualised TKA was rated significantly better across the six domains of the NASA TLX: mental demand by 5.6 points, physical demand by 6.3 points, temporal demand by 5.3 points, performance by 3.6 points, effort by 5.9 points and frustration by 5.8 points. Individualised TKA resulted in statistically significantly shorter mean total OR time (MD, 10 min; p = 0.018).ConclusionThe staff in the OR found that individualised TKA is less mentally, physically and temporally demanding than OTS TKA. The average total time spent in the OR during individualised TKA is 10 min less than during OTS TKA.Clinical Trial RegistrationThis study constitutes a part of a larger registered randomised controlled trial comparing patient satisfaction following OTS versus individualised TKA (NCT04460989).Level of EvidenceLevel III.

Better operating room efficiency and reduced staff demand: Individualised versus off‐the‐shelf total knee arthroplasty

Sappey‐Marinier,

Beel,

Bonnin

et al. 2024

Robotic‐assisted total knee arthroplasty reduces postoperative complications and length of stay without increased cost compared to navigation‐guided techniques: A national analysis

Maman,

Laver,

Becker

et al. 2024

IntroductionThis study compares postoperative outcomes of robotic‐assisted total knee arthroplasty (RA‐TKA) versus navigation‐guided total knee arthroplasty (NG‐TKA). Using Nationwide Inpatient Sample (NIS) data, it provides an analysis of postoperative complications, mortality, hospital costs and duration of stay.MethodsThe study analysed 217,715 patients (81,830 RA‐TKA; 135,885 NG‐TKA) using NIS data from 2016 to 2019. Elective TKA patients were identified through the International Classification of Diseases, 10th Revision codes. Statistical analyses, including logistic regression modelling, were performed using Statistical Package for the Social Sciences and MATLAB.ResultsRA‐TKA patients were younger (66.1 vs. 67.1 years, p < 0.0001) and had similar mortality rates (0.024% vs. 0.018%, p = 0.342) but shorter length of stay (LOS) (1.89 vs. 2.1 days, p < 0.0001). Mean total charges were comparable between RA‐TKA ($66,180) and NG‐TKA ($66,251, p = 0.669). RA‐TKA demonstrated lower incidences of blood‐related complications (11.67% vs. 14.19%, p < 0.0001), pulmonary oedema (0.0306% vs. 0.066%, p < 0.0001), deep vein thrombosis (0.196% vs. 0.254%, p = 0.006) and acute kidney injury (AKI) (1.356% vs. 1.483%, p = 0.016).ConclusionRA‐TKA reduces postoperative complications and LOS without increasing costs, highlighting the relevance of this technology in patient care.Level of EvidenceLevel III.

Trends and epidemiology in robotic‐assisted total knee arthroplasty: Reduced complications and shorter hospital stays

Maman,

Laver,

Becker

et al. 2024

IntroductionThis study provides an in‐depth analysis of the immediate postoperative outcomes and implications or robotic‐assisted total knee arthroplasty (RA‐TKA) compared with conventional TKA (C‐TKA), particularly with regard to mortality, complications, hospital stay and costs, drawing from a comprehensive nationwide data set.MethodsThe Nationwide Inpatient Sample (NIS) database, the largest all‐payer inpatient healthcare database in the United States, was used to identify all patients who underwent RA‐TKA or C‐TKA from 2016 to 2019. A total of 527,376 cases, representing 2,638,679 patients who underwent elective TKA were identified, of which 88,415 had RA‐TKA. To mitigate potential variations and selection bias in baseline characteristics between the two groups, a propensity score‐matched analysis was employed to further balance and refine our data set, resulting in 176,830 patients evenly distributed between the groups. Analysis was performed according to demographics, immediate post‐operative complications, and economic data, including payor class, length of stay and total charges.ResultsThere was a marked shift towards RA‐TKA, from an initial 0.70% in 2016 to a notable 7.30% by 2019. Patients who underwent RA‐TKA were slightly younger (66.2 ± SD years), compared to the C‐TKA group (66.7 ± SD years). Hospital stay was 1.89 days and 2.29 days for RA‐TKA and C‐TKA, respectively. Charges metrics revealed slightly higher charges for RA‐TKA. Less postoperative complications were found in the RA‐TKA group, such as blood loss, anaemia, acute kidney injury, venous thromboembolism, pulmonary embolism, pneumonia and surgical wound complication. Even following the propensity score matching, these findings remained consistent and statistically significant.ConclusionsRA‐TKA use in the United States has grown substantially in the last few years and has been associated with significantly reduced immediate post‐operative complications and length of hospital stay compared to C‐TKA, offering safer surgical management for TKA patients. Further studies on the short‐ and long‐term outcomes of RA‐TKA would improve the understanding of the full potential of this technology.Levels of EvidenceLevel III.