Revision Analysis of Robotic Arm–Assisted and Manual Unicompartmental Knee Arthroplasty

Cool, Christina; Needham, Keith; Khlopas, Anton; Mont, Michael A.

doi:10.1016/j.arth.2019.01.018

Cited by 36 publications

(35 citation statements)

References 29 publications

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“…4 In a retrospective study by Cool et al comparing revision rates of 738 knees (246 RAUKA and 492 MUKA), the study found revision rates in the RAUKA cohort to be statistically lower (0.81 vs. 5.28%, p ¼ 0.002) within 24 months following the index procedure. 23 The accuracy of implant positioning and mechanical axis alignment could potentially explain the increased utilization of RAUKA and decrease in revision incidence seen in the study, as compared with MUKA. In addition to accuracy and precision, studies have shown additional advantages to RAUKA.…”

Section: Discussionmentioning

confidence: 86%

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

et al. 2019

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Robotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, gender, comorbidities, Charlson-Comorbidity Index, and geographic region) were compared between cohorts. Annual primary and revision utilization rates as well as risk factors for revision procedures were also compared. Kaplan–Meier survivorship was also calculated. The Pearson χ2 test was used to test for significance in patient demographics, whereas the Welch t-test was used to compare the incidence of revisions as well as the revision burden (proportion of revisions to total sum of primary and revision procedures). Multivariate binomial logistic regression analysis was performed to compare risk factors for revision procedures. There were statistically significant differences in RAUKA versus MUKA patients with respect to age (p < 0.001), gender (p < 0.001), and region (p < 0.001). RAUKA procedures performed increased over 12-fold compared with manual, which increased only 4.5-fold. RAUKA procedures had significantly lower revision incidence (0.99 vs. 4.24%, p = 0.003) and revision burden (0.91 vs. 4.23%, p = 0.005) compared with manuals. For patients undergoing RAUKA, normal (19–24 kg/m2) and obese (30–39 kg/m2) body mass index (p < 0.05), congestive heart failure (p = 0.004), hypothyroidism (p < 0.001), opioid dependency (p = 0.002), and rheumatoid arthritis (p < 0.001) were risk factors for a revision procedure. Kaplan–Meier survival curve 3 years following the index procedure to all-cause revisions demonstrated that RAUKA patients maintained nearly 100% survivorship compared with manual patients who had 97.5% survivorship. The data demonstrate increased utilization of RAUKA in the United States. The current data indicated that RAUKA has significantly lower revision rates and improved survivorship compared with patients undergoing non-RAUKA within Medicare patients.

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Section: Discussionmentioning

confidence: 86%

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

et al. 2019

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“…Zambianchi et al reported the robotic‐assisted system had only 0.76% revision rates at 2 years in 395 knees undergoing UKA 23 . Comparing 246 robotic‐assisted UKA and 492 conventional UKA patients from database, Cool et al found the robotic group had a significant lower rate of revision 38 . By analysing the time difference data from the Australian Orthopaedic Association National Joint Arthroplasty Registry, Mart also found the nine months postoperative overall repair rate of the robot system (Mako) was significantly lower than that of the non‐robotically assisted technology (3068 robotically assisted and 6468 non‐robotically assisted UKA procedures) 39 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of robotic‐assisted versus conventional unicompartmental knee arthroplasty for the treatment of single compartment knee osteoarthritis: A meta‐analysis

Zhang

et al. 2020

Robotics Computer Surgery

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Background The robotic‐assisted unicompartmental knee arthroplasty (UKA) is proposed to improve the accuracy of component positioning. Methods We conducted a literature search in Medline, Embase, Web of Science and the Cochrane Library until April 2020. Results Our meta‐analysis included 10 articles, involving 1231 knees. Our meta‐analysis demonstrated that the robotic group had significantly better results in outliers of limb alignment (p < 0.001) and outliers of tibial alignment (p < 0.001). No statistical differences were found in the American Knee Society Score (p = 0.63), range of motion (p = 0.93), pain (p = 0.27), rate of revisions (p = 0.73) and rate of complications (p = 0.67). Conclusions Robotic‐assisted UKA has better component position accuracy compared with conventional UKA. But there was no significant difference in clinical results. In order to further evaluate the utility of robotic‐assisted UKA, long‐term follow‐up randomized controlled trials (RCTs) are needed, as well as studies to evaluate the correlation between postoperative alignment and long‐term clinical results.

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“…Beginning with the Robodoc/TSolution One (Think Surgical) and followed by Mako (Stryker), Navio (Smith and Nephew) and now Rosa (Zimmer Biomet), these robots have gained a stronghold by demonstrating fewer outliers in total knee 36 and hip arthroplasty, 37 with improved short-term revision rates reported for unicompartmental knee arthroplasty. 38 While the Mako, Navio and Rosa rely on boundary control and haptic feedback for saws (Mako), burrs (Navio) and jigs (Rosa), the TSolution One uses autonomous control by the robot, which completes a preoperative plan. While a significant learning curve has been consistently reported with adoption of this technology, 39 , 40 complications from the use of the robotic systems are rare.…”

Section: Principal Technologies To Meet Needsmentioning

confidence: 99%

Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery

et al. 2020

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There are many digital solutions which assist the orthopaedic trauma surgeon. This already broad field is rapidly expanding, making a complete overview of the existing solutions difficult. The AO Foundation has established a task force to address the need for an overview of digital solutions in the field of orthopaedic trauma surgery. Areas of new technology which will help the surgeon gain a greater understanding of these possible solutions are reviewed. We propose a categorization of the current needs in orthopaedic trauma surgery matched with available or potential digital solutions, and provide a narrative overview of this broad topic, including the needs, solutions and basic rules to ensure adequate use in orthopaedic trauma surgery. We seek to make this field more accessible, allowing for technological solutions to be clearly matched to trauma surgeons’ needs. Cite this article: EFORT Open Rev 2020;5:408-420. DOI: 10.1302/2058-5241.5.200021

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Revision Analysis of Robotic Arm–Assisted and Manual Unicompartmental Knee Arthroplasty

Cited by 36 publications

References 29 publications

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

Comparison of robotic‐assisted versus conventional unicompartmental knee arthroplasty for the treatment of single compartment knee osteoarthritis: A meta‐analysis

Finding NEEMO: towards organizing smart digital solutions in orthopaedic trauma surgery

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