Robotic Assistance Enables Inexperienced Surgeons to Perform Unicompartmental Knee Arthroplasties on Dry Bone Models with Accuracy Superior to Conventional Methods

Abstract

Robotic systems have been shown to improve unicompartmental knee arthroplasty (UKA) component placement accuracy compared to conventional methods when used by experienced surgeons. We aimed to determine whether inexperienced UKA surgeons can position components accurately using robotic assistance when compared to conventional methods and to demonstrate the effect repetition has on accuracy. Sixteen surgeons were randomised to an active constraint robot or conventional group performing three UKAs over three weeks. Implanted component positions and orientations were compared to planned component positions in six degrees of freedom for both femoral and tibial components. Mean procedure time decreased for both robot (37.5 mins to 25.7 mins) (P = 0.002) and conventional (33.8 mins to 21.0 mins) (P = 0.002) groups by attempt three indicating the presence of a learning curve; however, neither group demonstrated changes in accuracy. Mean compound rotational and translational errors were lower in the robot group compared to the conventional group for both components at all attempts for which rotational error differences were significant at every attempt. The conventional group's positioning remained inaccurate even with repeated attempts although procedure time improved. In comparison, by limiting inaccuracies inherent in conventional equipment, robotic assistance enabled surgeons to achieve precision and accuracy when positioning UKA components irrespective of their experience.

Preoperative Mapping in Unicompartmental Knee Arthroplasty Using Computed Tomography Scans Is Associated with Radiation Exposure and Carries High Cost

“…Robotic assistance enhances the accuracy of bone preparation, implant component alignment, and soft tissue balance in unicompartmental knee arthroplasty (UKA) [1][2][3][4][5][6]. Such precision relies on patient-specific preoperative and/or intraoperative mapping, which depending on the system utilized, may require a three-dimensional computed topography (CT) scan of the involved knee and ipsilateral hip and ankle.…”

Onlay Tibial Implants Appear to Provide Superior Clinical Results in Robotic Unicompartmental Knee Arthroplasty

“…First, at the time of study commencement, the senior author had already performed more than 30 robotic UKA cases, dampening the potential effect of a learning curve. Second, the use of a robotic-controlled protocol in performing UKA has been shown to allow even less experienced surgeons to implant UKAs with superior accuracy to conventional methods [5]. Thus, we do not feel that a learning curve effect played a vital role in the difference in outcomes between the two groups.…”

Protocol for Evaluation of Robotic Technology in Orthopedic Surgery

“…Robotics technology can improve surgical outcomes by providing the surgeon with the greatest amount of accuracy and precision regardless of long surgical training [21]. The robot gives the surgeon more control in terms of the position and alignment of the tools.…”