Artroplastía Total de Rodilla con Asistencia de Brazo-Robótico: Resultados Clínicos Postoperatorios Tempranos

Resumen

Objetivo Describir los resultados clínicos postoperatorios tempranos de la primera serie de pacientes operados de artroplastía total de rodilla (ATR) con asistencia de brazo-robótico en Latinoamérica.

Materiales y Métodos Estudio prospectivo de 52 pacientes (53 rodillas) con gonartoris tricompartimental sintomática operados de ATR primaria con asistencia de brazo-robótico (RIO-MAKO) de manera consecutiva, con seguimiento a 2 meses postoperados. No se excluyeron pacientes. Se utilizó el mismo protocolo anestésico y de rehabilitación. Se realizó revisión de fichas clínicas para recolectar los siguientes resultados: tiempo de isquemia quirúrgica, estadía hospitalaria, tiempo a marcha, dolor postoperatorio diario [Escala visual análoga (EVA)], uso de opioides, rangos de movilidad articular (ROM), pérdida sanguínea, complicaciones y eje mecánico postoperatorio.

Resultados Tiempos de Isquemia: 82 minutos (60–120). Estadía Hospitalaria: 4 días (2–12). Dolor postoperatorio: EVA el mismo día operatorio de 0 (0–10) y previa al alta de 0 (rango 0–4), con 0,3 purgas (0–6,5) de opioides por paciente. Tiempo a marcha (día logrado): 1 día (1–3), cuarenta y cinco pacientes (84,9%) iniciaron la marcha el primer día postoperatorio. ROM (Extensión-Flexión): Aumento progresivo durante el seguimiento. En el control ambulatorio de los dos primeros meses [23 días (13–50)], veintiún pacientes (40%) alcanzaron un ROM mayor o igual a 0–90° y once (20%) presentaron un ROM funcional máximo (0–120°). Pérdida sanguínea: Siete pacientes (13,2%) requirieron transfusión. Complicaciones: un paciente (1,89%) presentó una dehiscencia del cierre de la artrotomía. No hubo otras complicaciones. Eje mecánico postoperatorio: 179,1° (178,2–180).

Discusión Los resultados concuerdan con la evidencia descrita en otras regiones, sugiriendo que la asistencia de brazo-robótico permite resultados postquirúrgicos reproducibles.

Conclusión Los resultados clínicos postoperatorios tempranos de esta serie de pacientes operados de ATR con asistencia de brazo-robótico, muestran una baja percepción del dolor, con bajo consumo de opioides, una rápida recuperación funcional de la marcha y ROM, y excelentes resultados desde el punto de vista del eje mecánico postoperatorio.

Nivel de Evidencia IV.

Abstract

Objective Describe the early clinical postoperative outcomes, of the first series of patients operated on Robotic Arm-Assisted Total Knee Arthroplasty (TKA) in Latin America.

Material and Method Retrospective study including 52 patients (53 knees) with advanced symptomatic knee osteoarthritis, consecutively operated on Robotic Arm-Assisted TKA (RIO-MAKO) during October 2018 and May 2019 with two months of follow-up. No patients were excluded from the study. The same anesthetic and rehabilitation protocol was followed for all patients. Data were obtained from the clinical files for the following outcomes: Surgical tourniquet time, hospital stay, time to walk, postoperative daily pain [Visual Analog Scale (VAS)], opioid consumption, range of motion (ROM), blood loss, complications, and the attained postoperative mechanical axis.

Results Tourniquet Time: 82 minutes (60–120). Hospital Stay: 4 days (2–12). Postoperative Pain: VAS of 0 (0–10) the same day of surgery, and 0 (0–4) before discharge. The opioid consumption was 0,3 purge (0–6,5) per patient. Time to Walk (Day achieved): 1^st day (1–3), forty-five patients (84,9%) walked on their first postoperative day. ROM (Extension-Flexion): progressively increases during the follow up. On the first two-month visits [23 days (13–50)], twenty-one patients (40%) reached a ROM equal or superior to 0–90°, and eleven (20%) presented a maximal functional ROM (0–120°). Blood Loss: Seven patients (13.2%) required a blood transfusion. Complications: one patient (1.89%) presented dehiscence of the arthrotomy closure. No other complications were registered. Postoperative Mechanical Axis: 179.1° (178.2–180).

Discussion The results coincide with the reported evidence from other regions. Robotic-arm assistance may generate reproducible postoperative results.

Conclusions The early postoperative clinical results of this series of patients operated on Robotic Arm-Assisted TKA show a low pain perception and opioid use, a rapid functional rehabilitation in terms of gait and ROM, and excellent postoperative mechanical alignment.

Level of Evidence IV.

Palabras claves

gonartoris - artroplastía total de rodilla - asistencia robótica

Keywords

knee osteoarthritis - total knee replacement - robotic assistance

• Bibliografía

• 1 Wallace IJ, Worthington S, Felson DT. , et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci U S A 2017; 114 (35) 9332-9336
• 2 van den Berg WB. Osteoarthritis year 2010 in review: pathomechanisms. Osteoarthritis Cartilage 2011; 19 (04) 338-341 . Doi: 10.1016/j.joca.2011.01.022
• 3 Cross M, Smith E, Hoy D. , et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73 (07) 1323-1330
• 4 Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthr Cartil [Internet] 2017; 25 (11) 1797-1803 . Available from: http://www.ncbi.nlm.nih.gov/pubmed/28801208
• 5 Liddle AD, Judge A, Pandit H, Murray DW. Adverse outcomes after total and unicompartmental knee replacement in 101,330 matched patients: a study of data from the National Joint Registry for England and Wales. Lancet 2014; 384 (9952): 1437-1445 . Doi: 10.1016/S0140-6736(14)60419-0 [Internet]
• 6 Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet 2019; 393 (10172): 647-654 . Doi: 10.1016/S0140-6736(18)32531-5 [Internet]
• 7 Chang MJ, Lim H, Lee NR, Moon Y-W. Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg Relat Res 2014; 26 (02) 61-67
• 8 Bini SA, Beneyto FM. Complicaciones de la prótesis total de rodilla. Monografías AAOS-SECOT; 2012
• 9 Karthik K, Colegate-Stone T, Dasgupta P, Tavakkolizadeh A, Sinha J. Robotic surgery in trauma and orthopaedics: a systematic review. Bone Joint J 2015; 97-B [phone]
• 10 Lang JE, Mannava S, Floyd AJ. , et al. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br 2011; 93 (10) 1296-1299 http://online.boneandjoint.org.uk/doi/10.1302/0301-620X.93B10.27418 [Internet]
• 11 Ren Y, Cao S, Wu J, Weng X, Feng B. Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J 2019; 95 (1121): 125-133
• 12 Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic Arm-Assisted Total Knee Arthroplasty. J Arthroplasty 2018; 33 (07) 2002-2006 . Doi: 10.1016/j.arth.2018.01.060 [Internet]
• 13 Mannan A, Vun J, Lodge C, Eyre-Brook A, Jones S. Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: A systematic review and meta-analysis. Surgeon 2018; 16 (04) 237-244 . Doi: 10.1016/j.surge.2017.12.003 [Internet]
• 14 Fu J, Wang Y, Li X. , et al. Robot-assisted vs. conventional unicompartmental knee arthroplasty : Systematic review and meta-analysis. Orthopade 2018; 47 (12) 1009-1017
• 15 Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 2019; 8 (05) 327-336
• 16 Grau L, Lingamfelter M, Ponzio D. , et al. Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve. Arthroplast Today 2019; •••: 1-6 . Doi: 10.1016/j.artd.2019.04.007 [Internet]
• 17 Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 2013; 471 (01) 118-126
• 18 Kayani B, Konan S, Tahmassebi J, Rowan FE, Haddad FS. An assessment of early functional rehabilitation and hospital discharge in conventional versus robotic-arm assisted unicompartmental knee arthroplasty: a prospective cohort study. Bone Joint J 2019; 101-B (01) 24-33
• 19 Sodhi N, Khlopas A, Piuzzi NS. , et al. The Learning Curve Associated with Robotic Total Knee Arthroplasty. J Knee Surg 2018; 31 (01) 17-21
• 20 Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1132-1141 . Doi: 10.1007/s00167-018-5138-5
• 21 Donaldson J, Joyner J, Tudor F. Current Controversies of Alignment in Total Knee Replacements. Open Orthop J 2015; 9 (01) 489-494