Subscribe to RSS
Is Robotic TKA Having Added Advantage over Conventional TKA? A Comparative Study of Functional and Radiological Outcome of Robotic versus Conventional Total Knee ArthroplastyFunding None.
Objective Total knee arthroplasty (TKA) is most commonly performed procedure in patients who are not showing improvement in pain, activities of daily living, and quality of life by conservative modalities. Precise component implantation and soft tissue management is required to achieve desired outcome following TKA. 1.3% patients remain disappointed due to persistent pain, 24% due to instability, and 2.5% due to malalignment following TKA. Robotic TKA is associated with the use of customized implants and bone cuts leading to precise component implantation and reduced deviation from mechanical axis in coronal, transverse, and sagittal plane and proper soft tissue management. This study compares conventional against robotic TKA in terms of clinical, functional, and radiological outcome.
Materials and Methods This is a prospective randomized control trial carried over period of 3 years where patients were selected on the basis of inclusion and exclusion criteria and were randomly divided into both groups and compared using their pre- and postoperative radiological and functional outcomes as well as intraoperative and postoperative complications and statistical significance of difference was calculated.
Results There was no significant difference in terms of ROM, KOOS (Knee Injury and Osteoarthritis Outcome Score), (Knee Society Score) KSS, Eq. 5D, (Western Ontario and McMaster Universities Osteoarthritis Index) WOMAC, and (visual analog scale) VAS scores while we found significant difference in mechanical axis deviation, femoral and tibial implant alignment in both planes.
Discussion Advantages of using robotic TKA are customized preoperative planning, implants, cuts, accuracy of the intraoperative procedure, and radiological superiority with no significant differences in clinical and functional outcomes. In fact, robotic TKA is associated with steep learning curve, increased cost, and operative time. Still there are no added complications caused by it.
Keywordsrobotic - conventional - total knee arthroplasty - mechanical axis deviation - implant alignment - femoral shaft
16 August 2021 (online)
© 2021. Medical and Surgical Update Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Moon YW, Ha CW, Do KH. et al. Comparison of robot-assisted and conventional total knee arthroplasty: a controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg 2012; 17 (02) 86-95
- 2 Ofa SA, Ross BJ, Flick TR, Patel AH, Sherman WF. Robotic total knee arthroplasty vs conventional total knee arthroplasty: a nationwide database study. Arthroplast Today 2020; 6 (04) 1001-1008.e3
- 3 Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B (07) 930-937
- 4 Bhimani SJ, Bhimani R, Smith A, Eccles C, Smith L, Malkani A. Robotic-assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty. Bone Jt Open 2020; 1 (02) 8-12
- 5 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
- 6 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
- 7 Chin BZ, Tan SS, Chua KCX, Budiono GR, Syn NL, O’Neill GK. Robot-assisted versus conventional total and unicompartmental knee arthroplasty: a meta-analysis of radiological and functional outcomes. J Knee Surg 2020; DOI: 10.1055/s-0040-1701440.
- 8 Mancino F, Cacciola G, Malahias MA. et al. What are the benefits of robotic-assisted total knee arthroplasty over conventional manual total knee arthroplasty? A systematic review of comparative studies. Orthop Rev (Pavia 2020; 12 (Suppl. 01) 8657
- 9 Petursson G, Fenstad AM, Gøthesen Ø. et al. Computer-assisted compared with conventional total knee replacement: a multicenter parallel-group randomized controlled trial. J Bone Joint Surg Am 2018; 100 (15) 1265-1274
- 10 Pitta M, Esposito CI, Li Z, Lee YY, Wright TM, Padgett DE. Failure after modern total knee arthroplasty: a prospective study of 18,065 knees. J Arthroplasty 2018; 33 (02) 407-414
- 11 Liow MH, Chin PL, Tay KJ, Chia SL, Lo NN, Yeo SJ. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch™ ROBODOC® surgical system. Singapore Med J 2014; 55 (10) 529-534
- 12 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports PhysTher 1998; 28 (02) 88-96
- 13 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
- 14 EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990; 16 (03) 199-208
- 15 Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15 (12) 1833-1840
- 16 Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 2007; 464 (464) 111-116
- 17 Denis K, Van Ham G, Vander Sloten J. et al. Influence of bone milling parameters on the temperature rise, milling forces and surface flatness in view of robot-assisted total knee arthroplasty. Int Congr Ser 2001; 1230: 300-306
- 18 Eriksson RA, Albrektsson T. The effect of heat on bone regeneration: an experimental study in the rabbit using the bone growth chamber. J Oral Maxillofac Surg 1984; 42 (11) 705-711
- 19 Gromov K, Korchi M, Thomsen MG, Husted H, Troelsen A. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?. Acta Orthop 2014; 85 (05) 480-487
- 20 Peersman G, Laskin R, Davis J, Peterson MG, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2006; 2 (01) 70-72