Early Postoperative Results in Robotic-Arm-Assisted Total Knee Replacement versus Conventional Technique: First Latin American Experience

Abstract

Early results with robotic-arm-assisted total knee arthroplasty (TKA) are encouraging; nevertheless, literature might be unrepresentative, as it comes mostly from American, European, and Asian countries. There is limited experience and no comparative clinical reports in Latin America, a region of mainly low- and middle-income countries with limited access to these promising technologies. This study aims to compare the early postoperative results of the first Latin American experience with robotic-arm-assisted TKA versus conventional TKA. A cohort study was performed, including 181 consecutive patients (195 knees) with advanced symptomatic knee osteoarthritis (OA) undergoing primary TKA between March 2016 and October 2019. The cohort included 111 consecutive patients (123 knees) undergoing conventional TKA, followed by 70 consecutive patients (72 knees) undergoing robotic-arm-assisted TKA. The same surgical team (surgeon 1 and surgeon 2) performed all procedures. Patients with previous osteotomy, posttraumatic OA, and revision components were not considered. The same anesthetic and rehabilitation protocol was followed. The investigated clinical outcomes (for the first 60 postoperative days) were: surgical tourniquet time, time to home discharge, time to ambulation, postoperative daily pain (Visual Analog Scale), opioid use, range of motion, blood loss, complications, and postoperative mechanical axis. The early clinical postoperative results of this first Latin American comparative experience of robotic-arm-assisted TKA versus conventional technique showed lower opioids requirements and faster functional recovery of ambulation in those patients operated with the robotic system; nevertheless, surgical times were higher, without differences in total postoperative complications and other clinical outcomes.

Keywords

knee osteoarthritis - total knee arthroplasty - robotic assistance - robotic arm

Ethical Approval and Patient Consent

Previously to patient recruitment, institutional ethical approval was obtained. All patients were adequately informed and signed written consent for participation.

Publication History

Received: 01 June 2022

Accepted: 15 July 2023

Accepted Manuscript online:
17 July 2023

Article published online:
16 August 2023

• References

• 1 Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthritis Cartilage 2017; 25 (11) 1797-1803
• 2 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
• 3 Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee 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): 655-663
• 4 Scott CEH, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92 (09) 1253-1258
• 5 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]
• 6 Lang JE, Mannava S, Floyd AJ. et al. Robotic systems in orthopaedic surgery. J Bone Joint Surg Br 2011; 93 (10) 1296-1299
• 7 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
• 8 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
• 9 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
• 10 Hampp EL, Chughtai M, Scholl LY. et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019; 32 (03) 239-250
• 11 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
• 12 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
• 13 Grau L, Lingamfelter M, Ponzio D. et al. Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve. Arthroplast Today 2019; 5 (04) 465-470
• 14 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
• 15 World Bank Country and Lending Groups – World Bank Data Help Desk. At: Accessed February 26, 2023 at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
• 16 Stryker. Triathlon Knee System: Surgical Protocol. Available at: https://www.stryker.com/us/en/joint-replacement/products/triathlon-total-knee-system.html
• 17 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 [phone]
• 18 Pinto PR, McIntyre T, Ferrero R, Araújo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res 2013; 6: 691-703
• 19 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
• 20 Khlopas A, Chughtai M, Hampp EL. et al. Robotic-arm assisted total knee arthroplasty demonstrated soft tissue protection. Surg Technol Int 2017; 30: 441-446
• 21 Hampp EL, Sodhi N, Scholl L. et al. Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach: a blinded assessment. Bone Joint Res 2019; 8 (10) 495-501
• 22 Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: a prospective cohort study and validation of a new classification system. J Arthroplasty 2018; 33 (08) 2496-2501
• 23 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
• 24 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
• 25 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
• 26 Donaldson J, Joyner J, Tudor F. Current controversies of alignment in total knee replacements. Open Orthop J 2015; 9 (01) 489-494