Download PDF
J Knee Surg 2023; 36(04): 439-444
DOI: 10.1055/s-0041-1735313
Original Article

The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain

Stephen Gerard Zak 
1   Department of Orthopedic Surgery, NYU Langone Health, New York
,
David Yeroushalmi
1   Department of Orthopedic Surgery, NYU Langone Health, New York
,
Alex Tang 
1   Department of Orthopedic Surgery, NYU Langone Health, New York
,
Morteza Meftah
1   Department of Orthopedic Surgery, NYU Langone Health, New York
,
Erik Schnaser
2   Desert Orthopedic Center, Eisenhower Medical Center, Rancho Mirage, California
,
Ran Schwarzkopf
1   Department of Orthopedic Surgery, NYU Langone Health, New York
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

The use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT (n = 110) to a conventional TKA cohort (n = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; p = 0.005). While postoperative day 1 pain scores were similar (p = 0.316), the IT cohort has less opioid consumption at 2 weeks (p = 0.006) and 1 month (p = 0.005) postoperatively, but not at 3 months (p = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times (p = 0.610) and pain scores (p = 0.813). Both cohorts had similar opioid consumption at 2 weeks (p = 0.092), 1 month (p = 0.058), and 3 months (p = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.

Keywords

navigation - robotic-assisted - total knee arthroplasty - opioid - pain


Publication History

Received: 22 December 2020

Accepted: 22 July 2021

Article published online:
16 September 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71 (03) 262-267
    CrossrefPubMedGoogle Scholar
  • 2 Hofmann AA, Heithoff SM, Camargo M. Cementless total knee arthroplasty in patients 50 years or younger. Clin. Orthop. Relat. Res.. Lippincott Williams and Wilkins; 2002: 102-107
    Google Scholar
  • 3 Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplasty 2016; 31 (10) 2353-2363
    CrossrefPubMedGoogle Scholar
  • 4 Dalury DF, Barrett WP, Mason JB, Goldstein WM, Murphy JA, Roche MW. Midterm survival of a contemporary modular total knee replacement: a multicentre study of 1970 knees. J Bone Joint Surg Br 2008; 90 (12) 1594-1596
    CrossrefPubMedGoogle Scholar
  • 5 Crowder AR, Duffy GP, Trousdale RT. Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis. J Arthroplasty 2005; 20 (07, Suppl 3): 12-16
    CrossrefPubMedGoogle Scholar
  • 6 Decking J, Theis C, Achenbach T, Roth E, Nafe B, Eckardt A. Robotic total knee arthroplasty: the accuracy of CT-based component placement. Acta Orthop Scand 2004; 75 (05) 573-579
    CrossrefPubMedGoogle Scholar
  • 7 Bellemans J, Vandenneucker H, Vanlauwe J. Robot-Assisted Total Knee Arthroplasty. Clin. Orthop. Relat. Res., vol. 464. Lippincott Williams and Wilkins; 2007: 111-126
    Google Scholar
  • 8 Tolk JJ, Koot HWJ, Janssen RPA. Computer navigated versus conventional total knee arthroplasty. J Knee Surg 2012; 25 (04) 347-352
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Bae DK, Song SJ. Computer assisted navigation in knee arthroplasty. Clin Orthop Surg 2011; 3 (04) 259-267
    CrossrefPubMedGoogle Scholar
  • 10 Parisi TJ, Jennings JM, Dennis DA. Coronal alignment in TKA: traditional principles versus new concepts. Reconstr Rev 2018;8;
    PubMedGoogle Scholar
  • 11 Clark TC, Schmidt FH. Robot-assisted navigation versus computer-assisted navigation in primary total knee arthroplasty: efficiency and accuracy. ISRN Orthop 2013; 2013: 794827
    CrossrefPubMedGoogle Scholar
  • 12 Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK. Meta-analysis of navigation vs. conventional total knee arthroplasty. J Arthroplasty 2012; 27 (06) 1177-1182
    CrossrefPubMedGoogle Scholar
  • 13 Choong PF, Dowsey MM, Stoney JD. Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty. J Arthroplasty 2009; 24 (04) 560-569
    CrossrefPubMedGoogle Scholar
  • 14 Catani F, Biasca N, Ensini A. et al. Alignment deviation between bone resection and final implant positioning in computer-navigated total knee arthroplasty. J Bone Joint Surg Am 2008; 90 (04) 765-771
    CrossrefPubMedGoogle Scholar
  • 15 Anderson KC, Buehler KC, Markel DC. Computer assisted navigation in total knee arthroplasty: comparison with conventional methods. J Arthroplasty 2005; 20 (07, Suppl 3): 132-138
    CrossrefPubMedGoogle Scholar
  • 16 Lang JE, Mannava S, Floyd AJ, Goddard MS, Smith BP, Mofidi A. et al. Robotic systems in orthopaedic surgery. J Bone Jt Surg 2011; 93 B: 1296-1299
    CrossrefPubMedGoogle Scholar
  • 17 Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 2007; ;PAP 111-116
    CrossrefPubMedGoogle Scholar
  • 18 van der List JP, Chawla H, Joskowicz L, Pearle AD. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3482-3495
    CrossrefPubMedGoogle Scholar
  • 19 Kim YH, Yoon SH, Park JW. Does robotic-assisted TKA result in better outcome scores or long-term survivorship than conventional TKA? A randomized, controlled trial. Clin Orthop Relat Res 2020; 478 (02) 266-275
    CrossrefPubMedGoogle Scholar
  • 20 Jeon SW, Kim KI, Song SJ. Robot-assisted total knee arthroplasty does not improve long-term clinical and radiologic outcomes. J Arthroplasty 2019; 34: 1656-1661
    CrossrefPubMedGoogle Scholar
  • 21 McCarthy Deering E, Hu S, Abdulkarim A. Pain and tourniquet use in total knee arthroplasty: what is the evidence? A systematic review and meta-analysis. Orthop Proc 2018
    PubMedGoogle Scholar
  • 22 Tai TW, Chang CW, Lai KA, Lin CJ, Yang CY. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2012; 94 (24) 2209-2215
    CrossrefPubMedGoogle Scholar
  • 23 Clarke MT, Longstaff L, Edwards D, Rushton N. Tourniquet-induced wound hypoxia after total knee replacement. J Bone Joint Surg Br 2001; 83 (01) 40-44
    CrossrefPubMedGoogle Scholar
  • 24 Huang PS, Copp SN. Oral opioids are overprescribed in the opiate-naive patient undergoing total joint arthroplasty. J Am Acad Orthop Surg 2019; 27 (15) e702-e708
    CrossrefPubMedGoogle Scholar
  • 25 Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, Grifka J. Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 2004; 86 (05) 682-687
    CrossrefPubMedGoogle Scholar
  • 26 Burnett RSJ, Barrack RL. Computer-assisted total knee arthroplasty is currently of no proven clinical benefit: a systematic review. Clin Orthop Relat Res 2013; 471 (01) 264-276
    CrossrefPubMedGoogle Scholar
  • 27 Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 2019; 4 (10) 611-617
    CrossrefPubMedGoogle Scholar
  • 28 Sires JD, Wilson CJ. CT validation of intraoperative implant position and knee alignment as determined by the MAKO total knee arthroplasty system. J Knee Surg 2020; DOI: 10.1055/s-0040-1701447.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Meding JB, Berend ME, Ritter MA, Galley MR, Malinzak RA. Intramedullary vs. extramedullary femoral alignment guides: a 15-year follow-up of survivorship. J Arthroplasty 2011; 26 (04) 591-595
    CrossrefPubMedGoogle Scholar
  • 30 Alfred J, Tria J, Giles RScuderi, Fred DCushner. Complex Cases in Total Knee Arthroplasty. Cham, Switzerland: Springer International Publishing; 2018
    Google Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar
  • 32 Song E-K, Seon J-K, Yim J-H, 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
    CrossrefPubMedGoogle Scholar
  • 33 Denawa Y, Kurtz W, Conermann T. The social and functional implications of high- versus low-dose opioids on chronic non-cancer pain. Pain Physician 2019; 22 (04) 401-411
    CrossrefPubMedGoogle Scholar
  • 34 Kobus AM, Smith DH, Morasco BJ. et al. Correlates of higher-dose opioid medication use for low back pain in primary care. J Pain 2012; 13 (11) 1131-1138
    CrossrefPubMedGoogle Scholar
  • 35 Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ. Computer navigation versus conventional total knee replacement: no difference in functional results at two years. J Bone Joint Surg Br 2007; 89 (04) 477-480
    CrossrefPubMedGoogle Scholar
  • 36 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
    CrossrefPubMedGoogle Scholar