Total knee arthroplasty (TKA) has evolved during the past 30 years to a well-defined technical surgery with excellent results for as many as 20 years of followup. The concepts of exposure, ligament balancing, and joint alignment have been established clearly by Insall and others. In the early 1990s, Repicci introduced minimally invasive surgery for unicondylar knee arthroplasty. This approach suggested that less invasive surgery could accomplish similar results to those of standard unicondylar knee arthroplasty. Early reports in the literature support these conclusions. It only was logical that the minimally invasive surgery approach eventually would be applied to TKA. It is extremely important to establish a clear definition of the minimally invasive surgery and, then, to follow the results. We have completed 70 minimally-invasive TKAs during the past 9 months with early results that indicate less intraoperative blood loss, shorter length of stay, increased range of motion (ROM), with similar implant accuracy to standard TKA. These new procedures will require thorough evaluation as with any new clinical endeavor. It also is of paramount importance to remember that the main goal of any new technology is to advance the science of medicine without compromising the ultimate result for the patient. The early findings are encouraging for the future of minimally invasive TKA and we hope to improve the technology during the next few years.

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Background:Robotic-arm-assisted unicompartmental knee arthroplasty (UKA) has been shown to result in high short- and mid-term survivorship. However, it is not known whether these outcomes are maintained at long-term follow-up. This study aimed to evaluate long-term implant survivorship, modes of failure, and patient satisfaction following robotic-arm-assisted medial UKA.Methods:A prospective multicenter study of 474 consecutive patients (531 knees) undergoing robotic-arm-assisted medial UKA was conducted. A cemented, fixed-bearing system with a metal-backed onlay tibial implant was used in all cases. Patients were contacted at 10-year follow-up to determine implant survivorship and satisfaction. Survival was analyzed using Kaplan-Meier models.Results:Data were analyzed for 366 patients (411 knees) with a mean follow-up of 10.2 ± 0.4 years. A total of 29 revisions were reported, corresponding to a 10-year survivorship of 91.7% (95% confidence interval, 88.8% to 94.6%). Of all revisions, 26 UKAs were revised to total knee arthroplasty. Unexplained pain and aseptic loosening were the most commonly reported modes of failure, accounting for 38% and 35% of revisions, respectively. Of patients without revision, 91% were either satisfied or very satisfied with their overall knee function.Conclusions:This prospective multicenter study found high 10-year survivorship and patient satisfaction following robotic-arm-assisted medial UKA. Pain and fixation failure remained common causes for revision following cemented fixed-bearing medial UKA, despite the use of a robotic-arm-assisted technique. Prospective comparative studies are needed to assess the clinical value of robotic assistance over conventional techniques in UKA.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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