A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA

Abstract

Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little research has been conducted to ascertain if this results in a measureable improvement in knee function post operatively and a more normal gait. The kinematics of 70 OA knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Statistically significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There were no significant difference between the healthy group and the robotic assisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also some kinematic benefits to the user during gait.

Robotic arm-assisted vs conventional unicompartmental knee arthroplasty

“…Eleven studies (including 498 patients undergoing robotic-assisted UKA; 589 patients receiving conventional UKA) published between 2005 and 2018 were included for this meta-analysis. [11,13–16,18,19,23–26] Among them, 5 were designed as randomized controlled trials (RCT), 2 quasi-RCT, and 4 prospective cohort trials (PCTs). Seven studies were performed in the United Kingdom, 3 in the United States, and 1 in the France.…”

“…The gait (knee excursion during weight acceptance) was determined in 2 studies. [23,25] Using a fixed-effects model ( P = .470, I 2 = 0%), knee excursion degree was shown to be significantly larger in patients after robotic-assisted UKA than those undergoing conventional UKA (SMD: 0.62, 95% CI: 0.25–1.00; P = .001; Fig. 5).…”

Comparison of 1-year outcomes between MAKO versus NAVIO robot-assisted medial UKA: nonrandomized, prospective, comparative study

“…These systems also provide realtime quantification of soft-tissue balancing, which may contribute to the reported successful clinical and functional outcomes with semiautonomous systems [17]. The results show that both robot-assisted surgical systems have better intraoperative (surgical time and blood loss) and postoperative (range of motion [ROM], function, complications, and revisions) outcomes and return to activity than conventional UKA [13][14][15][16]. However, no randomized controlled trials, systematic reviews, or meta-analyses have compared intraoperative (surgical time, tourniquet time, operative time and blood loss) and postoperative (ROM, function, complications, revisions and return to activity) outcomes of the NAVIO versus MAKO systems in UKA.…”

“…The changes in surgical instruments that have taken place include systems that allow more accurate flexion-extension gap balancing and more accurate bone preparation. However, despite these improvements in manual instruments, some surgeons have also recently adopted advances in robotic surgery that have led to improved accuracy and alignment of UKA prostheses [6][7][8][9][10][11][12][13]. Currently, there are two semiautonomous systems approved by the U.S. Food and Drug Administration for robot-assisted UKA: an imageless (NAVIO) system [14] and an image-based (MAKO) system [6,8,13,15,16].…”

“…However, despite these improvements in manual instruments, some surgeons have also recently adopted advances in robotic surgery that have led to improved accuracy and alignment of UKA prostheses [6][7][8][9][10][11][12][13]. Currently, there are two semiautonomous systems approved by the U.S. Food and Drug Administration for robot-assisted UKA: an imageless (NAVIO) system [14] and an image-based (MAKO) system [6,8,13,15,16]. The current semiautonomous systems use different methods to safeguard against inadvertent bone preparation, one by providing haptic constraint beyond which movement of the burr is limited (MAKO: Restoris MCK partial knee implant system; Stryker, Kalamazoo, MI, USA) and the other by modulating the exposure or speed of the handheld robotic burr (NAVIO: Journey UNI unicompartmental knee system; Smith & Nephew, Memphis, TN, USA).…”