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

Abstract

Background: We have conducted a prospective cohort study with the aim of comparing operative time, intraoperative blood loss, and radiologic and clinical outcomes between imageless (NAVIO) and image-based (MAKO) robot-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis (OA) of the knee. Methods: A total of 33 patients with medial compartment OA of the knee were prospectively allocated on alternate operative days of their surgery to MAKO (16 patients) or NAVIO (17 patients) robot-assisted UKA. The primary outcome (Knee Society Score [KSS] and Knee Functional Score [KFS]) and the secondary outcomes (intraoperative time of seven steps [registration of hip and ankle, femur and tibia, ligament tension, implant planning, preparation femur, tibia and trial implant], component alignment [coronal and sagittal of femur, tibia implant], blood loss, complications, and revision at 1 year after surgery) were compared between two groups. Statistical significance was set at P < 0.05. Results: Mean KSS measured at baseline and 1 year were, respectively, 70.3 (5.6) and 96.9 (5.7) in the NAVIO group and 72.3 (4.5) and 94.7 (10.01) in the MAKO group. Mean KFS measured at baseline and 1 year were, respectively, 95.5 (7.9) and 99.9 (0.25) in the NAVIO group and 67.3 (7.8) and 99.5 (1.2) in the MAKO group. There were no significant differences for KFS and KSS outcomes (P = 0.203 and P = 0.457, respectively) between the NAVIO and MAKO groups. Mean operative time and blood loss in the NAVIO versus MAKO robot-assisted UKA groups were 98 min versus 82.5 min and 136.3 ml versus 80 ml, respectively, and these differences were statistically significant. In the MAKO group, the intraoperative time was statistically significantly shorter in registration of hip and ankle center, femur and tibia, femur preparation, and trial implantation compared with the NAVIO group. There were no significant differences of component alignment and radiologic alignment at 1 year between the two groups. No perioperative or delayed complications (infection, periprosthetic fracture, thromboembolism, and compromised wound healing) and revisions were reported in either group. Conclusions: This study demonstrated that two robotic systems showed no difference in clinical outcomes at 1 year and radiologic alignment of implants, whereas operative time and intraoperative blood loss were found to be less in MAKO robot-assisted UKA. Trial registration: ClinicalTrials.gov, NCT03954912. Registered on 17 May 2019.

Robotics improves alignment accuracy and reduces early revision rates for UKA in the hands of low-volume UKA surgeons

“…Kayani et al reported a mean surgery time of 62 min after finishing the learning curve [ 10 ]. Leelasestaporn et al reported a mean surgery time of 98 min for the IL system and 82.5 min for the IB system [ 39 ]. However, the total sample size of this cohort was 33 and the surgeries were performed over a period of 3 years.…”

A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design

“…Although there are few studies on Navio UKA demonstrating improved alignment without any difference in revision rates, 54 , 69 there are currently no reports, to our knowledge, on short or long-term data for Navio TKA. Currently, there is an ongoing prospective randomized controlled trial evaluating conventional versus Navio TKA with an estimated completion date of December 2022.…”

“…However, studies comparing imageless versus CT-based imaging robotic platforms demonstrate no difference in reliability with landmarking and implant positioning. 51 – 53 There are only two systems in the US that utilize an imageless robotic platform: Navio Surgical System (Smith & Nephew, Memphis, TN, USA) 54 and OMNIBotics for gap balancing (Corin, Raynham, MA, USA). 55 …”

The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty—What Do They Tell Us and at What Risk?

“…In consideration of efforts to decrease radiation exposure, nondiagnostic CT examinations, as used for robot-assisted knee arthroplasty or for customization of cutting guides, are not an ideal application of this technology and may be best substituted by navigation systems or cutting guide customization methods that are not dependent upon CT imaging if accuracy and safety are not compromised. Indeed, published data demonstrate equivalent precision of alignment with CT-based and image-free robot-assisted TKA and UKA systems, as well as safety, raising the question of whether the use of CT is justified in light of its increased cost and risk [ [53] , [54] , [55] ].…”