Robot-assisted Knee Arthroplasty: Randomized Clinical Trial

Abstract

BACKGROUND: Osteoarthritis of the knee joint leads to a decrease in the volume of movements, a violation of the sliding of articular surfaces, and a change in the axis of the limb under load, which affects the biomechanics of walking. AIM: This study aims to compare the results of robot-assisted total knee arthroplasty (TKA) and manual techniques, their influence on the biomechanical and podometric parameters of the patient’s walk. METHODS: A prospective randomized study of 68 patients was carried out in the period from 2020 to 2021. Our follow-up period was 1 year. All patients were performed arthroplasty of one knee joint. The main Group “A” included 33 patients TKA with the use of an active robotic setting “TSolution-One” (“THINK Surgical, Inc.” [Fremont, California, USA]); the comparison Group “B” consisted of 35 patients with manual technic of TKA. We studied pain syndrome on the visual analog scale, functional state on the Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC), the volume of ROM movements, and the deviation of the mechanical axis by teleroentgenography of the lower limb. Objective analysis of limb function was performed on the «Alter-G» and the «C-mill». RESULTS: Post-operative pain syndrome on the 1st day after surgery in Group A is stronger by 7.9%, but by the 5th day after surgery in Group A, the pain syndrome is lower by 14.3%. ROM in Group A is better by 16% by 3 months after surgery, after 1 year by 10%. The positioning accuracy of the implant in Group A is 30% better. There are no statistically significant differences in the OKS and WOMAC scales between the groups. The results of restoring normal step in Group A are 13.5% better than in Group B. CONCLUSIONS: Robot-assisted TKA gives more accurate alignment of the mechanical axis, which improves the biomechanics of walking.

Clinical and radiological outcomes of robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

“…Of the 759 citations retrieved from electronic databases, 407 articles remained after duplicates were removed. We assessed 106 full texts and included 12 eligible RCTs in the final analysis of this review ( 22 - 33 ). Details of the study screening and selection process, as well as reasons for exclusion at each stage, are presented in Figure 1 .…”

“…All 12 included studies are parallel-group RCTs published during 2007–2020. 10 studies were conducted in Asia: South Korea (n = 4) ( 22 - 24 , 27 ), China (n = 2) ( 31 , 32 ), Singapore (n = 2) ( 25 , 26 ), Thailand (n = 1) ( 29 ), and India (n = 1) ( 30 ), and 2 were from Europe: Russia (n = 1) ( 33 ), and England (n = 1) ( 28 ). Their sample sizes ranged from 30 to 1,406, with participants’ mean age ranging from 60 to 77 years.…”

“…ROBODOC (Curexo Technology, Fremont, CA, USA) was the most common robotic system employed (n = 6) ( 22 - 27 ), followed by NAVIO (Smith & Nephew, Memphis, TN, USA) (n = 2) ( 29 , 30 ) and Mako (Stryker, Portage, MI, USA) (n = 1) ( 28 ). The 3 other studies from China and Russia utilized locally invented robotic apparatus ( 31 - 33 ). More studies reported using PS ( 22 , 25 – 27 , 29 - 31 ) than CR prostheses ( 23 , 24 , 28 ).…”

“…Most studies failed to report their method of allocation concealment and whether assessors of some of the outcomes were blinded. Moreover, only 5 studies had their trials registered and can be assessed for reporting bias ( 27 - 29 , 31 , 33 ).…”

“…6 studies reported the WOMAC score in 1,744 participants ( 23 , 24 , 27 , 31 - 33 ). As shown in Figure 3A , the WOMAC score was on average 0.35 points lower (CI –0.78 to 0.07, moderate certainty) in the RATKA than in the COTKA group (I 2 = 3%, p = 0.4).…”