Robotic‐arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five‐year follow‐up

Kayani, Babar; Fontalis, Andreas; Haddad, Isabella Catrina; Donovan, Christian; Rajput, Vishal; Haddad, Fares Sami

doi:10.1007/s00167-023-07578-7

Cited by 10 publications

(2 citation statements)

References 44 publications

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“…Chithartha et al [25] found a constant evolution of the mean modified FJS from 64.4 at 3 weeks to 89.9 at 2 years, before a progressive decline to 82.7 at 10 years. Kayani et al [26] noted a significant improvement in the FJS at one-year, two-year, and at five-year follow-ups. The variability in time to FJS follow-up of this study may explain these differences with the literature.…”

Section: Discussionmentioning

confidence: 95%

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment

Jeffrey,

Marchand,

Kouyoumdjian

et al. 2024

SICOT-J

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Introduction: Ligament balancing is essential to the functional outcome of total knee arthroplasty (TKA). The optimal method of alignment remains a controversial issue. The primary objective was to compare the clinical outcomes of TKA between functional and adjusted mechanical alignment techniques. The secondary objectives were to compare bone resection, robotic alignment, and radiological assessment. Materials and methods: This was a retrospective case-control series comparing TKA performed with functional alignment (FA) and adjusted mechanical alignment (aMA). Sixty-four FA subjects were matched with 64 aMA controls. These two groups were matched for age, gender, body mass index (BMI), surgeon, and type of frontal deformity. Both surgical procedures were performed using the MAKO® haptic robotic system. Functional scores (Forgotten Joint Score (FJS), Knee Society Score (KSS), and Oxford Knee Score (OKS)) were measured at the final postoperative follow-up. A radiographic evaluation was performed at the same time. Results: Mean FJS were respectively 63.4 ± 25.1 [0–100] and 51.2 ± 31.8 [0–100] in FA versus aMA group (p = 0.034). Mean OKS were respectively 40.8 ± 6.3 [21–48] and 34.9 ± 11.8 [3–48] in FA versus aMA group (p = 0.027). Mean KSS were respectively 184.9 ± 17.0 [126–200] and 175.6 ± 23.1 [102–200] in FA versus aMA group (p = 0.02). The main residual symptom was “none” for 73.0% versus 57.8%, “instability” for 6.4% versus 21.9%, “Pain” for 19.1% versus 12.5%, and “effusion” for 1.6% and 7.8% respectively for FA and aMA group (p = 0.016). There were 4 complications in the FA group versus 5 in the aMA group (p > 0.999). Mean postoperative hip-knee-ankle (HKA) robotic assessment were respectively 177.3° ± 2.0 [172–180] and 178.2° ± 2.0 [173–180] for FA and aMA group (p = 0.018). The median difference between HKA robotic and HKA radiological was −3.0° (IQR = 3.0; p < 0.001). Conclusion: With greater residual deformity and without release, functional alignment showed a statistically significantly better short-term clinical outcome than adjusted mechanical alignment. This difference may not be clinically significant.

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Section: Discussionmentioning

confidence: 95%

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment

Jeffrey,

Marchand,

Kouyoumdjian

et al. 2024

SICOT-J

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“…[1][2][3][4][5][6][7] Current literature also suggests that use of robotic-assisted TKA can reduce soft tissue trauma leading to decreased pain and expedited recovery. 8,9 However, some studies have suggested that the benefits of robotic-assisted TKA may be only apparent in the early postoperative period 10,11 and have highlighted concerns regarding the learning curve 12,13 and increased costs associated with the use of robotic surgery. 14,15 The DePuy Synthes VELYS robotic-assisted solution (VRAS) is one of the latest entrants in the rapidly evolving field of robotic technology for TKA.…”

mentioning

confidence: 99%

Early Clinical and Economic Outcomes for the VELYS Robotic-Assisted Solution Compared with Manual Instrumentation for Total Knee Arthroplasty

Huang,

Cross,

Gupta

et al. 2024

J Knee Surg

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Robotic-assisted total knee arthroplasty (TKA) has been developed to improve functional outcomes after TKA by increasing surgical precision of bone cuts and soft tissue balancing, thereby reducing outliers. The DePuy Synthes VELYS robotic-assisted solution (VRAS) is one of the latest entrants in the robotic TKA market. Currently, there is limited evidence investigating early patient and economic outcomes associated with the use of VRAS. The Premier Healthcare Database was analyzed to identify patients undergoing manual TKA with any implant system compared with a cohort of robotic-assisted TKAs using VRAS between September 1, 2021 and February 28, 2023. The primary outcome was all-cause and knee-related all-setting revisits within 90-day post-TKA. Secondary outcomes included number of inpatient revisits (readmission), operating room time, discharge status, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. The cohorts included 866 VRAS and 128,643 manual TKAs that had 90-day follow-up data. The rates of both all-cause and knee-related all-setting follow-up visits (revisits) were significantly lower in the VRAS TKA cohort compared with the manual TKA cohort (13.86 vs. 17.19%; mean difference [MD]: −3.34 [95% confidence interval: −5.65 to −1.03] and 2.66 vs. 4.81%; MD: −2.15 [−3.23 to −1.08], respectively, p-value < 0.01) at 90-day follow-up. The incidence of knee-related inpatient readmission was also significantly lower (53%) for VRAS compared with manual TKA. There was no significant difference between total cost of care at 90-day follow-up between VRAS and manual TKA cases. On average, the operating room time was higher for VRAS compared with manual TKA (138 vs. 134 minutes). In addition, the discharge status and revision rates were similar between the cohorts. The use of VRAS for TKA is associated with lower follow-up visits and knee-related readmission rates in the first 90-day postoperatively. The total hospital cost was similar for both VRAS and manual TKA cohort while not accounting for the purchase of the robot.

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Functional alignment maximises advantages of robotic arm‐assisted total knee arthroplasty with better patient‐reported outcomes compared to mechanical alignment

Lee,

Kwon,

Hwang

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeRobotic arm‐assisted total knee arthroplasty (RTKA) enables adjustment of implant position to achieve the surgeon's preferred alignment. However, the alignment concept that most effectively enhances patient satisfaction remains unclear. This study compares the clinical outcomes of patients who underwent functionally aligned RTKA (FA‐RTKA), mechanically aligned conventional TKA (MA‐CTKA) and mechanically aligned RTKA (MA‐RTKA).MethodsA prospectively collected database was retrospectively reviewed for patients who underwent primary TKA for knee osteoarthritis. One hundred and forty‐seven knees were performed with MA‐CTKA, followed by 72 consecutive knees performed with MA‐RTKA, and subsequently, 70 consecutive knees performed with FA‐RTKA were enrolled. After 1:1 propensity score matching of patient demographics, 70 knees were finally included in each group. The extent of additional soft tissue release during surgery was identified, and the Coronal Plane Alignment of the Knee classification was utilised to categorise the alignment. At the 1‐year follow‐up, patient‐reported outcomes, including the pain Visual Analogue Scale, Knee Society Score, Western Ontario and McMaster Universities Arthritis Index and Forgotten Joint Score‐12, were also compared among the groups.ResultsThe FA‐RTKA group showed significantly less additional soft tissue release than the MA‐CTKA and MA‐RTKA groups (15.7%, 38.6% and 35.7%, respectively; p = 0.006). Statistically significant differences in functional scores were observed in the postoperative 1‐year clinical outcomes in favour of the FA‐RTKA group, which had a significantly larger percentage of knees that maintained constitutional alignment and joint line obliquity than those of the other groups.ConclusionsFunctionally aligned TKA showed superior 1‐year postoperative patient‐reported outcomes compared with those of conventional and robotic arm‐assisted mechanically aligned TKA. Therefore, the advantage of RTKA is maximised when the implant positioning is based on functional alignment. The application of RTKA with mechanical alignment has been proven ineffective in improving the clinical outcomes of patients.Level of EvidenceLevel III.

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Robotic‐arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five‐year follow‐up

Cited by 10 publications

References 44 publications

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment

Short-term functional outcomes of robotic-assisted TKA are better with functional alignment compared to adjusted mechanical alignment

Early Clinical and Economic Outcomes for the VELYS Robotic-Assisted Solution Compared with Manual Instrumentation for Total Knee Arthroplasty

Functional alignment maximises advantages of robotic arm‐assisted total knee arthroplasty with better patient‐reported outcomes compared to mechanical alignment

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