Robotic-Arm–Assisted vs Conventional Unicompartmental Knee Arthroplasty. The 2-Year Clinical Outcomes of a Randomized Controlled Trial

Robotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444). Patient demographics (age, gender, comorbidities, Charlson-Comorbidity Index, and geographic region) were compared between cohorts. Annual primary and revision utilization rates as well as risk factors for revision procedures were also compared. Kaplan–Meier survivorship was also calculated. The Pearson χ2 test was used to test for significance in patient demographics, whereas the Welch t-test was used to compare the incidence of revisions as well as the revision burden (proportion of revisions to total sum of primary and revision procedures). Multivariate binomial logistic regression analysis was performed to compare risk factors for revision procedures. There were statistically significant differences in RAUKA versus MUKA patients with respect to age (p < 0.001), gender (p < 0.001), and region (p < 0.001). RAUKA procedures performed increased over 12-fold compared with manual, which increased only 4.5-fold. RAUKA procedures had significantly lower revision incidence (0.99 vs. 4.24%, p = 0.003) and revision burden (0.91 vs. 4.23%, p = 0.005) compared with manuals. For patients undergoing RAUKA, normal (19–24 kg/m2) and obese (30–39 kg/m2) body mass index (p < 0.05), congestive heart failure (p = 0.004), hypothyroidism (p < 0.001), opioid dependency (p = 0.002), and rheumatoid arthritis (p < 0.001) were risk factors for a revision procedure. Kaplan–Meier survival curve 3 years following the index procedure to all-cause revisions demonstrated that RAUKA patients maintained nearly 100% survivorship compared with manual patients who had 97.5% survivorship. The data demonstrate increased utilization of RAUKA in the United States. The current data indicated that RAUKA has significantly lower revision rates and improved survivorship compared with patients undergoing non-RAUKA within Medicare patients.

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“…26 In addition, survivorship of RAUKA was 100% at 2 years compared with 96.3% in MUKA patients, similar to the findings in this study. 26…”

Section: Discussionsupporting

confidence: 89%

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

et al. 2019

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“…Forgotten Joint Score (FJS) was recorded for 3 studies. 12,13,20 FJS of RA-UKA was 57.9 and FJS of manual UKA was 52.4 (p ¼ 0.049; ►Table 3). The revision rate was 3% for both RA-UKA and manual UKA groups (p ¼ 0.8; ►Table 4).…”

Section: Resultsmentioning

confidence: 94%

Robotic-Assisted versus Manual Unicompartmental Knee Arthroplasty: Contemporary Systematic Review and Meta-analysis of Early Functional Outcomes

et al. 2020

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Robotic-assisted unicompartmental knee arthroplasty (RA-UKA) aims to improve accuracy of component placement. Studies have shown improvement in radiographic positioning/alignment with RA-UKA but have not addressed clinical outcome measures (COMs). The purpose of this study was to determine if RA-UKA is associated with improved early revision rates and functional outcome scores (FOS) compared with manual UKA. A systematic review of all English language articles from 1999 to 2019 on RA-UKA using Medline, EMBASE, Scopus, and Web of Science databases identified 277 studies. Seven (three randomized controlled trials) met inclusion criteria. Revision rates/FOS were aggregated for RA-UKA and manual UKA; a forest plot was constructed utilizing inverse variance/Mantel–Haenszel fixed-effects meta-analysis. The seven articles included a total of 363 RA-UKA patients and 425 manual UKA patients. Mean age was 66 ± 3.5 and 65 ± 4.0 years, and mean body mass index (BMI) was 26.8 ± 2.1 and 27.1 ± 1.5 kg/m2, respectively. Mean follow-up was 25.5 months (4.5–48) and 29.1 months (4.5–48) for RA-UKA and manual UKA, respectively. At latest follow-up, RA-UKA patients showed a 26% ± 12 improvement in COMs versus 24% ± 12 improvement for manual UKA patients (p = 0.6). The revision rate was 3% for both groups (p = 0.8); however, a meta-analysis of RCTs showed no difference. Robotic and manual UKAs offer comparable improvements in pain, FOS, and revision rates. The effects of follow-up duration, ceiling effects of COMs, and surgeon experience remain unknown. Future studies comparing robotic versus manual UKAs with longer term follow-up may inform further benefits of each, with respect to component durability, alignment, and functional improvement.

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“…Unicompartmental knee arthroplasty At short-term follow-up ( 3 years), three UKA studies 19,36,37 involving 265 knees examined Knee Society Score (KSS), with another three UKA studies 6). A high level of heterogeneity was detected for KSS (with no significant moderators identified), whereas the UKA studies which analyzed KSFS were homogeneous.…”

Section: Subjective Knee Scoresmentioning

confidence: 99%

Robot-Assisted versus Conventional Total and Unicompartmental Knee Arthroplasty: A Meta-analysis of Radiological and Functional Outcomes

et al. 2020

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The study aims to provide an up-to-date systematic review and meta-analysis comparing radiological and functional outcomes of total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) using either robotic assistance or conventional methods from the latest assemblage of evidence. This study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. All studies in PubMed, EMBASE, Medline, and Cochrane that reported radiological and functional outcomes after TKA or UKA with either robotic or conventional methods were included in the review. Selected endpoints for random effects, pairwise meta-analysis included operative details, radiological outcomes (mechanical axis, component angle deviation, and outliers), and functional outcomes (American Knee Society Score, Knee Society Function Score, revision and complication rate, range of motion (ROM), Hospital for Special Surgery score, and Western Ontario and McMaster Universities Osteoarthritis Index). A total of 23 studies comprising 2,765 knees were included from the initial search. Robot-assisted TKA and UKA were associated with significantly better component angle alignment accuracy (low-to-high quality evidence) at the cost of significantly greater operation time. Robot-assisted UKA was found to have significantly better short-term functional outcomes compared with conventional UKA (moderate-to-high quality evidence). Robot-assisted TKA, however, did not exhibit significantly better short- and midterm subjective knee outcome scores compared with its conventional counterpart (high-quality evidence). Robot-assisted TKA and UKA were associated with nonstatistically significant improved ROM and lesser rates of revision. Robot-assisted total and unicompartmental knee arthroplasty leads to better radiological outcomes, with no significant differences in mid- and long-term functional outcomes compared with conventional methods for the former. Larger prospective studies with mid- and long-term outcomes are required to further substantiate findings from the present study.

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Robotic-Arm–Assisted vs Conventional Unicompartmental Knee Arthroplasty. The 2-Year Clinical Outcomes of a Randomized Controlled Trial

Abstract: Overall, participants achieved an outcome equivalent to the most widely implanted UKA in the United Kingdom. Sub-group analysis suggests that more active patients may benefit from robotic-arm- assisted surgery. Long term follow-up is required to evaluate differences in survivorship.

Cited by 102 publications

References 37 publications

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty

Robotic-Assisted versus Manual Unicompartmental Knee Arthroplasty: Contemporary Systematic Review and Meta-analysis of Early Functional Outcomes

Robot-Assisted versus Conventional Total and Unicompartmental Knee Arthroplasty: A Meta-analysis of Radiological and Functional Outcomes

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