Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty

Bayoumi, Tarik; Kleeblad, Laura J.; Borus, Todd; Coon, Thomas M.; Dounchis, Jon; Nguyen, Joseph; Pearle, Andrew D.

doi:10.2106/jbjs.22.01104

Cited by 12 publications

(8 citation statements)

References 52 publications

(54 reference statements)

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“…Consequently, the higher prevalence of patellofemoral incongruence among under corrected knees could be attributed to under correction of the mechanical axis, potentially leading to increased contact forces across the patellofemoral joint. In a prequel to the current study, Bayoumi et al [1] demonstrated inferior implant survival of knees with under correction from their pre‐arthritic coronal alignment relative to knees restored to the pre‐arthritic coronal alignment [3]. It is possible that the suboptimal patellofemoral congruence and worse anterior knee pain observed in this group with under corrected knees contributed to the higher incidence of revision surgeries.…”

Section: Discussionmentioning

confidence: 66%

Higher incidence of patellar incongruence after under correction of pre‐arthritic coronal alignment following medial unicompartmental knee arthroplasty

Ruderman,

Bayoumi,

Burger

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose This study aimed to compare patellofemoral joint alignment of knees with restored pre-arthritic coronal alignment versus knees with under-or overcorrection from their pre-arthritic coronal alignment following medial unicompartmental knee arthroplasty (UKA) and evaluate the effect of patellofemoral joint alignment on patient-reported outcomes. Methods A retrospective analysis of 517 knees following robotic-arm assisted medial UKA was conducted. Postoperative mechanical hip-knee-ankle angle (mHKA) was compared to estimated pre-arthritic coronal alignment, using the arithmetic hip-knee-ankle angle (aHKA). Knees were considered restored to the pre-arthritic coronal alignment if mHKA was within 2.0° of aHKA (Group 1). Non-restored knees were subdivided into > 2.0° over correction (Group 2), or > 2.0° under correction (Group 3) from the pre-arthritic coronal alignment. Patellar congruence and patellar tilt angles were compared between groups. The Kujala score and Knee Injury and Osteoarthritic Outcome Score for Joint Replacement (KOOS, JR) were analyzed by group. Continuous data was compared using analysis of variance or Kruskal-Wallis tests. Chi-squared tests were used to compare discrete variables. Logistic regressions were conducted to estimate the probability of postoperative patellofemoral malalignment. Results Group 1 included 357 knees (69.1%), Group 2 included 57 knees (11.0%), and Group 3 included 57 knees (11.0%). The prevalence of postoperative abnormal patellar congruence (i.e. ≥ 17°) was higher in Group 3 at 40.4% (p = 0.009), with a higher odds ratio of having an abnormal patellar congruence angle (2.3, p = 0.01) compared to Group 1. The prevalence of postoperative abnormal patellar tilt (i.e. ≥ 14°) was comparable between groups (n.s.). At mean follow up of 4.4 ± 1.6 years, Kujala was worse in Group 3 (76.6 ± 17.4 compared to 84.0 ± 14.9 and 85.0 ± 14.4 in Groups 1 and 2, respectively; p = 0.006). Mean KOOS, JR outcomes were comparable among groups. No significantly inferior Kujala or KOOS, JR outcomes were observed in patients across all groups with abnormal patellar congruence or tilt angles. Conclusion Knees with under correction from their pre-arthritic coronal alignment following medial UKA were associated with a two-fold higher probability of having postoperative patellofemoral incongruence, as well as inferior mid-term Kujala scores compared to knees with restored pre-arthritic coronal alignment and knees with overcorrection from their pre-arthritic coronal alignment. Patellofemoral incongruence alone did not negatively impact functional outcome scores. Level of Evidence IV, case series.

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Section: Discussionmentioning

confidence: 66%

Higher incidence of patellar incongruence after under correction of pre‐arthritic coronal alignment following medial unicompartmental knee arthroplasty

Ruderman,

Bayoumi,

Burger

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…However, a recent ten-year follow-up study of 366 patients undergoing rUKA (MAKO Restoris) demonstrated a survival rate of 91.7%, which is similar to that observed following mUKA. 25…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of robotic arm-assisted medial compartment knee arthroplasty

Clement,

Fraser,

Gilmour

et al. 2023

Bone Jt Open

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AimsTo perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA).MethodsThis was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated.ResultsrUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero.ConclusionrUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up.Cite this article: Bone Jt Open 2023;4(11):889–899.

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“…Data from 366 patients who underwent robotic medial UKA were analyzed in a prospective, multicenter study to determine the 10-year implant survivorship and satisfaction among patients without revision. Survivorship was 91.7%, and the proportion of patients who were either very satisfied or satisfied with the operatively treated knee was 91% 15 . In a long-term population-based cohort study of 2,015 patients, cemented fixed-bearing UKAs or mobile-bearing UKAs performed without cement exhibited better implant survivorship compared with cemented mobile-bearing designs at a mean follow-up of 8 years 16 .…”

Section: Unicompartmental Knee Arthroplasty (Uka)mentioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa,

Hosseinzadeh,

Higuera-Rueda

2023

Journal of Bone and Joint Surgery

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In the current Guest Editorial, we evaluate and summarize the most relevant findings from recent, meaningful, peer-reviewed publications in different research areas. Articles at various Levels of Evidence were included, but increased attention was paid to Level-I and award-winning reports. EconomicsConsiderable debate continues with regard to the economics of reconstructive knee surgery. An updated Medicare projection revealed that, by 2040, the annual number of revision total knee arthroplasties (TKAs) performed would be 115,147, whereas, by 2060, it would be 286,740. These values are important for understanding the future health-care resource utilization involving revision TKA, which is only expected to increase 1 . A secondary analysis of a randomized clinical trial (RCT) evaluating health-care resource utilization up to 12 months after primary TKA, among dissatisfied and satisfied patients, showed that patients dissatisfied with their return to function incurred a mean cost of $19,007.70, compared with $13,523.83 for satisfied patients (p = 0.07). Although the cost difference was not significant, its magnitude deserves attention 2 . Data from the New Zealand Joint Registry indicated that patients undergoing TKA have a mortality rate 8% higher than that of the general population 3 . Assessing mortality after primary TKA is relevant for future economic analyses.

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Ten-Year Survivorship and Patient Satisfaction Following Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty

Cited by 12 publications

References 52 publications

Higher incidence of patellar incongruence after under correction of pre‐arthritic coronal alignment following medial unicompartmental knee arthroplasty

Higher incidence of patellar incongruence after under correction of pre‐arthritic coronal alignment following medial unicompartmental knee arthroplasty

Cost-utility analysis of robotic arm-assisted medial compartment knee arthroplasty

What’s New in Adult Reconstructive Knee Surgery

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