The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis

Karunaratne, Sascha; Duan, Michael; Pappas, Evangelos; Fritsch, Brett; Boyle, Richard; Gupta, Sanjeev; Stalley, Paul; Horsley, Mark; Steffens, Daniel

doi:10.1007/s00264-018-4140-3

Cited by 64 publications

(65 citation statements)

References 34 publications

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“…Also, we contacted experts in the field resulting in one more article eligible for inclusion. As a result, we included 42 SRs 12–14 36–74…”

Section: Resultsmentioning

confidence: 99%

“…Four SRs were published in languages other than English: one German,40 one Korean,62 and two Mandarin 54 68. Of all the 42 SRs, 3 compared conventional to CA modalities of both TKA and THA,38 52 71 9 addressed THA,36 42 49 53 55 59 63 70 74 and the rest addressed TKA. The approach to evidence synthesis was as follows: 7 SRs synthesized the evidence qualitatively,38 40 44 52 56 63 66 7 SRs conducted meta-analysis and qualitative evidence synthesis,37 45 67 70 71 73 74 and the remaining 28 SRs conducted only meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Of all the 42 SRs, 3 compared conventional to CA modalities of both TKA and THA,38 52 71 9 addressed THA,36 42 49 53 55 59 63 70 74 and the rest addressed TKA. The approach to evidence synthesis was as follows: 7 SRs synthesized the evidence qualitatively,38 40 44 52 56 63 66 7 SRs conducted meta-analysis and qualitative evidence synthesis,37 45 67 70 71 73 74 and the remaining 28 SRs conducted only meta-analysis. Regarding the intervention, four SRs compared minimally invasive (MI) CA TKA to MI TKA,39 64–66 one SR compared MI THA to CA THA to conventional THA,63 four SRs compared robotic THA to conventional THA,38 52 70 71 five SRs compared robotic TKA to conventional TKA 38 52 66 71 73.…”

Section: Resultsmentioning

confidence: 99%

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An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

Hasan

Zhang

Beal

et al. 2020

BMJ Surg Interv Health Technologies

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BackgroundSystematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs.MethodsWe searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies.ResultsBased on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs.ConclusionsDespite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.

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“…Also, we contacted experts in the field resulting in one more article eligible for inclusion. As a result, we included 42 SRs 12–14 36–74…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

Hasan

Zhang

Beal

et al. 2020

BMJ Surg Interv Health Technologies

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“…To date, only three other reviews on this subject have been published. These reviews, however, have either incorrectly entered data for clinical outcomes and thus affecting the true results, 52 included only a limited number of studies specifically designed to compare differences in functional outcomes of robotic versus conventional TKA and UKA, 11,15,17 or did not use appropriate methods to grade quality of evidence of their studies. 15,17,52 The authors of the previous reviews acknowledged a lack of recent studies in their analysis, thus warranting further investigation into the said topic.…”

Section: Discussionmentioning

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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“…With the use of semi-active robotic systems in total hip arthroplasty, the surgeon may control the robotic arm to ream the acetabulum to a specified depth and size, without the need for sequential reaming. Imaging software can also control for limb length equality [3][4][5][6][7][8][9][10][11].…”

Section: The Clinical Applicationsmentioning

confidence: 99%

Surgeons and robots

Mavrogenis

Scarlat

2019

International Orthopaedics (SICOT)

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The effectiveness of robotic hip and knee arthroplasty on patient-reported outcomes: A systematic review and meta-analysis

Cited by 64 publications

References 34 publications

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence

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

Surgeons and robots

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