PDF herunterladen
J Knee Surg 2021; 34(07): 730-738
DOI: 10.1055/s-0039-1700837
Original Article

Improved Patient Satisfaction following Robotic-Assisted Total Knee Arthroplasty

Austin F. Smith
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Christian J. Eccles
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Samrath J. Bhimani
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Kevin M. Denehy
1   Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky
,
Rohat B. Bhimani
2   Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Langan S. Smith
3   Orthopedic Associates, Kentucky One Health Medical Group, Louisville, Kentucky
,
Arthur L. Malkani 
4   Adult Reconstruction Program, Kentucky One Health, University of Louisville, Louisville, Kentucky
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Approximately 20% of the patients are dissatisfied with their total knee arthroplasty (TKA). Computer technology has been introduced for TKA to provide real time intraoperative information on limb alignment and exact flexion/extension gap measurements. The purpose of this study was to determine if patient satisfaction could be improved with the use of robotic-assisted (RA) technology following primary TKA. A total of 120 consecutive patients undergoing RA-TKA with real time intraoperative alignment and gap balancing information were compared with a prospective cohort of 103 consecutive patients undergoing TKA with manual jig-based instruments during the same time period. There were no differences between groups with age, gender, baseline Knee Society Score (KSS) knee and function scores, follow-up, and ASA scores. TKAs were performed using same technique, implant design, anesthesia, and postoperative treatment protocols. Patient satisfaction survey using KSS and Likert scoring system were obtained at 1-year follow-up. Likert scoring system demonstrated 94% of the patients in the RA group were either very satisfied or satisfied versus 82% in the manual instruments TKA group (p = 0.005). RA-TKA group had better average scores of all five satisfaction questions although not significant. RA-TKA group had a better average overall satisfaction score of 7.1 versus 6.6 in the manual instrument group, p = 0.03. KSS function scores were significantly better at 6 weeks and 1 year postoperatively (p = 0.02, 0.005), and KSS knee scores were significantly better at 1 year postoperatively (p = 0.046). There are multiple reasons for patient dissatisfaction following primary TKA. Using intraoperative computer technology with RA surgery for patients undergoing a primary TKA, a significant improvement in patient satisfaction was demonstrated compared with TKA using conventional manual jig-based instruments. RA surgery provides several advantages in TKA including real time information in millimeters to help obtain balanced gaps, accurate bone cuts, reduced soft tissue injury, and achieve the target alignment which may lead to improved patient satisfaction.

Keywords

total knee arthroplasty - robotic-assisted - patient satisfaction - outcomes


Publikationsverlauf

Eingereicht: 21. Juni 2019

Angenommen: 18. September 2019

Artikel online veröffentlicht:
15. November 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
    CrossrefPubMedSuche in Google Scholar
  • 2 Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall award: patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006; 452 (452) 35-43
    CrossrefPubMedSuche in Google Scholar
  • 3 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJJ. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
    CrossrefPubMedSuche in Google Scholar
  • 4 Kleeblad LJ, Borus TA, Coon TM, Dounchis J, Nguyen JT, Pearle AD. Midterm survivorship and patient satisfaction of robotic-arm-assisted medial unicompartmental knee arthroplasty: a multicenter study. J Arthroplasty 2018; 33 (06) 1719-1726
    CrossrefPubMedSuche in Google Scholar
  • 5 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
    CrossrefPubMedSuche in Google Scholar
  • 6 Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K. Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 2007; 22 (08) 1097-1106
    CrossrefPubMedSuche in Google Scholar
  • 7 Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee arthroplasties failing today?. Clin Orthop Relat Res 2002; (404) 7-13
    CrossrefPubMedSuche in Google Scholar
  • 8 Fehring TK, Valadie AL. Knee instability after total knee arthroplasty. Clin Orthop Relat Res 1994; (299) 157-162
    PubMedSuche in Google Scholar
  • 9 Hockstein NG, Gourin CG, Faust RA, Terris DJ. A history of robots: from science fiction to surgical robotics. J Robot Surg 2007; 1 (02) 113-118
    CrossrefPubMedSuche in Google Scholar
  • 10 Zelhart M, Kaiser AM. Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 2018; 32 (01) 24-38
    CrossrefPubMedSuche in Google Scholar
  • 11 Matthews CA. New developments in robotics and single-site gynecologic surgery. Clin Obstet Gynecol 2017; 60 (02) 296-311
    CrossrefPubMedSuche in Google Scholar
  • 12 Song E-K, Seon J-K, Yim J-H, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 2013; 471 (01) 118-126
    CrossrefPubMedSuche in Google Scholar
  • 13 Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B (07) 930-937
    CrossrefPubMedSuche in Google Scholar
  • 14 Marchand RC, Sodhi N, Khlopas A. et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J Knee Surg 2017; 30 (09) 849-853
    Thieme ConnectPubMedSuche in Google Scholar
  • 15 Noble PC, Scuderi GR, Brekke AC. et al. Development of a new Knee Society Scoring System. Clin Orthop Relat Res 2012; 470 (01) 20-32
    CrossrefPubMedSuche in Google Scholar
  • 16 Likert R. A technique for the measurement of attitudes. Arch Psychol 1932; 22: 55
    PubMedSuche in Google Scholar
  • 17 Kuriyama S, Ishikawa M, Nakamura S, Furu M, Ito H, Matsuda S. No condylar lift-off occurs because of excessive lateral soft tissue laxity in neutrally aligned total knee arthroplasty: a computer simulation study. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2517-2524
    CrossrefPubMedSuche in Google Scholar
  • 18 Nakamura S, Ito H, Yoshitomi H, Kuriyama S, Komistek RD, Matsuda S. Analysis of the flexion gap on in vivo knee kinematics using fluoroscopy. J Arthroplasty 2015; 30 (07) 1237-1242
    CrossrefPubMedSuche in Google Scholar
  • 19 Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG. Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 1994; (299) 31-43
    PubMedSuche in Google Scholar
  • 20 Gustke KA, Golladay GJ, Roche MW, Jerry GJ, Elson LC, Anderson CR. Increased satisfaction after total knee replacement using sensor-guided technology. Bone Joint J 2014; 96-B (10) 1333-1338
    CrossrefPubMedSuche in Google Scholar
  • 21 Gustke KA, Golladay GJ, Roche MW, Elson LC, Anderson CR. A new method for defining balance: promising short-term clinical outcomes of sensor-guided TKA. J Arthroplasty 2014; 29 (05) 955-960
    CrossrefPubMedSuche in Google Scholar
  • 22 Rebal BA, Babatunde OM, Lee JH, Geller JA, Patrick Jr DA, Macaulay W. Imageless computer navigation in total knee arthroplasty provides superior short term functional outcomes: a meta-analysis. J Arthroplasty 2014; 29 (05) 938-944
    CrossrefPubMedSuche in Google Scholar
  • 23 Mannan A, Vun J, Lodge C, Eyre-Brook A, Jones S. Increased precision of coronal plane outcomes in robotic-assisted total knee arthroplasty: a systematic review and meta-analysis. Surgeon 2018; 16 (04) 237-244
    CrossrefPubMedSuche in Google Scholar
  • 24 Liow MHL, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL. Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 2014; 29 (12) 2373-2377
    CrossrefPubMedSuche in Google Scholar
  • 25 Liow MHL, Goh GS-HH, Wong MK, Chin PL, Tay DK-JJ, Yeo S-JJ. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2942-2951
    CrossrefPubMedSuche in Google Scholar
  • 26 Pearle AD, van der List JP, Lee L, Coon TM, Borus TA, Roche MW. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up. Knee 2017; 24 (02) 419-428
    CrossrefPubMedSuche in Google Scholar
  • 27 Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012; 470 (01) 3-19
    CrossrefPubMedSuche in Google Scholar