Robotic Arm-Assisted Lateral Unicompartmental Knee Arthroplasty: How Are Components Aligned?

Abstract

The purpose of this multicenter, retrospective, observational study was to investigate the association between intraoperative component positioning and soft tissue balancing, as reported by robotic technology for a cohort of patients who received robotic arm-assisted lateral unicompartmental knee arthroplasty (UKA) as well as short-term clinical follow-up of these patients. Between 2013 and 2016, 78 patients (79 knees) underwent robotic arm-assisted lateral UKAs at two centers. Pre- and postoperatively, patients were administered the Knee Injury and Osteoarthritis Score (KOOS) and the Forgotten Joint Score-12 (FJS-12). Clinical results were dichotomized based upon KOOS and FJS-12 scores into either excellent or fair outcome, considering excellent KOOS and FJS-12 to be greater than or equal to 90. Intraoperative, postimplantation robotic data relative to computed tomography-based components placement were collected and classified. Following exclusions and loss to follow-up, a total of 74 subjects (75 knees) who received robotic arm-assisted lateral UKAs were taken into account with an average follow-up of 36.3 months (range: 25.0–54.2 months) postoperative. Of these, 66 patients (67 knees) were included in the clinical outcome analysis. All postoperative clinical scores showed significant improvement compared with the preoperative evaluation. No association was reported between three-dimensional component positioning and soft tissue balancing throughout knee range of motion with overall KOOS, KOOS subscales, and FJS-12 scores. Lateral UKA three-dimensional placement does not seem to affect short-term clinical performance. However, precise boundaries for lateral UKA positioning and balancing should be taken into account. Robotic assistance allows surgeons to acquire real-time information regarding implant alignment and soft tissue balancing.

Keywords

robotic arm - unicompartmental knee arthroplasty - lateral - alignment

Authors' Contributions

F.Z. – Interpreted the data and wrote the manuscript. G.F. – Collected the data. F.B. – Analyzed the data. A.M. – Collected the data and revised the manuscript critically. A.E. – Revised the manuscript critically. F.C. – Generated the hypothesis, drafted the manuscript, and revised the manuscript critically.

Ethical Approval

The present study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and was approved by the local Institutional Review Board (69/2018/OSS/AOUMO, protocol N. 0008124/18).

Publication History

Received: 04 May 2020

Accepted: 12 November 2020

Article published online:
28 January 2021

• References

• 1 Argenson J-NA, Parratte S, Bertani A, Flecher X, Aubaniac J-M. Long-term results with a lateral unicondylar replacement. Clin Orthop Relat Res 2008; 466 (11) 2686-2693
• 2 Nakagawa S, Kadoya Y, Todo S. et al. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br 2000; 82 (08) 1199-1200
• 3 Weidow J, Pak J, Kärrholm J. Different patterns of cartilage wear in medial and lateral gonarthrosis. Acta Orthop Scand 2002; 73 (03) 326-329
• 4 Tokuhara Y, Kadoya Y, Nakagawa S, Kobayashi A, Takaoka K. The flexion gap in normal knees. An MRI study. J Bone Joint Surg Br 2004; 86 (08) 1133-1136
• 5 Victor J, Wong P, Witvrouw E, Sloten JV, Bellemans J. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?. Am J Sports Med 2009; 37 (10) 2028-2036
• 6 Demange MK, Von Keudell A, Probst C, Yoshioka H, Gomoll AH. Patient-specific implants for lateral unicompartmental knee arthroplasty. Int Orthop 2015; 39 (08) 1519-1526
• 7 Ollivier M, Abdel MP, Parratte S, Argenson J-N. Lateral unicondylar knee arthroplasty (UKA): contemporary indications, surgical technique, and results. Int Orthop 2014; 38 (02) 449-455
• 8 van der List JP, Chawla H, Joskowicz L, Pearle AD. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24 (11) 3482-3495
• 9 Zuiderbaan HA, van der List JP, Kleeblad LJ. et al. Modern indications, results, and global trends in the use of unicompartmental knee arthroplasty and high tibial osteotomy in the treatment of isolated medial compartment osteoarthritis. Am J Orthop 2016; 45 (06) E355-E361
• 10 van der List JP, Chawla H, Pearle AD. Robotic-assisted knee arthroplasty: an overview. Am J Orthop 2016; 45 (04) 202-211
• 11 Kayani B, Konan S, Pietrzak JRT, Huq SS, Tahmassebi J, Haddad FS. The learning curve associated with robotic-arm assisted unicompartmental knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B [phone]
• 12 Clement ND, Deehan DJ, Patton JT. Robot-assisted unicompartmental knee arthroplasty for patients with isolated medial compartment osteoarthritis is cost-effective: a Markov decision analysis. Bone Joint J 2019; 101-B [phone]
• 13 Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplasty 2016; 31 (10) 2353-2363
• 14 Plate JF, Mofidi A, Mannava S. et al. Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop 2013; 2013: 837167
• 15 Burger JA, Kleeblad LJ, Laas N, Pearle AD. Mid-term survivorship and patient-reported outcomes of robotic-arm assisted partial knee arthroplasty. Bone Joint J 2020; 102-B [phone]
• 16 Zambianchi F, Franceschi G, Rivi E. et al. Clinical results and short-term survivorship of robotic-arm-assisted medial and lateral unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; DOI: 10.1007/s00167-019-05566-4.
• 17 Dyrhovden GS, Lygre SHL, Badawy M, Gøthesen Ø, Furnes O. Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades?. Clin Orthop Relat Res 2017; 475 (07) 1874-1886
• 18 Epinette JA, Brunschweiler B, Mertl P, Mole D, Cazenave A. French Society for Hip and Knee. Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicentre study of 418 failed knees. Orthop Traumatol Surg Res 2012; 98 (6, Suppl): S124-S130
• 19 Thein R, Khamaisy S, Zuiderbaan HA, Nawabi DH, Pearle AD. Lateral robotic unicompartmental knee arthroplasty. Sports Med Arthrosc Rev 2014; 22 (04) 223-228
• 20 van der List JP, Chawla H, Villa JC, Pearle AD. Different optimal alignment but equivalent functional outcomes in medial and lateral unicompartmental knee arthroplasty. Knee 2016; 23 (06) 987-995
• 21 Zambianchi F, Franceschi G, Rivi E. et al. Does component placement affect short-term clinical outcome in robotic-arm assisted unicompartmental knee arthroplasty?. Bone Joint J 2019; 101-B [phone]
• 22 Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA. Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. J Arthroplasty 2012; 27 (05) 803-8.e1
• 23 Pearle AD, O'Loughlin PF, Kendoff DO. Robot-assisted unicompartmental knee arthroplasty. J Arthroplasty 2010; 25 (02) 230-237
• 24 Monticone M, Ferrante S, Salvaderi S. et al. Development of the Italian version of the knee injury and osteoarthritis outcome score for patients with knee injuries: cross-cultural adaptation, dimensionality, reliability, and validity. Osteoarthritis Cartilage 2012; 20 (04) 330-335
• 25 Behrend H, Giesinger K, Giesinger JM, Kuster MS. The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty 2012; 27 (03) 430-436.e1
• 26 Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res 2010; 468 (01) 141-146
• 27 Gilmour A, MacLean AD, Rowe PJ. et al. Robotic-arm-assisted vs conventional unicompartmental knee arthroplasty. The 2-year clinical outcomes of a randomized controlled trial. J Arthroplasty 2018; 33 (7S) S109-S115
• 28 Servien E, Fary C, Lustig S. et al. Tibial component rotation assessment using CT scan in medial and lateral unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 2011; 97 (03) 272-275
• 29 Weinberg DS, Williamson DFK, Gebhart JJ, Knapik DM, Voos JE. Differences in medial and lateral posterior tibial slope: an osteological review of 1090 tibiae comparing age, sex, and race. Am J Sports Med 2017; 45 (01) 106-113
• 30 Sanna M, Sanna C, Caputo F, Piu G, Salvi M. Surgical approaches in total knee arthroplasty. Joints 2013; 1 (02) 34-44
• 31 Edmiston TA, Manista GC, Courtney PM, Sporer SM, Della Valle CJ, Levine BR. Clinical outcomes and survivorship of lateral unicompartmental knee arthroplasty: does surgical approach matter?. J Arthroplasty 2018; 33 (02) 362-365