Robot-Assisted Unicompartmental Knee Arthroplasty: Increasing Surgical Accuracy? A Cadaveric Study

Abstract

Unicompartmental knee arthroplasty (UKA) represents 10% of knee arthroplasties. Advantages are better functional results, quicker recovery, shorter hospitalization time, and lower blood loss, among others. However, revision rates are larger than total knee arthroplasty. Among the most important factors that explain this are the implant position and alignment, and the correct surgical indication. Greater accuracy in the implant placement may improve clinical results and increase the rate of implant survival. The objective of this study is to evaluate the precision of the Navio robot-assisted system in the position and alignment of medial UKA compared with the conventional technique. This is an experimental pilot study. Twenty-six cadaveric models were randomized into 2 groups: Robot-Assisted surgery (R) and Conventional Surgery (C). Radiological study was performed pre- and post-surgery, evaluating the medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), tibial slope, tibiofemoral angle (TFA), sagittal femoral angle (SFA), and size of the femoral and tibial components. The main result measurement was the change in postoperative angulation. The results of this study are MDFA median of 1.07° (0.19–4.5) for group R and 0.12° (0.03–10.4) with a significant difference in variances; a Welch t-test of p = 0.013; and an MPTA of 1.28° (0.05–5.87) for R and 1.3°(0.08–14.1) for C with significantly different variances (p = 0.0064). Size of the femoral component has a difference of p < 0.05 between groups. No differences for dispersion of TFA nor for the size of the tibial component were observed. In conclusion, using robot-assisted UKA allows for greater accuracy in the positioning of the implants and in the prediction of the size of the femoral component.

Keywords

unicompartmental knee arthroplasty - robotics

Publication History

Received: 05 May 2019

Accepted: 01 September 2019

Article published online:
22 October 2019

• References

• 1 Hernandez D, Garimella R, Eltorai AEM, Daniels AH. Computer-assisted orthopaedic surgery. Orthop Surg 2017; 9 (02) 152-158
• 2 Zheng G, Nolte LP. Computer-assisted orthopedic surgery: current state and future perspective. Front Surg 2015; 2: 66
• 3 Pearle AD, Kendoff D, Musahl V. Perspectives on computer-assisted orthopaedic surgery: movement toward quantitative orthopaedic surgery. J Bone Joint Surg Am 2009; 91 (Suppl. 01) 7-12
• 4 Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplasty 2016; 31 (10) 2353-2363
• 5 van der List JP, Chawla H, Pearle AD. Robotic-assisted knee arthroplasty: an overview. Am J Orthop 2016; 45 (04) 202-211
• 6 Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am 2016; 98 (08) 627-635
• 7 Cobb J, Henckel J, Gomes P. et al. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 2006; 88 (02) 188-197
• 8 Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty 2006; 21 (06) (Suppl. 02) 108-115
• 9 Rosenberger RE, Fink C, Quirbach S, Attal R, Tecklenburg K, Hoser C. The immediate effect of navigation on implant accuracy in primary mini-invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2008; 16 (12) 1133-1140
• 10 Wallace D, Gregori A, Picard J. et al. The learning curve of a novel handheld robotic system for unicondylar knee arthroplasty. Orthopaedic Proceedings 2014;96-B, No. SUPP_16
• 11 Weber P, Crispin A, Schmidutz F. et al. Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013; 21 (11) 2453-2461
• 12 Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am 2002; 84 (12) 2235-2239
• 13 Berger RA, Meneghini RM, Jacobs JJ. et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am 2005; 87 (05) 999-1006
• 14 Lombardi Jr AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile-bearing unicompartmental than total knee arthroplasty?. Clin Orthop Relat Res 2009; 467 (06) 1450-1457
• 15 Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; ;•••: [ Epub ahead of print ] DOI: 10.1007/s00167-018-5081-5.
• 16 Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery. 10-year minimum follow-up period. J Arthroplasty 1996; 11 (07) 782-788
• 17 Australian Orthopaedic Association National Joint Replacement Registry. Accessed September 13, 2013 at: https://aoanjrr.dmac.adelaide.edu.au/en
• 18 National Joint Registry. Accessed April 24, 2014 at: www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/10th_annual_report/NJR%2010th%20Annual%20Report%202013%20B.pdf
• 19 New Zealand Joint Registry. Accessed September 13, 2013 at: www.nzoa.org.nz/news/new-zealand-joint-registry-thirteen-year-report
• 20 Norwegian Arthroplasty Register. Accessed September 13, 2013 at: http://nrlweb.ihelse.net/eng/Report_2010.pdf
• 21 Lonner JH, Smith JR, Picard F, Hamlin B, Rowe PJ, Riches PE. High degree of accuracy of a novel image-free handheld robot for unicondylar knee arthroplasty in a cadaveric study. Clin Orthop Relat Res 2015; 473 (01) 206-212