Preliminary clinical results of robotic-assisted unicompartmental knee arthroplasty
Wang Qiaojie*, Chai Wei#, Wang Qi, Chen Yunsu, Shen Hao, Peng Xiaochun, Ni Ming, Fu Jun, Chen Jiying, Zhang Xianlong.
*Division of Adult Reconstruction, Department of Orthopaedic Surgery, Shanghai 6th People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China; #Division of Adult Reconstruction, Department of Orthopaedic Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China
Abstract：Objective To investigate the accuracy of robotic-assisted UKA and its safety and short term functional outcomes.Methods The clinical data of 20 patients who received robotic-assisted UKA in Shanghai 6th People's Hospital and Chinese PLA General Hospital from September 2016 to December 2016 were retrospectively reviewed, with 10 patients in each hospital. All patients had a preoperative diagnosis of osteoarthritis. Five patients received simultaneous bilateral UKA. Of all the 20 patients, there were 3 male patients and 17 female patients, with an average age of 65 years old (range from 51 to 79 years old) and an average BMI of (26.9±3.4) kg/m2. All the procedures were performed with MAKO RIO robotic-assisted surgical system and RESTORIS MCK unicompartmental knee prosthesis (STRYKER MAKO Surgical, USA). Each patient's operation time, blood loss and post-operative pain scores were recorded. Pre-operative and post-operative knee society scores were recorded; lower limb alignment and the position of the tibial component in coronal plane were measured.Results For patients who received unilateral procedure, the mean operating time of tourniquet was (27±10) minutes. The average total blood loss on post-op day 2 was (476±290) mL, and no transfusion was needed for any patient. The mean visual analogue scale pain score at 8, 16 and 24 hours after surgery was 3.2±1.2, 1.8±0.8 and 1.1±0.3, respectively. All 20 patients (25 knees) were followed-up at a minimal time of 8 weeks (average 14.1 weeks, range from 8 to 20 weeks). On latest follow-up visit, the mean Knee Society Score was improved from a pre-operative value of 57±13 to 90±6, the mean function score was improved from a preoperative value of 48±18 to 79±12, both changes were statistically significant (t=14.941 and 10.014 respectively, all P values<0.01). The position of the tibial component relative to the mechanical axis of the tibial in coronal plane was at a mean varus of 1.7°±1.2°(range, 0°-3.9°), the mean deviation from the target position (1°of varus) was 1.1°±0.9°, none of these cases had a deviation of more than 3°. The mean deviation from the target position of cases from the 2 centers was 1.2°±1.1° and 1.0°±0.6°, respectively. There was no statistic significant difference between the 2 centers (t=0.421, P＞0.05). No severe complications, such as surgical site infection, deep venous thrombosis or vascular and nerve injury, were observed during the follow-up period.Conclusions Robotic-assisted UKA can provide us with excellent precision and safety through a minimally invasive approach. Further long-term controlled study is required to identify the long term clinical outcomes and the role of robotic technique on the improvement of post-operative knee function warrant.
Isaac SM, Barker KL, Danial IN, et al. Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty[J]. Knee, 2007, 14(3): 212-217. DOI:10.1016/j.knee.2007.01.001
[2]
Jeer PJ, Cossey AJ, Keene GC. Haemoglobin levels following unicompartmental knee arthroplasty: influence of transfusion practice and surgical approach[J]. Knee, 2005, 12(5): 358-361. DOI:10.1016/j.knee.2004.11.006
[3]
Price AJ, Webb J, Topf H, et al. Rapid recovery after oxford unicompartmental arthroplasty through a short incision[J]. J Arthroplasty, 2001, 16(8): 970-976. DOI:10.1054/arth.2001.25552
[4]
Liddle AD, Pandit H, Judge A, et al. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales[J]. Bone Joint J, 2015, 97-B(6): 793-801. DOI:10.1302/0301-620X.97B6.35155
[5]
Collier MB, Eickmann TH, Sukezaki F, et al. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty[J]. J Arthroplasty, 2006, 21(6 Suppl 2): 108-115. DOI:10.1016/j.arth.2006.04.012
[6]
Emerson RH Jr, Higgins LL. Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis[J]. J Bone Joint Surg Am, 2008, 90(1): 118-122. DOI:10.2106/JBJS.F.00739
[7]
Lyons MC, MacDonald SJ, Somerville LE, et al. Unicompartmental versus total knee arthroplasty database analysis: is there a winner[J]. Clin Orthop Relat Res, 2012, 470(1): 84-90. DOI:10.1007/s11999-011-2144-z
[8]
Lonner JH. Indications for unicompartmental knee arthroplasty and rationale for robotic arm-assisted technology[J]. Am J Orthop, 2009, 38(2 Suppl): 3-6
[9]
van der List JP, Chawla H, Joskowicz L, et al. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(11): 3482-3495. DOI:10.1007/s00167-016-4305-9
[10]
van der List JP, Chawla H, Pearle AD. Robotic-Assisted knee arthroplasty: an overview[J]. Am J Orthop, 2016, 45(4): 202-211
[11]
Bell SW, Anthony I, Jones B, et al. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study[J]. J Bone Joint Surg Am, 2016, 98(8): 627-635. DOI:10.2106/JBJS.15.00664
Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults[J]. Surgery, 1962, 51(2): 224-232
[16]
Ackroyd CE. Medial compartment arthroplasty of the knee[J]. J Bone Joint Surg Br, 2003, 85(7): 937-942. DOI:10.1302/0301-620x.85b7.14650
[17]
Foran JR, Brown NM, Della Valle CJ, et al. Long-term survivorship and failure modes of unicompartmental knee arthroplasty[J]. Clin Orthop Relat Res, 2013, 471(1): 102-108. DOI:10.1007/s11999-012-2517-y
[18]
Lisowski LA, Meijer LI, Bekerom MP, et al. Ten- to 15-year results of the Oxford Phase III mobile unicompartmental knee arthroplasty: a prospective study from a non-designer group[J]. Bone Joint J, 2016, 98-B(10 Supple B): 41-47. DOI:10.1302/0301-620X.98B10.BJJ-2016-0474.R1
[19]
Bottomley N, Jones LD, Rout R, et al. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: a comparison between consultant and trainee surgeons[J]. Bone Joint J, 2016, 98-B(10 Supple B): 22-27. DOI:10.1302/0301-620X.98B10.BJJ-2016-0483.R1
[20]
Coon T, Roche M, Pearle A, et al. Two year survivorship of robotically guided unicompartmental knee arthroplasty[C].International Society for Technology in Arthroplasty 26th Annual Congress. FL: Palm Beach, 2013
[21]
Müller PE, Pellengahr C, Witt M, et al. Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty[J]. J Arthroplasty, 2004, 19(3): 296-301. DOI:10.1016/j.arth.2003.09.013
[22]
Gulati A, Chau R, Simpson DJ, et al. Influence of component alignment on outcome for unicompartmental knee replacement[J]. Knee, 2009, 16(3): 196-199. DOI:10.1016/j.knee.2008.11.001
[23]
Cobb J, Henckel J, Gomes P, et al. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system[J]. J Bone Joint Surg Br, 2006, 88(2): 188-197. DOI:10.1302/0301-620X.88B2.17220
[24]
Dunbar NJ, Roche MW, Park BH, et al. Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty[J]. J Arthroplasty, 2012, 27(5): 803-808. DOI:10.1016/j.arth.2011.09.021
[25]
Vasso M, Del Regno C, D'Amelio A, et al. Minor varus alignment provides better results than neutral alignment in medial UKA[J]. Knee, 2015, 22(2): 117-121. DOI:10.1016/j.knee.2014.12.004
[26]
Badawy M, Espehaug B, Indrekvam K, et al. Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals[J]. Acta Orthop, 2014, 85(4): 342-347. DOI:10.3109/17453674.2014.920990
[27]
Baker P, Jameson S, Critchley R, et al. Center and surgeon volume influence the revision rate following unicondylar knee replacement: an analysis of 23,400 medial cemented unicondylar knee replacements[J]. J Bone Joint Surg Am, 2013, 95(8): 702-709. DOI:10.2106/JBJS.L.00520
[28]
Coon T, Driscoll M, Conditt M. Early clinical success of novel tactile guided UKA technique[C]. 21st Congress of the ISTA. CA: Sacremento, 2008
2017, Vol. 22 
