Bell, J Bone Joint Surg Am 2016 - Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty

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Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty

Bell, Blyth, et al.·J Bone Joint Surg Am·2016·304 citations·RCT

Background

Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques.

Methods

139 patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at 3 months to assess the accuracy of the axial, coronal, and sagittal component positioning.

Results

Data were available for 120 patients, 62 who had undergone robotic-assisted unicompartmental knee arthroplasty and 58 who had undergone conventional unicompartmental knee arthroplasty.
Intraobserver agreement was good for all measured component parameters.
The accuracy of component positioning was improved with the use of the robotic-assisted surgical procedure, with lower root mean square errors and significantly lower median errors in all component parameters (p < 0.01).
The proportion of patients with component implantation within 2° of the target position was significantly greater in the group who underwent robotic-assisted unicompartmental knee arthroplasty compared with the group who underwent conventional unicompartmental knee arthroscopy with regard to the femoral component sagittal position (57% compared with 26%, p = 0.0008), femoral component coronal position (70% compared with 28%, p = 0.0001), femoral component axial position (53% compared with 31%, p = 0.0163), tibial component sagittal position (80% compared with 22%, p = 0.0001), and tibial component axial position (48% compared with 19%, p = 0.0009).

Conclusions

Robotic-assisted surgical procedures with the use of the MAKO RIO lead to improved accuracy of implant positioning compared with conventional unicompartmental knee arthroplasty surgical techniques.

Level of evidence: Therapeutic Level I . Copyright remains with the authors and publisher.

Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty

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Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty

Bell, Blyth, et al.·J Bone Joint Surg Am·2016·304 citations·RCT

Background

Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques.

Methods

139 patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at 3 months to assess the accuracy of the axial, coronal, and sagittal component positioning.

Results

Data were available for 120 patients, 62 who had undergone robotic-assisted unicompartmental knee arthroplasty and 58 who had undergone conventional unicompartmental knee arthroplasty.
Intraobserver agreement was good for all measured component parameters.
The accuracy of component positioning was improved with the use of the robotic-assisted surgical procedure, with lower root mean square errors and significantly lower median errors in all component parameters (p < 0.01).
The proportion of patients with component implantation within 2° of the target position was significantly greater in the group who underwent robotic-assisted unicompartmental knee arthroplasty compared with the group who underwent conventional unicompartmental knee arthroscopy with regard to the femoral component sagittal position (57% compared with 26%, p = 0.0008), femoral component coronal position (70% compared with 28%, p = 0.0001), femoral component axial position (53% compared with 31%, p = 0.0163), tibial component sagittal position (80% compared with 22%, p = 0.0001), and tibial component axial position (48% compared with 19%, p = 0.0009).

Conclusions

Robotic-assisted surgical procedures with the use of the MAKO RIO lead to improved accuracy of implant positioning compared with conventional unicompartmental knee arthroplasty surgical techniques.

Level of evidence: Therapeutic Level I . Copyright remains with the authors and publisher.

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