1
|
Liu C, Huang C, Suyalatu X, Zhang Q, Zhang Y, Sun W, Guo W, Wang W. Optimizing uni-compartmental knee arthroplasty: the impact of preoperative planning and arithmetic hip-knee-ankle angle. BMC Musculoskelet Disord 2025; 26:275. [PMID: 40102874 PMCID: PMC11916953 DOI: 10.1186/s12891-025-08512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/10/2025] [Indexed: 03/20/2025] Open
Abstract
PURPOSE The purpose of this study was to evaluate whether the combination of preoperative planning software combined with arithmetic hip-knee-ankle angle (aHKA) can help patients who underwent uni-compartmental knee arthroplasty (UKA) recover the constitutional alignment of the lower limb, obtain a better prosthetic position, and achieve better early patient-reported outcome measurements (PROMs). METHODS A total of 150 patients who underwent UKA (planning group: 50 patients using the preoperative planning software; conventional group: 100 patients using the conventional method) were included in the study. The aHKA was defined as 180° + mechanical medial proximal tibial angle (MPTA) - mechanical distal lateral femoral angle (LDFA). All patients in the planning group underwent UKA according to the planning software with the planned lower limb alignment of aHKA. All patients were divided into three groups: constitutional alignment group (postoperative HKA (post-HKA): aHKA ± 2.0°); overcorrection group (post-HKA > aHKA + 2.0°); under-correction group (post-HKA < aHKA - 2.0°). Comparisons between the planning and conventional groups were conducted: (1) the proportion of post-HKA restored to constitutional alignment group; (2) the postoperative prosthesis position parameter based on the guideline of the Oxford group; (3) the American Knee Society scores (KSS) at six months after surgery. RESULTS The proportion of the constitutional alignment group in the planning group was higher than that in the conventional group (86% vs. 66%) (p = 0.033). There was no significant difference in postoperative prosthesis position parameters between the two groups. No significant difference was found between the KSS clinical score (91.02 ± 4.20 vs. 90.61 ± 4.24) and KSS functional score (86.10 ± 7.23 vs. 84.30 ± 6.82) in six months after surgery between the planning and conventional groups. CONCLUSION Patients who underwent UKA using preoperative planning software in combination with aHKA were able to recover a higher proportion of the constitutional alignment than those with the conventional method. In addition, the planning group could achieve similar postoperative prosthesis position and short-term PROMs compared to the conventional group. CLINICAL TRIAL NUMBER Not applicable.
Collapse
Affiliation(s)
- Changquan Liu
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, 518035, China
- Department of Orthopaedic Surgery, China-Japan, Friendship Hospital, Beijing, 100029, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China-Japan, Friendship Hospital, Beijing, 100029, China
| | - Xin Suyalatu
- Department of Orthopaedic Surgery, Ordos Central Hospital, Ordos, Inner Mongolia, 017000, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan, Friendship Hospital, Beijing, 100029, China
| | - Yiling Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Wei Sun
- Department of Orthopedics, Shenzhen Second People's Hospital/First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, 518035, China.
| | - Wanshou Guo
- Department of Orthopaedic Surgery, China-Japan, Friendship Hospital, Beijing, 100029, China.
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan, Friendship Hospital, Beijing, 100029, China.
| |
Collapse
|
2
|
Avram GM, Tomescu H, Dennis C, Rusu V, Mengis N, Ammann E, Pacchiarotti G, Hirschmann MT, Predescu V, Russu O. Robotic-Assisted Medial Unicompartmental Knee Arthroplasty Provides Better FJS-12 Score and Lower Mid-Term Complication Rates Compared to Conventional Implantation: A Systematic Review and Meta-Analysis. J Pers Med 2024; 14:1137. [PMID: 39728050 DOI: 10.3390/jpm14121137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 11/22/2024] [Accepted: 11/28/2024] [Indexed: 12/28/2024] Open
Abstract
Background: Robotic-assisted unicompartmental arthroplasty (rUKA) is gradually gaining more popularity than its conventional counterpart (cUKA). Current studies are highly heterogenic in terms of methodology and the reported results; therefore, establishing the optimal recommendation for patients becomes less straightforward. For this reason, this meta-analysis aims to provide an up-to-date evidence-based analysis on current evidence regarding clinical outcomes and complication rates following rUKA and cUKA. Methods: A meta-analysis was conducted following PRISMA guidelines. Five databases were searched, PubMed via MEDLINE, Epistemonikos, Cochrane Library, Web of Science, and Scopus. The relevant inclusion criteria were as follows: comparative clinical studies in which medial rUKA was compared to medial cUKA (prospective or retrospective designs), (2) human studies, (3) meta-analyses for cross-referencing, and (4) English language. The relevant extracted data were patient demographics, patient-reported outcome measures (PROMs), range of motion, and complications. A random-effects meta-analysis and subgroup analysis were conducted. The results include mean differences (MDs) and odds ratios (ORs), along with 95% confidence intervals (CIs) for continuous and binary variables, respectively. Results: rUKA showed a higher overall FJS-12 score compared to cUKA, with MD = 6.02 (95%CI: -0.07 to 12.1), p = 0.05. At 6 months postoperatively, the MD increased to 10.31 (95%CI: 5.14 to 15.49), p < 0.01. At a minimum 36-month follow-up, cUKA had a higher all-cause revision rate, with OR = 3.31 (95%CI: 1.25 to 8.8), p = 0.02, and at a minimum 60-month follow-up, a higher aseptic loosening rate, with OR = 3.86 (95%CI: 1.51 to 9.91), p < 0.01, compared to rUKA. Conclusions: rUKA provides better FJS-12 results compared to cUKA, as well as lower all-cause revision and aseptic loosening rates at 36- and 60-month follow-up, respectively. However, long-term follow-up is still pending.
Collapse
Affiliation(s)
- George M Avram
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Horia Tomescu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, Bvd. Eroii Sanitari Nr. 8, Sector 5, 050474 Bucuresti, Romania
| | - Cicio Dennis
- Faculty of General Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Str. Victor Babeş Nr. 8, 400012 Cluj-Napoca, Romania
| | - Vlad Rusu
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology "George Emil Palade" of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Natalie Mengis
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Elias Ammann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Giacomo Pacchiarotti
- Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Roma, Italy
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Vlad Predescu
- Orthopaedics and Traumatology Department, Ponderas Academic Hospital, 014142 Bucharest, Romania
| | - Octav Russu
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology "George Emil Palade" of Târgu Mureş, 540139 Târgu Mureş, Romania
- Orthopaedic and Traumatology Department, University of Medicine, Pharmacy, Science, and Technology, 540139 Targu Mures, Romania
| |
Collapse
|
3
|
Pavone M, Baroni A, Taliento C, Goglia M, Lecointre L, Rosati A, Forgione A, Akladios C, Scambia G, Querleu D, Marescaux J, Seeliger B. Robotic platforms in gynaecological surgery: past, present, and future. Facts Views Vis Obgyn 2024; 16:163-172. [PMID: 38950530 PMCID: PMC11366121 DOI: 10.52054/fvvo.16.2.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background More than two decades ago, the advent of robotic laparoscopic surgery marked a significant milestone, featuring the introduction of the AESOP robotic endoscope control system and the ZEUS robotic surgery system. The latter, equipped with distinct arms for the laparoscope and surgical instruments, was designed to accommodate remote connections, enabling the practice of remote telesurgery as early as 2001. Subsequent technological progress has given rise to a range of options in today's market, encompassing multi-port and single-port systems, both rigid and flexible, across various price points, with further growth anticipated. Objective This article serves as an indispensable guide for gynaecological surgeons with an interest in embracing robotic surgery. Materials and methods Drawing insights from the experience of the Strasbourg training centre for minimally invasive surgery (IRCAD), this article offers a comprehensive overview of existing robotic platforms in the market, as well as those in development. Results Robotic surgical systems not only streamline established operative methods but also broaden the scope of procedures, including intra- and transluminal surgeries. As integral components of the digital surgery ecosystem, these robotic systems actively contribute to the increasing integration and adoption of advanced technologies, such as artificial intelligence-based data analysis and support systems. Conclusion Robotic surgery is increasingly being adopted in clinical practice. With the growing number of systems available on the marketplace, the primary challenge lies in identifying the optimal platform for each specific procedure and patient. The seamless integration of robotic systems with artificial intelligence, image-guided surgery, and telesurgery presents undeniable advantages, enhancing the precision and effectiveness of surgical interventions. What is new? This article provides a guide to the robotic platforms available on the market and those in development for gynaecologists interested in robotic surgery.
Collapse
|
4
|
Ghazal AH, Fozo ZA, Matar SG, Kamal I, Gamal MH, Ragab KM. Robotic Versus Conventional Unicompartmental Knee Surgery: A Comprehensive Systematic Review and Meta-Analysis. Cureus 2023; 15:e46681. [PMID: 37869054 PMCID: PMC10589056 DOI: 10.7759/cureus.46681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 10/24/2023] Open
Abstract
Robotic-assisted surgery is a computer-controlled technique that may improve the accuracy and outcomes of unicompartmental total knee arthroplasty (TKA), a partial knee replacement surgery. The purpose of a meta-analysis about robotic-assisted versus conventional surgery for unicompartmental TKA is to compare the effectiveness of these two methods based on the current evidence. Our meta-analysis can help inform clinical decisions and guidelines for surgeons and patients who are considering unicompartmental TKA as a treatment option. We searched four online databases for studies that compared the two methods until March 2023. We used RevMan software to combine the data from the studies. We calculated the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between the two methods. We included 16 studies in our analysis. We found that robotic-assisted surgery had a better hip-knee-ankle angle, which is a measure of how well the knee is aligned, than conventional surgery (MD = 0.86, 95% CI = 0.16-1.56). We also found that robotic-assisted surgery had a better Oxford Knee score, which is a measure of how well the knee functions, than conventional surgery (MD = 3.03, 95% CI = 0.96-5.110). This study compared the results of conventional and robotic-assisted unicompartmental knee arthroplasty in 12 studies. We concluded that robotic-assisted surgery may have some benefits over conventional surgery in terms of alignment and function of the knee. However, we did not find any significant difference between the two methods in terms of other outcomes, such as pain, range of motion, health status, and joint awareness. Therefore, we suggest that more research is needed to confirm these results and evaluate the long-term effects and cost-effectiveness of robotic-assisted surgery.
Collapse
Affiliation(s)
- Ahmed Hussein Ghazal
- Orthopaedics, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, GBR
| | | | - Sajeda G Matar
- Pharmacology and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, JOR
| | - Ibrahim Kamal
- General Medicine, Al-Azhar University, Alexandria, EGY
| | - Mohamed Hesham Gamal
- Pharmacology and Therapeutics, Faculty of Pharmacy, Tanta University, Tanta, EGY
| | | |
Collapse
|
5
|
Adamska O, Modzelewski K, Szymczak J, Świderek J, Maciąg B, Czuchaj P, Poniatowska M, Wnuk A. Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020236. [PMID: 36837438 PMCID: PMC9963242 DOI: 10.3390/medicina59020236] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023]
Abstract
Background and objectives: The introduction of novel techniques in total knee arthroplasty (TKA) aiming to enhance outcomes and satisfaction of the procedure is constantly ongoing. In order to evidence a priority of one, we have conducted a randomized controlled trial with the aim of comparing patient-reported functional outcomes, radiographic outcomes and intraoperative measures between imageless (NAVIO and CORI), robotic-assisted (ra)- TKA (ra-TKA) and manual TKA (mTKA) for primary knee osteoarthritis (KOA). Materials and Methods: A total of 215 patients with the diagnosis of KOA of the knee were randomly assigned to one of the three groups: NAVIO (76 patients) or CORI (71 patients) robotic-assisted TKA, or manual technique (68 patients) TKA. The primary outcome (Knee Injury and Osteoarthritis Outcome Study [KOOS]), Visual Analogue Scale (VAS), Range of motion (ROM), femoral component rotational alignment and the secondary outcomes (surgery time, blood loss, complications, and revision at 12 months after surgery) were compared between three groups. KOOS and VAS were collected at particular follow up visits from each patient individually and ROM in flexion and extension was assessed during the physical examination. Femoral component rotational alignment was measured on the CT scan performed postoperatively utilizing the Berger's method. Statistical significance was set at p < 0.05. Results: Both the ra-TKA groups and mTKA group displayed significant improvements in the majority of the functional outcome scores at 12 months. Despite having more prominent surgery time (NAVIO: mean +44.5 min in comparison to mTKA and CORI: mean +38.5 min in comparison to mTKA), both NAVIO and CORI tend to achieve highly accurate femoral component rotational alignment with mean radiographic scores in NAVIO vs. CORI vs. mTKA of 1.48° vs. 1.33° vs. 3.15° and lower blood loss (NAVIO: 1.74; CORI: 1.51; mTKA: 2.32. Furthermore, the investigation revealed the significant difference in femoral component rotational alignment between mTKA-NAVIO and mTKA-CORI and significantly different KOOS scores in NAVIO vs. CORI vs. mTKA of 87.05 vs. 85.59 vs. 81.76. Furthermore, the KOOS analysis showed between group significant statistical differences, but did not reach minimal clinically significant difference. There were no differences in postoperative ROM and VAS. There were no differences in complications between groups. Conclusions: To achieve a successful TKA, the precise tool and individualised objective is of great importance. The results suggest satisfactory results after both ra-TKA methods and mTKA. Ra-TKA and mTKA stand for a safe and reliable treatment method for OA. Patients reported excellent alleviation in functional outcomes and the radiological results revealed that the better precision does not necessarily lead to a better outcome. Therefore, ra-TKA does not imply strong enough advantages in comparison to the manual method, especially in terms of cost-efficiency and surgical time.
Collapse
Affiliation(s)
- Olga Adamska
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
- Correspondence:
| | - Krzysztof Modzelewski
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Jakub Szymczak
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Jakub Świderek
- Faculty of Medicine, Medical University of Bialystok, 1 Jana Kilińskiego St., 15-089 Bialystok, Poland
| | - Bartosz Maciąg
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | - Paweł Czuchaj
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
| | | | - Artur Wnuk
- Hospital in Ostrow Mazowiecka, 68 Dubois St., 07-300 Ostrów Mazowiecka, Poland
| |
Collapse
|