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McClennen T, Carvalho B, Yousef M, Ayers DC. Evaluating Robotic-Assisted Total Knee Arthroplasty Compared to Conventional Methods: A Systematic Review of the Literature in the United States. Int J Med Robot 2025; 21:e70067. [PMID: 40252242 DOI: 10.1002/rcs.70067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 11/12/2024] [Accepted: 04/07/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (rTKA) offers a new method of surgical management for advanced arthritis of the knee. The objective of this review was to evaluate the current literature evidence comparing rTKA to conventional methods (cTKA) across multiple outcome measures. METHODS PubMed was used to perform a review of articles that discussed outcomes of primary rTKA. Forty-four articles were selected. RESULTS rTKA improves surgical precision and accuracy compared with cTKA, potentially leading to better functional outcomes and fewer complications. rTKA has longer intraoperative times and higher initial costs but leads to shorter hospital stays, lower readmission rates, reduced long-term costs and less revisions. Patient-reported outcomes for rTKA indicate less postoperative pain, reduced opioid use, and improved function. CONCLUSIONS rTKA may provide improved outcomes compared with cTKA. More robust clinical evidence from US-based multicenter prospective propensity matched trials is needed to fully delineate the long-term benefits and limitations of rTKA.
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Affiliation(s)
- Taylor McClennen
- Department of Orthopedics and Rehabilitation, University of Massachusetts T.H. Chan School of Medicine, Worcester, Massachusetts, USA
| | - Brian Carvalho
- Department of Orthopedics and Rehabilitation, University of Massachusetts T.H. Chan School of Medicine, Worcester, Massachusetts, USA
| | - Mohamed Yousef
- Department of Orthopedics and Rehabilitation, University of Massachusetts T.H. Chan School of Medicine, Worcester, Massachusetts, USA
| | - David C Ayers
- Department of Orthopedics and Rehabilitation, University of Massachusetts T.H. Chan School of Medicine, Worcester, Massachusetts, USA
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Putzer D, Schroeder L, Wassilew G, Liebensteiner M, Nogler M, Thaler M. Early Learning Curve in Robotic-Assisted Total Knee Arthroplasty: A Single-Center Experience. J Clin Med 2024; 13:7253. [PMID: 39685712 DOI: 10.3390/jcm13237253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 11/19/2024] [Accepted: 11/25/2024] [Indexed: 12/18/2024] Open
Abstract
Background/Objectives: This study evaluated the learning curve for robotic-assisted total knee arthroplasty (RA TKA) performed by three experienced surgeons, focusing on procedure duration, surgeon satisfaction, and confidence. Methods: A prospective study was conducted with three senior arthroplasty surgeons, each performing 15 RA TKA procedures using the Triathlon Knee System with the Robotic Arm Interactive Orthopedic (RIO) System. Data on preparation, cut-to-suture, and breakdown times were collected. Surgeon anxiety levels were measured preoperatively using the STAI-6 scale, while postoperative satisfaction and confidence were assessed via a questionnaire. Statistical analysis was conducted using GraphPad Prism. Results: Of 50 scheduled surgeries, 45 were completed. The average cut-to-suture time was 1 h 38 min, with significant time reductions in robotic-specific steps as experience increased. Comparing the first five surgeries to the last five, the time for navigation hardware mounting, landmarks registration, femur and tibia registration, and bone preparation decreased by up to 30% (p < 0.001 to p = 0.025). General instrument preparation time decreased by 20% (p = 0.004). Surgeon anxiety levels dropped, indicating increased comfort with the system, while postoperative surveys showed increased satisfaction and confidence. Conclusions: The study demonstrated a substantial learning curve for RA TKA, with improved efficiency and surgeon confidence by the fifteenth procedure. These findings highlight the potential for streamlined workflows and guide training for new adopters of robotic knee arthroplasty.
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Affiliation(s)
- David Putzer
- Experimental Orthopaedics, Department of Orthopaedic and Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Lennart Schroeder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, 80336 München, Germany
| | - Georgi Wassilew
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, 17489 Greifswald, Germany
| | - Michael Liebensteiner
- Department of Orthopaedic and Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Michael Nogler
- Experimental Orthopaedics, Department of Orthopaedic and Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Martin Thaler
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, 17489 Greifswald, Germany
- Arthroplasty Center Munich West, Helios Klinikum, 81241 Munich, Germany
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Song SJ, Park CH. Learning curve for robot-assisted knee arthroplasty; optimizing the learning curve to improve efficiency. Biomed Eng Lett 2023; 13:515-521. [PMID: 37872999 PMCID: PMC10590338 DOI: 10.1007/s13534-023-00311-w] [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: 05/13/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 10/25/2023] Open
Abstract
The introduction of robot-assisted (RA) systems in knee arthroplasty has challenged surgeons to adopt the new technology in their customized surgical techniques, learn system controls, and adjust to automated processes. Despite the potential advantages of RA knee arthroplasty, some surgeons remain hesitant to adopt this novel technology owing to concerns regarding the cumbersome adaptation process. This narrative review addresses the learning-curve issues in RA knee arthroplasty based on the existing literature. Learning curves exist in terms of the operative time and stress level of the surgical team but not in the final implant positions. The factors that reduce the learning curve are previous experience with computer-assisted surgery (including robot or navigation systems), specialization in knee surgery, high volume of knee arthroplasty, optimization of the RA workflow, sequential implementation of RA surgery, and consistency of the surgical team. Worse clinical outcomes may occur in the early postoperative period, but not in the later period, in RA knee arthroplasty performed during the learning phase. No significant differences were observed in implant survival or complication rates between the RA knee arthroplasties performed during the learning and proficiency phases.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447 Korea
| | - Cheol Hee Park
- Department of Orthopedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, 26 Kyunghee-Daero, Dongdaemun-Gu, Seoul, 02447 Korea
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Wininger AE, Lambert BS, Sullivan TC, Brown TS, Incavo SJ, Park KJ. Robotic-Assisted Total Knee Arthroplasty Can Increase Frequency of Achieving Target Limb Alignment in Primary Total Knee Arthroplasty for Preoperative Valgus Deformity. Arthroplast Today 2023; 23:101196. [PMID: 37745954 PMCID: PMC10517281 DOI: 10.1016/j.artd.2023.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Background Robotic-assisted total knee arthroplasty (rTKA) has been shown to reduce the number of alignment outliers and to improve component positioning compared to manual TKA (mTKA). The primary purpose of this investigation was to compare the frequency of achieving target postoperative limb alignment and component positioning for rTKA vs mTKA. Methods A retrospective comparative study was performed on 250 patients undergoing primary TKA by 2 fellowship-trained arthroplasty surgeons. Surgeon A performed predominantly rTKA (103 cases) with the ROSA system (Zimmer Biomet, Warsaw, IN) and less frequently mTKA (44 cases) with conventional instrumentation. Surgeon B performed only mTKA (103 cases). Target limb alignment for surgeon A was 0° for all cases and for surgeon B was 2° varus for varus knees and 0° for valgus knees. Radiographic measurements were determined by 2 reviewers. Target zone was set at ± 2 degrees from the predefined target. Results When comparing rTKA to mTKA performed by different surgeons, there were no differences in the percentage within the target zone (57.28% vs 53.40%, P = .575), but rTKA did result in a greater percentage for cases with preoperative valgus (71.42% vs 44.12%, P = .031). Patient-reported Outcomes Measurement Information System Global-10 physical scores were statistically higher at both 3 (P = .016) and 6 months (P = .001) postoperatively for rTKA compared to mTKA performed by different surgeons. Conclusions Although experienced surgeons can achieve target limb alignment correction with similar frequency when comparing rTKA to mTKA for all cases, rTKA may achieve target limb alignment with more accuracy for preoperative valgus deformity. Level of Evidence Retrospective Cohort Study, Level III.
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Affiliation(s)
- Austin E. Wininger
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Bradley S. Lambert
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Thomas C. Sullivan
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Timothy S. Brown
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Stephen J. Incavo
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
| | - Kwan J. Park
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA
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Wan D, Wang R, Wei J, Zan Q, Shang L, Ma J, Yao S, Xu C. Mapping knowledge landscapes and emerging trends of robotic-assisted knee arthroplasty: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e35076. [PMID: 37746959 PMCID: PMC10519459 DOI: 10.1097/md.0000000000035076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
The robotic-assisted knee arthroplasty has gained increasing attention in the research field. To date, no comprehensive bibliometric analysis has been carried out on this topic. The present study aimed to introduce the research status and hotspots and explore the field of robotic-assisted knee arthroplasty from a bibliometric perspective. The Web of Science Core Collection database was utilized to retrieve articles and reviews on robotic-assisted knee arthroplasty published between 1993 and 2023. CiteSpace, VOSviewer, Scimago Graphica, Pajek, and a bibliometric online analysis platform (http://bibliometric.com/) were employed to analyze the regions, institutions, journals, authors, and keywords, aiming to predict the latest trends in research related to robotic-assisted knee arthroplasty. This study encompasses 697 records. The annual publication count pertaining to robotic-assisted knee arthroplasty demonstrates consistent growth. The United States leads with the highest number of studies (298), trailed by the United Kingdom (110) and France (49). The Hospital for Special Surgery emerges as the most prolific institution, while Professor Mont, Michael A holds significant author influence. The Journal of Arthroplasty reigns supreme in this field, boasting the highest publication and citation figures. Funding sources predominantly include Stryker (34), Smith Nephew (19), and the National Natural Science Foundation of China (17). Noteworthy research themes within robotic-assisted knee arthroplasty encompass patient satisfaction, kinematic alignment, and clinical benefits. The landscape of robotic-assisted knee arthroplasty research is thriving. Anticipated trajectories of research will be geared toward refining the precision of robotic technology and enhancing clinical outcomes within the realm of robotic-assisted knee arthroplasty.
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Affiliation(s)
- Dongping Wan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi Province, China
| | - Rui Wang
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi Province, China
| | - Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Qiang Zan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
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Ramezani A, Ghaseminejad Raeini A, Sharafi A, Sheikhvatan M, Mortazavi SMJ, Shafiei SH. Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:392. [PMID: 35964047 PMCID: PMC9375332 DOI: 10.1186/s13018-022-03281-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a single stage or two separate stages. Each surgical procedure's reliability, safety, and complications have been reported controversially. This study aimed to review the current evidence regarding the outcomes of simultaneous and staged bilateral total hip arthroplasty. METHODS We conducted a meta-analysis using MEDLINE, EMBASE, Web of Science, and Scopus databases. Eligible studies compared complications and related outcomes between simultaneous and staged bilateral THA. Two reviewers independently screened initial search results, assessed methodological quality, and extracted data. We used the Mantel-Haenszel method to perform the meta-analysis. RESULTS In our study, we included 29,551 patients undergoing simBTHA and 74,600 patients undergoing stgBTHA. In favor of the simBTHA, a significant reduction in deep vein thrombosis (DVT) and systemic, local, and pulmonary complications was documented. However, we evidenced an increased pulmonary embolism (PE) and periprosthetic fracture risk in simBTHA. In the simBTHA, total blood loss, length of hospital stay, and total cost were lower. CONCLUSION This meta-analysis shows that simultaneous bilateral THA accompanies fewer complications and lower total cost. Well-designed randomized controlled trials are needed to provide robust evidence.
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Affiliation(s)
- Akam Ramezani
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Ghaseminejad Raeini
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Sharafi
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikhvatan
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Heidelberg Medical Hospital, Heidelberg, Germany
| | | | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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