1
|
Cochrane NH, Kim BI, Stauffer TP, Hallows RK, Urish KL, Carvajal Alba JA, Seyler TM. Revision Total Knee Arthroplasty With an Imageless, Second-Generation Robotic System. J Arthroplasty 2024:S0883-5403(24)00118-9. [PMID: 38355066 DOI: 10.1016/j.arth.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty is increasingly used in revision total knee arthroplasty (rTKA), with imageless systems recently receiving Food and Drug Administration (FDA) approval. However, there remains a paucity of literature on the use of robotic assistance in revision total knee arthroplasty (TKA). This paper describes the imageless surgical technique for robotic revision TKA using a second-generation robotic system and details both intraoperative and 90-day outcomes. METHODS This was a retrospective review of 115 robotic revision TKAs from March 2021 to May 2023 at 3 tertiary academic centers. Patient demographics, perioperative surgical data, and 90-day outcomes were collected. Pain and Patient-Reported Outcomes Measurement Information System scores preoperatively and postoperatively were recorded. All-cause reoperations at the final follow-up were detailed. The mean patient age was 65 years (range, 43 to 88), and 58% were women. The mean follow-up time was 13 months (range, 3 to 51). RESULTS The most common indications for rTKA were instability (n = 37, 32%) and aseptic loosening (n = 42, 37%). There were 83 rTKAs to a posterior-stabilized liner, 22 to a varus-valgus constrained liner, and 5 to a hinged construct. The median polyethylene size was 11 (interquartile range, 10 to 13), and 93% of patients had their joint line restored within 5 millimeters of the native contralateral knee. Within the 90-day postoperative window, there were 8 emergency department visits and 2 readmissions. At the final follow-up, there were 5 reoperations and 2 manipulations under anesthesia. There were 4 patients who required irrigation and debridement after superficial wound dehiscence, and one had an arthrotomy disruption after a fall. CONCLUSIONS This review demonstrates favorable intraoperative and 90-day outcomes and suggests that imageless robotic surgery is a promising modality in rTKA. Further studies comparing the longitudinal outcomes after robotic and conventional rTKA are warranted.
Collapse
Affiliation(s)
- Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy I Kim
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Taylor P Stauffer
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rhett K Hallows
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaime A Carvajal Alba
- Department of Orthopaedic Surgery, University of Miami Health System, Miami, Florida
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
2
|
Constantinescu DS, Costello JP, Yakkanti RR, Vanden Berge DJ, Carvajal Alba JA, Hernandez VH, D'Apuzzo MR. Varying Complication Rates and Increased Costs in Technology-Assisted Total Hip Arthroplasty Versus Conventional Instrumentation in 1,372,300 Primary Total Hips. J Arthroplasty 2023:S0883-5403(23)01211-1. [PMID: 38103802 DOI: 10.1016/j.arth.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The use of technology allows surgeons increased precision in component positioning in total hip arthroplasty (THA). The objective of this study was to compare (1) perioperative complications and (2) resource utilizations between robotic-assisted (RA) and computer-navigated (CN) versus conventional instrumenttaion (CI) THA. METHODS A retrospective cohort study was performed using a large national database to identify patients undergoing unilateral, primary elective THA from January 1, 2016 to December 31, 2019 using RA, CN, or CI. There were 1,372,300 total patients identified and included RA (29,735), CN (28,480), and CI (1,314,085) THA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analyses were performed. RESULTS The use of RA THA led to lower rates of intraoperative fracture (0.22% versus 0.39%), delirium (0.1% versus 0.2%), postoperative anemia (14.4% versus 16.7%), higher myocardial infarction (0.13% versus 0.08%), renal failure (1.7% versus 1.6%), blood transfusion (2.0% versus 1.9%), and wound dehiscence (0.02% versus 0.01%) compared to CI THA. The use of CN led to lower rates of respiratory complication (0.5% versus 0.8%), renal failure (1.1% versus 1.6%), blood transfusion (1.3% versus 1.9%), and pulmonary embolism (0.02% versus 0.1%) compared to CI THA. Total costs were increased in RA ($17,729 versus $15,977) and CN ($22,529 versus $15,977). Lengths of hospital stay were decreased in RA (1.8 versus 1.9 days) and CN (1.7 versus 1.9 days). CONCLUSIONS Perioperative complication rates vary in technology-assisted THA, with higher rates in RA THA and lower rates in CN THA, relative to CI THA. Both RA THA and CN THA were associated with more costs, shorter postoperative hospital stays, and higher rates of discharge home compared to CI THA.
Collapse
Affiliation(s)
- David S Constantinescu
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Joseph P Costello
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Ramakanth R Yakkanti
- Rothman Orthopaedic Institute at Jefferson Health, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | - Dennis J Vanden Berge
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Jaime A Carvajal Alba
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Victor H Hernandez
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Michele R D'Apuzzo
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| |
Collapse
|
3
|
Constantinescu DS, Costello JP, Yakkanti RR, Vanden Berge DJ, Carvajal Alba JA, Hernandez VH, D'Apuzzo MR. Lower Perioperative Complication Rates and Shorter Lengths of Hospital Stay Associated With Technology-Assisted Total Knee Arthroplasty Versus Conventional Instrumentation in Primary Total Knee Arthroplasty. J Arthroplasty 2023:S0883-5403(23)01207-X. [PMID: 38103801 DOI: 10.1016/j.arth.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The use of technology allows increased precision in component positioning in total knee arthroplasty (TKA). The objectives of this study were to compare (1) perioperative complications and (2) resource utilization between robotic-assisted (RA) and computer-navigated (CN) versus conventional (CI) TKA. METHODS A retrospective cohort study was performed using a national database to identify patients undergoing unilateral, primary elective TKA from January 2016 to December 2019. A total of 2,174,685 patients were identified and included RA (69,445), CN (112,225), or CI (1,993,015) TKA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analysis was performed. RESULTS The RA TKA cohort had lower rates of intraoperative fracture (0.05 versus 0.08%, P < .05), respiratory complications (0.6 versus 1.1%, P < .05), renal failure (1.3 versus 1.7%, P < .05), delirium (0.1 versus 0.2%, P < .05), gastrointestinal complications (0.04 versus 0.09%, P < .05), postoperative anemia (8.9 versus 13.9%, P < .05), blood transfusion (0.4 versus 0.9%, P < .05), pulmonary embolism, and deep vein thrombosis (0.1 versus 0.2%, P < .05), and mortality (0.01 versus 0.02%, P < .05) compared to conventional TKA, though the cohort did have higher rates of myocardial infarction (0.09 versus 0.07%, P < .05). The CN cohort had lower rates of myocardial infarction (0.02 versus 0.07%, P < .05), respiratory complications (0.8 versus 1.1%, P < .05), renal failure (1.5 versus 1.7%, P < .05), blood transfusion (0.8 versus 0.9%, P < .05), pulmonary embolism (0.08 versus 0.2%, P < .05), and deep vein thrombosis (0.2 versus 0.2%, P < .05) over CI TKA. Total cost was increased in RA (16,190 versus $15,133, P < .05) and CN (17,448 versus $15,133, P < .05). However, the length of hospital stay was decreased in both RA (1.8 versus 2.2 days, P < .05) and CN (2.1 versus 2.2 days, P < .05). CONCLUSIONS Technology-assisted TKA was associated with lower perioperative complication rates and faster recovery.
Collapse
Affiliation(s)
| | | | - Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Jefferson Health, Philadelphia, Pennsylvania
| | | | | | | | | |
Collapse
|
4
|
Stadnyk M, Liu T, Arezodar FF, Westover L, Carvajal Alba JA, Masson E, Beaupre L, Jaremko JL, El-Rich M. Analysis of four methods of measuring three-dimensional pelvic tilt in the lateral decubitus position. Med Biol Eng Comput 2020; 58:2387-2396. [PMID: 32725540 DOI: 10.1007/s11517-020-02235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
Proper alignment of acetabular implantation is necessary for good patient outcomes and preventing complications or additional surgeries in total hip arthroplasty (THA). Rotation of the pelvis in lateral decubitus (LD) is typically not accounted for as surgeons use the surgery table as a reference plane to align implants. This study compared four techniques to measure 3D pelvic rotations in LD position using computer models. CT scans of 19 subjects in LD position were used to create 3D pelvis models. Pelvic rotations were measured by three users using four techniques: landmark (LM), defined plane (DP), anterior pelvic plane (APP), and plane of best symmetry (POBS) methods. Measurements were analysed for intra-user reliability and relationships between methods were assessed using intraclass correlation coefficient, standard error of measurement, and coefficient of determination. The POBS method exhibited the highest inter-observer reliability and is recommended as a new measurement technique to measure pelvic rotations before THA surgery. The LM method exhibited low reliability but may be suitable for expert users familiar with pelvic landmarks. The APP method should only be used when the patients' APP planes are known in neutral standing and side-lying postures. The DP method is not recommended due to substantial individual variability. Graphical abstract.
Collapse
Affiliation(s)
- Meredith Stadnyk
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Tao Liu
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada.,Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | | | - Edward Masson
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Marwan El-Rich
- Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates.
| |
Collapse
|
5
|
Carvajal Alba JA, Vincent HK, Sodhi JS, Latta LL, Parvataneni HK. How Reliable is the Acetabular Cup Position Assessment from Routine Radiographs? Iowa Orthop J 2017; 37:181-187. [PMID: 28852355 PMCID: PMC5508274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cup position is crucial for optimal outcomes in total hip arthroplasty. Radiographic assessment of component position is routinely performed in the early postoperative period. AIMS The aims of this study were to determine in a controlled environment if routine radiographic methods accurately and reliably assess the acetabular cup position and to assess if there is a statistical difference related to the rater's level of training. METHODS A pelvic model was mounted in a spatial frame. An acetabular cup was fixed in different degrees of version and inclination. Standardized radiographs were obtained. Ten observers including five fellowship-trained orthopaedic surgeons and five orthopaedic residents performed a blind assessment of cup position. Inclination was assessed from anteroposterior radiographs of the pelvis and version from cross-table lateral radiographs of the hip. RESULTS The radiographic methods used showed to be imprecise specially when the cup was positioned at the extremes of version and inclination. An excellent inter-observer reliability (Intra-class coefficient > 0,9) was evidenced. There were no differences related to the level of training of the raters. CONCLUSIONS These widely used radiographic methods should be interpreted cautiously and computed tomography should be utilized in cases when further intervention is contemplated.
Collapse
Affiliation(s)
- Jaime A Carvajal Alba
- Department of Orthopaedics, University of Miami1611 NW 12th Ave. Suite 303. Miami, FL 33136.
| | - Heather K Vincent
- Department of Orthopaedics and RehabilitationUniversity of Florida 3450 Hull Road, Gainesville, FL 32607.
| | | | - Loren L Latta
- Max Biedermann Institute of Biomechanics Department of OrthopaedicsUniversity of Miami 1611 NW 12th Ave. Suite 303. Miami, FL 33136.
| | - Hari K Parvataneni
- Department of Orthopaedics and RehabilitationUniversity of Florida 3450 Hull Road, Gainesville, FL 32607. USA.
| |
Collapse
|
6
|
Carvajal Alba JA, Elpers ME, Rosenberg AE, Robinson RP. Suboptimal Component Position Leading to Severe Wear of an Alumina-Alumina Total Hip Coupling: Biomechanical Analysis and Documentation of Limited Tissue Response. HSS J 2015; 11:166-71. [PMID: 26140037 PMCID: PMC4481258 DOI: 10.1007/s11420-015-9443-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Jaime A. Carvajal Alba
- />Department of Orthopaedic Surgery, University of Miami, 1611 N.W. 12th Ave, Suite 303, Miami, FL 33136 USA
| | - Marcella E. Elpers
- />Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | | | - Raymond P. Robinson
- />Department of Orthopaedic Surgery, University of Miami, 1611 N.W. 12th Ave, Suite 303, Miami, FL 33136 USA
| |
Collapse
|
7
|
Jose J, Buller LT, Rivera S, Carvajal Alba JA, Baraga M. Wrisberg-variant discoid lateral meniscus: current concepts, treatment options, and imaging features with emphasis on dynamic ultrasonography. Am J Orthop (Belle Mead NJ) 2015; 44:135-139. [PMID: 25750948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Discoid lateral menisci represent a range of morphologic abnormalities of the lateral meniscus. The Wrisberg-variant discoid lateral meniscus is an unstable type that lacks posterior ligament attachments, resulting in "snapping knee syndrome." Abnormally mobile discoid lateral menisci are difficult to diagnose both clinically and with traditional static imaging, such as magnetic resonance imaging. In this article, we discuss the pathophysiology, clinical features, imaging findings, and treatment options for Wrisberg-variant discoid lateral menisci. We focus on the role of dynamic ultrasonography in revealing lateral meniscal subluxation during provocative maneuvers.
Collapse
Affiliation(s)
| | - Leonard T Buller
- Department of Orthopaedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL.
| | | | | | | |
Collapse
|
8
|
Carvajal Alba JA, Jose J, Clifford PD. Hemophilic arthropathy. Am J Orthop (Belle Mead NJ) 2010; 39:548-550. [PMID: 21623422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Jaime A Carvajal Alba
- Department of Orthopaedics, Miller School of Medicine, University of Miami, Florida, USA
| | | | | |
Collapse
|
9
|
Abstract
Metal-backed modular ceramic bearing systems using a recessed alumina liner in a titanium sleeve were developed to decrease ceramic chipping or fracture due to femoral neck impingement after total hip arthroplasty (THA). However, malseating of the metal-backed ceramic liner has recently been described. The goal of this study was to assess the prevalence, etiology, and clinical relevance of this event. Between 2005 and 2008, 51 consecutive patients (61 hips) underwent THA with a metal-backed alumina liner housed in a titanium shell. The metal-backed ceramic liner was aligned, seated, and impacted into the shell, and satisfaction in terms of liner stability and seating was confirmed intraoperatively. Postoperative assessment of seating was assessed with standard radiographs. Liner seating was classified as well seated, suspicious, or malseated. Seven liners (11.5%) were found to be malseated and 4 (6.5%) were considered suspicious. Radiographically, there was a gap between the liner and the shell located inferomedially in 4 patients and superolaterally in 3 patients. Two liners subsequently seated at 1 and 3 months postoperatively, respectively. No dislodgement, failures, or adverse events were identified. There were no revision surgeries. The significant percentage of malseated liners were potentially attributed to poor exposure, bony/soft tissue interposition, and surgeon learning curve.
Collapse
Affiliation(s)
- Jaime A Carvajal Alba
- Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Florida, USA.
| | | | | | | |
Collapse
|