Advertisement

Robotic-Assisted Unicompartmental Knee Arthroplasty

  • Andrew Battenberg
  • Sébastien Parratte
  • Jess Lonner
Chapter

Abstract

Unicompartmental arthroplasty (UKA) is a highly effective treatment for isolated compartmental arthritis in the knee, especially among high volume surgeons. Implant loosening and technical problems related to bone resection and implant positioning may lead to higher rates of failure compared to total knee arthroplasty (TKA), particularly for low volume and novice surgeons. Robotic-assisted UKA was developed in an effort to improve implant positioning and kinematics, reduce technical error, and ultimately improve patient outcomes. Two semiautonomous robotic systems have demonstrated high levels of accuracy and precision compared to conventional techniques, quantify soft tissue balance, and preserve the bone by optimizing bony resections. Short-term clinical data is encouraging, but mid- and long-term data is needed to confirm that clinical benefits arise from the enhanced precision of robotic assistance. Cost-effectiveness and surgical efficiency continue to serve as barriers to more widespread adoption of robotic technology. Future study of mid- and long-term outcomes, as well as patient functional outcomes, will provide important insight into the cost-benefit analysis.

Keywords

Robotics Unicompartmental knee arthroplasty Cost-effectiveness Surgical efficiency 

References

  1. 1.
    Lum ZC, Lombardi AV, Hurst JM, Morris MJ, Adams JB, Berend KR. Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty. Bone Joint J. 2016;98-b:28–33.CrossRefGoogle Scholar
  2. 2.
    van der List JP, McDonald LS, Pearle AD. Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty. Knee. 2015;22(6):454–60.CrossRefGoogle Scholar
  3. 3.
  4. 4.
    Epinette JA, Brunschweiler B, Mertl P, Mole D, Cazenave A. Unicompartmental knee arthroplasty modes of failure: wear is not the main reason for failure: a multicenter study of 418 failed knees. Orthop Traumatol Surg Res. 2012;98:S124–30.CrossRefGoogle Scholar
  5. 5.
    Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplast. 2006;21(6 Suppl 2):108–15.CrossRefGoogle Scholar
  6. 6.
    Fisher DA, Watts M, Davis KE. Implant position in knee surgery: a comparison of minimally invasive, open unicompartmental, and total knee arthroplasty. J Arthroplast. 2003;18(7 Suppl 1):2–8.CrossRefGoogle Scholar
  7. 7.
    Hamilton WG, Collier MB, Tarabee E, McAuley JP, Engh CA Jr, Engh GA. Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty. J Arthroplast. 2006;21(6 Suppl 2):98–107.CrossRefGoogle Scholar
  8. 8.
    Keene G, Simpson D, Kalairajah Y. Limb alignment in computer-assisted minimally-invasive unicompartmental knee replacement. J Bone Joint Surg Br. 2006;88:44–8.CrossRefGoogle Scholar
  9. 9.
    Cobb J, Henckel J, Gomes P, et al. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br. 2006;88:188–97.CrossRefGoogle Scholar
  10. 10.
    Romanowski MR, Repicci JA. Minimally invasive unicondylar arthroplasty: eight-year follow-up. J Knee Surg. 2002;15:17–22.PubMedGoogle Scholar
  11. 11.
    Hernigou P, Deschamps G. Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res. 2004;423:161–5.CrossRefGoogle Scholar
  12. 12.
    Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J Bone Joint Surg Am. 2004;86-A(3):506–11.CrossRefGoogle Scholar
  13. 13.
    Lonner JH. Robotically assisted unicompartmental knee arthroplasty with a handheld image-free sculpting tool. Orthop Clin North Am. 2016;47:29–40.CrossRefGoogle Scholar
  14. 14.
    Orthopedic Network News. Hip and knee implant review. 2013. Available at: www.OrthopedicNetworkNews.com. 24 July 2013.
  15. 15.
    Medical Device and Diagnostic Industry. March 5, 2015. http://www.mddionline.com.
  16. 16.
    Dalton DM, Burke TP, Kelly EG, Curtin PD. Quantitative analysis of technological innovation in knee arthroplasty: using patent and publication metrics to identify developments and trends. J Arthroplast. 2016;31:1366–72.CrossRefGoogle Scholar
  17. 17.
    Bargar WL. Robots in orthopaedic surgery: past, present, and future. Clin Orthop Relat Res. 2007;463:31–6.PubMedGoogle Scholar
  18. 18.
    Lonner JH, Moretti VM. The evolution of image-free robotic assistance in unicompartmental knee arthroplasty. Am J Orthop. 2016;45(5):249–54.PubMedGoogle Scholar
  19. 19.
    van der List JP, Chawla H, Pearle AD. Robotic-assisted knee arthroplasty: an overview. Am J Orthop. 2016;45(4):202–11.PubMedGoogle Scholar
  20. 20.
    Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplast. 2016;31:2353–63.CrossRefGoogle Scholar
  21. 21.
    Bell SW, Anthony I, Jones B, MacLean A, Rowe P, Blyth M. Improved accuracy of component positioning with robotic-assisted unicompartmental knee arthroplasty: data from a prospective, randomized controlled study. J Bone Joint Surg Am. 2016;98:627–35.CrossRefGoogle Scholar
  22. 22.
    Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res. 2010;468:141–6.CrossRefGoogle Scholar
  23. 23.
    Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA. Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty. J Arthroplast. 2012;27(5):803–808.e1.CrossRefGoogle Scholar
  24. 24.
    Pearle AD, O’Loughlin PF, Kendoff DO. Robot-assisted unicompartmental knee arthroplasty. J Arthroplast. 2010;25(2):230–7.CrossRefGoogle Scholar
  25. 25.
    Citak M, Suero EM, Citak M, et al. Unicompartmental knee arthroplasty: is robotic technology more accurate than conventional technique? Knee. 2013;20:268–71.CrossRefGoogle Scholar
  26. 26.
    Plate JF, Mofidi A, Mannava S, et al. Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop. 2013;2013:837167.CrossRefGoogle Scholar
  27. 27.
    MacCallum KP, Danoff JR, Geller JA. Tibial baseplate positioning in robotic assisted and conventional unicompartmental knee arthroplasty. Eur J Orthop Surg Traumatol. 2016;26:93–8.CrossRefGoogle Scholar
  28. 28.
    Hansen DC, Kusuma SK, Palmer RM, Harris KB. Robotic guidance does not improve component position or short-term outcome in medial unicompartmental knee arthroplasty. J Arthroplast. 2014;29:1784–9.CrossRefGoogle Scholar
  29. 29.
    Smith JR, Picard F, Rowe PJ. The accuracy of a robotically-controlled freehand sculpting tool for unicondylar knee arthroplasty. J Bone Joint Surg Br. 2013;95(Suppl):68.Google Scholar
  30. 30.
    Smith JR, Riches PE, Rowe PJ. Accuracy of a freehand sculpting tool for unicondylar knee replacement. Int J Med Robot. 2014;10:162–9.CrossRefGoogle Scholar
  31. 31.
    Lonner JH, Smith JR, Picard F, et al. High degree of accuracy of a novel image-free handheld robot for unicondylar knee arthroplasty in a cadaveric study. Clin Orthop Relat Res. 2015;473:206–12.CrossRefGoogle Scholar
  32. 32.
    Picard F, Gregori A, Bellemans J, et al. Handheld robot-assisted unicondylar knee arthroplasty: a clinical review. 14th annual meeting of the International Society for Computer Assisted Orthopaedic Surgery. Milan, Italy, June 18–21, 2014.Google Scholar
  33. 33.
    Ponzio DY, Lonner JH. Robotic technology produces more conservative tibial resection than conventional techniques in UKA. Am J Orthop. 2016;45:e465–8.PubMedGoogle Scholar
  34. 34.
    Schwarzkopf R, Mikhael B, Li L. Effect of initial tibial resection thickness on outcomes of revision UKA. Orthopedics. 2013;36:e409–14.CrossRefGoogle Scholar
  35. 35.
    Blyth MJG, Anthony I, Rowe P, Banger MS, MacLean A, Jones B. Robotic arm-assisted versus conventional unicompartmental knee arthroplasty: exploratory secondary analysis of a randomised controlled trial. Bone Joint Res. 2017;6:631–9.CrossRefGoogle Scholar
  36. 36.
    Pearle AD, van der List JP, Lee L, Coon TM, Borus TA, Roche MW. Survivorship and patient satisfaction of robotic-assisted medial unicompartmental knee arthroplasty at a minimum two-year follow-up. Knee. 2017;24:419–28.CrossRefGoogle Scholar
  37. 37.
    Pandit H, Jenkins C, Gill HS, Barker K, Dodd CA, Murray DW. Minimally invasive Oxford phase 3 unicompartmental knee replacement: results of 1000 cases. J Bone Joint Surg Br. 2011;93(2):198–204.CrossRefGoogle Scholar
  38. 38.
    Yoshida K, Tada M, Yoshida H, Takei S, Fukuoka S, Nakamura H. Oxford phase 3 unicompartmental knee arthroplasty in Japan—clinical results in greater than one thousand cases over ten years. J Arthroplast. 2013;28(9 Suppl):168–71.CrossRefGoogle Scholar
  39. 39.
    Swank ML, Alkire M, Conditt M, Lonner JH. Technology and cost-effectiveness in knee arthroplasty: computer navigation and robotics. Am J Orthop. 2009;38(2 Suppl):32–6.PubMedGoogle Scholar
  40. 40.
    Moschetti WE, Konopka JF, Rubash HE, Genuario JW. Can robot-assisted unicompartmental knee arthroplasty be cost-effective? a markov decision analysis. J Arthroplast. 2016;31:759–65.CrossRefGoogle Scholar
  41. 41.
    Lonner JH. Robotically assisted unicompartmental knee arthroplasty with a handheld image-free sculpting tool. Oper Tech Orthop. 2015;25:104–13.CrossRefGoogle Scholar
  42. 42.
    Wallace D, Gregori A, Picard F, et al. The learning curve of a novel handheld robotic system for unicondylar knee arthroplasty. Paper presented at: 14th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery. Milan, Italy, June 18–21, 2014.Google Scholar
  43. 43.
    Jinnah R, Horowitz S, Lippincott C, et al. The learning curve of robotically assisted UKA. 22nd annual Congress of ISTA. Big Island, October 22–24, 2009.Google Scholar
  44. 44.
    Hamilton WG, Ammeen D, Engh CA Jr, et al. Learning curve with minimally invasive unicompartmental knee arthroplasty. J Arthroplast. 2010;25(5):735.CrossRefGoogle Scholar
  45. 45.
    Karia M, Masjedi M, Andrews B, Jaffry Z, Cobb J. Robotic assistance enables inexperienced surgeons to perform unicompartmental knee arthroplasties on dry bone models with accuracy superior to conventional methods. Adv Orthop. 2013;2013:481039.CrossRefGoogle Scholar
  46. 46.
    Coon TM. Integrating robotic technology into the operating room. Am J Orthop. 2009;38:7.PubMedGoogle Scholar
  47. 47.
    Ponzio DY, Lonner JH. Preoperative mapping in unicompartmental knee arthroplasty using computed tomography scans is associated with radiation exposure and carries high cost. J Arthroplast. 2015;30:964–7.CrossRefGoogle Scholar
  48. 48.
    Wysocki RW, Sheinkop MB, Virkus WW, et al. Femoral fracture through a previous pin site after computer-assisted total knee arthroplasty. J Arthroplast. 2008;23:462–5.CrossRefGoogle Scholar
  49. 49.
    Sinha RK. Outcomes of robotic arm-assisted unicompartmental knee arthroplasty. Am J Orthop. 2009;38(2 Suppl):20–2.PubMedGoogle Scholar
  50. 50.
    Chun YS, Kim KI, Cho YJ, Kim YH, Yoo MC, Rhyu KH. Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplast. 2011;26:621–5.CrossRefGoogle Scholar
  51. 51.
    Lonner JH, Kerr GJ. Low rate of iatrogenic complications during unicompartmental knee arthroplasty with two semi-autonomous robotic systems, Jess Lonner, MD unpublished data.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrew Battenberg
    • 1
  • Sébastien Parratte
    • 2
  • Jess Lonner
    • 1
  1. 1.Rothman Institute, Department of Orthopedic SurgeryThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Institute for Locomotion, Aix-Marseille University, Hospital Sainte MargueriteMarseilleFrance

Personalised recommendations