Robotic UKA

Chapter

Abstract

Unicompartmental knee arthroplasty (UKA) is a reliable, although technically challenging, treatment option for osteoarthritis. Successful clinical outcomes depend on accurate implant placement, lower limb alignment, and soft tissue balance intraoperatively. Robot-assisted systems aim to improve the surgical accuracy, precision, and reproducibility of clinical outcomes. Semi-active UKA systems with a minimally invasive approach have been developed and are becoming more interesting. These robotic systems can be either image-based or imageless. Recently, two robotic systems have been approved for UKA by the US Food and Drug Administration: the MAKO Robotic Arm, which is an image-based system, and the Navio Precision Free-Hand Sculptor (PFS), which is an image-free system. Several studies have shown that robotic UKA offers greater accuracy of the mechanical axis, implant positioning, and soft tissue balance than conventional UKA. They concluded that robot-assisted UKA achieved more reproducible, accurate, and precise bone cuts, suggesting that the system could improve surgical survivorship. Although robot-assisted UKA has a high capital cost, some studies have shown that it is cost-effective under the following conditions: (1) centers must perform at least 94 cases annually in (2) patients younger than age 67 years, and (3) the 2-year revision rate does not exceed 1.2%. Thus, these early results and cost-effectiveness analyses seem promising. The limitation of robotic surgery may be the longer learning curve regarding the operative time, although some studies reported that the robot-assisted UKA system significantly decreased the learning curve over that required for UKA with traditional instrumentation.

Keywords

Partial knee arthroplasty Robot Robotic UKA Unicompartmental knee arthroplasty 

References

  1. 1.
    Jamali AA, Scott RD, Rubash HE, Freiberg AA. Unicompartmental knee arthroplasty: past, present, and future. Am J Orthop (Belle Mead NJ). 2009;38(1):17–23.Google Scholar
  2. 2.
    Insall J, Aglietti P. A five to seven-year follow-up of unicondylar arthroplasty. J Bone Joint Surg Am. 1980;62(8):1329–37.CrossRefGoogle Scholar
  3. 3.
    Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. J Bone Joint Surg Br. 1998;80(5):862–5.CrossRefGoogle Scholar
  4. 4.
    Watanabe T, Abbasi AZ, Conditt MA, Cristopher J, Kreuzer S, Otto JK, Banks SA. In vivo kinematics of a robot-assisted uni-and multi-compartment knee arthroplasty. J Orthop Sci. 2014;19(4):552–7.CrossRefGoogle Scholar
  5. 5.
    Robertson O, Borgquist L, Knutson K, Lewold S, Lidgren L. Use of unicompartmental instead of tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand. 1999;70(2):170–5.CrossRefGoogle Scholar
  6. 6.
    Schwab P-E, Lavand’homme P, Yombi JC, Thienpont E. Lower blood loss after unicompartmental than total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3494–500.CrossRefGoogle Scholar
  7. 7.
    McAllister CM. The role of unicompartmental knee arthroplasty versus total knee arthroplasty in providing maximal performance and satisfaction. J Knee Surg. 2008;21(4):286–92.CrossRefGoogle Scholar
  8. 8.
    Borus T, Thornhill T. Unicompartmental knee arthroplasty. J Am Acad Orthop Surg. 2008;16(1):9–18.CrossRefGoogle Scholar
  9. 9.
    Badly M, Espehaug B, Indrekvam K, Havelin LI, Furnes O. Higher revision risk for unicompartmental knee arthroplasty in low-volume hospitals. Acta Orthop. 2014;85(4):342–7.CrossRefGoogle Scholar
  10. 10.
    Vass M, Del Regno C, D’Amelio A, Viaggiano D, Corona K, Schiavone Panni A. Minor varus alignment provides better results than neutral alignment in medial UKA. Knee. 2015;22(2):117–21.CrossRefGoogle Scholar
  11. 11.
    Plate JF, Mofidi A, Mannava S, Smith BP, Lang JE, Poehling GG, Conditt MA, Jinnah RH. Achieving accurate ligament balancing using robotic-assisted unicompartmental knee arthroplasty. Adv Orthop. 2013;2013:837167.CrossRefGoogle Scholar
  12. 12.
    Niinimaki TT, Murray DW, Partanen J, Pajala A, Leppilahti JI. Unicompartment knee arthroplasties implanted for osteoarthritis with partial loss of joint space have higher re-operation rates. Knee. 2011;18(6):432–5.CrossRefGoogle Scholar
  13. 13.
    Zuiderbaan HA, Khamaisy S, Thein R, Nawabi DH, Pearle AD. Congruence and joint space width alternations of medial compartment following lateral unicompartmental knee arthroplasty. Bone Joint J. 2015;97-B(1):50–55.31.CrossRefGoogle Scholar
  14. 14.
    Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CA, Gill HS, Murray DW. Tibial component overhang following unicompartmental knee replacement-does it matter? Knee. 2009;16(5):310–3.CrossRefGoogle Scholar
  15. 15.
    Kendrick BJ, Kaptein BL, Valstar ER, Gill HS, Jackson WF, Dodd CA, Price AJ, Murray DW. Cemented versus cementless Oxford unicompartmental knee arthroplasty using radiostereometric analysis: a randomised controlled trial. Bone Joint J. 2015;97-B(2):185–91.CrossRefGoogle Scholar
  16. 16.
    Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J Arthroplast. 2016;31(10):2353–63.CrossRefGoogle Scholar
  17. 17.
    Bargar WL. Robots in orthopaedic surgery: past, present, and future. Clin Orthop Relat Res. 2007;463:31–6.PubMedPubMedCentralGoogle Scholar
  18. 18.
    DiGioia AM III. What is computer assisted orthopaedic surgery? Clin Orthop Relat Res. 1998;(354):2–4.Google Scholar
  19. 19.
    Pearle AD, O’Loughlin PF, Kendoff DO. Robot-assisted unicompartment knee arthroplasty. J Arthroplast. 2010;25(2):230–7.CrossRefGoogle Scholar
  20. 20.
    Dunbar NJ, Roche MW, Park BH, Branch SH, Conditt MA, Banks SA. Accuracy of dynamic tactile-guided unicompartment knee arthroplasty. J Arthroplast. 2012;27(5):803–8.CrossRefGoogle Scholar
  21. 21.
    Jacofsky DJ, Allen M. Robotic in arthroplasty: a comprehensive review. J Arthroplast. 2016;31:2353–63.CrossRefGoogle Scholar
  22. 22.
    Picard F, Gregori A, Bellemans J, et al. Handheld robot-assisted unicondylar knee arthroplasty: a clinical review. Bone Joint J. 2014;96-B(Suppl 16):25.Google Scholar
  23. 23.
    Smith JR, Riches PE, Rowe PJ. Accuracy of a freehand sculpting tool for unicondylar knee replacement. Int J Med Robot. 2014;10(2):162–9.CrossRefGoogle Scholar
  24. 24.
    Lonner JH, Smith JR, Picard F, Hamlin B, Rowe PJ, Riches PE. 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(1):206–12.CrossRefGoogle Scholar
  25. 25.
    Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B. Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br. 2006;88(2):188–97.CrossRefGoogle Scholar
  26. 26.
    Lonner JH, John TK, Conditt MA. Robotic arm-assisted UKA improves tibial component alignment: a pilot study. Clin Orthop Relat Res. 2010;468(1):141–6.CrossRefGoogle Scholar
  27. 27.
    Coon T, Roche M, Pearle AD, Dounchis J, Borus T, Buechel F Jr. Two year survivorship of robotically guided unicompartmental knee arthroplasty. Paper presented at: International Society for technology in arthroplasty 26th Annual Congress 16–19, 2013. Palm Beach, FL.Google Scholar
  28. 28.
    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
  29. 29.
    MacCallum KP, Danoff JR, Geller JA. Tibial baseplate positioning in robotic-assisted and conventional unicompartmental knee arthroplasty. Eur J Orthop Surg Traumatol. 2016;26(1):93–8.CrossRefGoogle Scholar
  30. 30.
    Ponzio DY, Lonner JH. Robotic technology produces more conservative tibial resection than conventional techniques in UKA. Am J Orthop (Belle Mead NJ). 2016;45(7):E465–8.Google Scholar
  31. 31.
    Swank ML, Alkire M, Conditt M, Lonner JH. Technology and cost-effectiveness in knee arthroplasty: computer navigation and robotics. Am J Orthop (Belle Mead NJ). 2009;38(2 Suppl):32–6.Google Scholar
  32. 32.
    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(4):759–65.CrossRefGoogle Scholar
  33. 33.
    Hamilton WG, Ammeen D, Engh CA Jr, Engh GA. Learning curve with minimally invasive unicompartmental knee arthroplasty. J Arthroplast. 2010;25(5):735–40.CrossRefGoogle Scholar
  34. 34.
    Jinnah R, Horowitz S, Lippincott C, et al. The learning curve of robotically assisted UKA. 56th Annual Meeting of the Orthopaedic Research Society; p. 407.Google Scholar
  35. 35.
    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(2):188–97.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic, Bhumibol Adulyadej HospitalThe Royal Thai Air ForceBangkokThailand

Personalised recommendations