Adoption of Robotic-Arm-Assisted Total Knee Arthroplasty Is Associated with Decreased Use of Articular Constraint and Manipulation under Anesthesia Compared to a Manual Approach

Jenny Zhang; Chelsea N. Matzko; Andrew Sawires; Joseph O. Ehiorobo; Michael A. Mont; Matthew S. Hepinstall

doi:10.1055/s-0040-1721123

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2022; 35(08): 849-857
DOI: 10.1055/s-0040-1721123

Original Article

Adoption of Robotic-Arm-Assisted Total Knee Arthroplasty Is Associated with Decreased Use of Articular Constraint and Manipulation under Anesthesia Compared to a Manual Approach

Jenny Zhang

¹Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Hempstead, New York

,

Chelsea N. Matzko

²Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York

,

Andrew Sawires

²Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York

,

Joseph O. Ehiorobo

²Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York

,

Michael A. Mont

¹Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Hempstead, New York

²Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York

,

Matthew S. Hepinstall

¹Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Hempstead, New York

²Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York

³NYU Grossman School of Medicine, New York, New York

⁴Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York

› Author Affiliations

Abstract

Haptic robotic-arm-assisted total knee arthroplasty (RATKA) seeks to leverage three-dimensional planning, intraoperative assessment of ligament laxity, and guided bone preparation to establish and achieve patient-specific targets for implant position. We sought to compare (1) operative details, (2) knee alignment, (3) recovery of knee function, and (4) complications during adoption of this technique to our experience with manual TKA. We compared 120 RATKAs performed between December 2016 and July 2018 to 120 consecutive manual TKAs performed between May 2015 and January 2017. Operative details, lengths of stay (LOS), and discharge dispositions were collected. Tibiofemoral angles, Knee Society Scores (KSS), and ranges of motion were assessed until 3 months postoperatively. Manipulations under anesthesia, complications, and reoperations were tabulated. Mean operative times were 22 minutes longer in RATKA (p < 0.001) for this early cohort, but decreased by 27 minutes (p < 0.001) from the first 25 RATKA cases to the last 25 RATKA cases. Less articular constraint was used to achieve stability in RATKA (93 vs. 55% cruciate-retaining, p < 0.001; 3 vs. 35% posterior stabilized (PS), p < 0.001; and 4 vs. 10% varus-valgus constrained, p_ = _0.127). RATKA had lower LOS (2.7 vs. 3.4 days, p < 0.001). Discharge dispositions, tibiofemoral angles, KSS, and knee flexion angles did not differ, but manipulations were less common in RATKAs (4 vs. 17%, p = 0.013). We observed less use of constraint, shorter LOS, and fewer manipulations under anesthesia in RATKA, with no increase in complications. Operative times were longer, particularly early in the learning curve, but improved with experience. All measured patient-centered outcomes were equivalent or favored the newer technique, suggesting that RATKA with patient-specific alignment targets does not compromise initial quality. Observed differences may relate to improved ligament balance or diminished need for ligament release.

Keywords

total knee arthroplasty - robotic-arm-assisted total knee arthroplasty

Full Text

References

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