Robotic Assisted Unicopartimental Knee Arthroplasty: Can We Improve Accuracy?

Transcription

1 Robotic Assisted Unicopartimental Knee Arthroplasty: Can We Improve Accuracy? Magaly Iñiguez C, Roberto Negrín V, Jaime Duboy U, Mauricio Wainer E, Nicolas Reyes L, Carlos Infante, G Ferrer, Julio Soto, Rodrigo Diaz P. Department of Traumatology and Orthopaedics Clínica Las Condes, Santiago, Chile

2 Disclosures M. Iñiguez: Nothing to disclose R. Negrin: Academic consultant Smith & Nephew and Zimmer Biomet J. Duboy: Academic consultant Smith & Nephew M. Wainer: Nothing to disclose N.Reyes: Nothing to disclose C. Infante: Nothing to disclose J. Soto: Nothing to disclose R. Diaz: Nothing to disclose

3 Unicompartmental Knee Arthroplasty 10% of all knee Replacements. Advantages ofer TKA: Better functional results, faster recovery, less blood loss But: Higher Revision Rates! poor alignment of the post-operatory extremity implant malpositioning. Improving precision Better clinical results Higher survival rates. Robotic assisted surgery Role

4 Robotic assisted Surgery in Knee Arthroplasty Most studies conducted with other robots Escasa Literatura con Navio Main Advantages: Imageless system, Open

5 Objetive To evaluate the precision of the Navio robotics assisted system in the positioning of unicompartmental knee implants compared with the conventional technique by means of radiological surgery planning in cadaveric models.

6 Materials and Methods Experimental cadaveric pilot study 26 fresh-frozen cadaveric models (hemipelvis-knee-foot) Randomized in 2 groups Navio Robotic System (Blue Belt Technologies, Plymouth, Minnesota, USA) Medial unicompartmental knee implant Journey UNI (Smith & Nephew Inc, Cordova, TN, USA) 26 cadaveric models Pre-op X-Rays 13 Robotic assisted UKA 13 Conventional UKA Post-op X-Rays

7 X-Rays

8 Results Medial Distal Femoral Angle Greater dispersion in conventional surgery V/s robótica Welch F=5,787 p=0,0057 SIGNIFICANT Non parametric U-Mann-Whitney p=0,5114 Medial Proximal Tibial Angle Greater dispersion in conventional surgery Welch F=5,797 p=0,0057 SIGNIFICANT Non parametric U-Mann-Whitney p=0,2840

9 Results Tibio-femoral Angle NO DIFFERENCES Welch F=2,634 p=0,1152 Non parametric U-Mann-Whitney p=0,5441 Sagital Femoral Angle NO DIFFERENCES Welch F=2,041 p=0,2417 Non parametric U-Mann-Whitney p=0,2508

10 Results Tibial Slope Greater variance in conventional group. Welch F=3,944 p=0,0279 SIGNIFICANT Non parametric U-Mann-Whitney p=0,3632 Femoral and Tibial Component Size Femoral Fisher s exact test p=0,00188 SIGNIFICANT Tibial size with no significance

11 Results MDFA MTPA Tibial Slope Tibio-femoral angle Sagital femoral Angle Femoral component size F de Welch VARIANCES F=5,787 p=0,0057 F=5,797 p=0,0057 F=3,944 p=0,0279 F=2,634 p=0,1152 F=2,041 p=0,2417 Fisher Extact Test Fisher p=0,0188 Significance Non parametric (U-Mann-Whitney) YES p=0,5514 NO YES p=0,2840 NO YES p=0,3632 NO NO p=0,5441 NO NO p=0,2508 NO Significance YES Significance

12 Conclusion There are differences in the variances of medial distal femoral angles, medial proximal tibial angle and tibial slope Less Dispersion and "outliers" in robotic surgery Use of Robotic assisted surgery results in greater precision than coventional surgery Robotic and conventional surgery do not show differences in angular accuracy of component placement Robotic assisted surgery allows to better predict the size of the femoral component, compared with conventional surgery

13 Gracias 1. Hernandez D, Garimella R, Eltorai AEM, Daniels AH. Computer-assisted Orthopaedic Surgery. Orthop Surg May;9(2): Zheng G, Nolte LP. Computer-Assisted Orthopedic Surgery: Current State and Future Perspective. Front Surg Dec 23;2: Pearle AD, Kendoff D, Musahl V. Perspectives on computer-assisted orthopaedic surgery: movement toward quantitative orthopaedic surgery. J Bone Joint Surg Am Feb;91 Suppl 1: Jacofsky DJ, Allen M. Robotics in Arthroplasty: A Comprehensive Review. J Arthroplasty Oct;31(10): van der List JP, Chawla H, Pearle AD. Robotic-Assisted Knee Arthroplasty: An Overview. Am J Orthop (Belle Mead NJ) May-Jun; 45(4): Bell S. 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: 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 Feb;88 (2): Collier MB, Eickmann TH, Sukezaki F, McAuley JP, Engh GA. Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty. J Arthroplasty Sep;21(6)(Suppl 2): Rosenberger RE, Fink C, Quirbach S, Attal R, Tecklenburg K, Hoser C.The immediate effect of navigation on implant accuracy in primary mini-invasive unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc Dec;16(12): D Wallace et al. The Learning Curve of a Novel Handheld Robotic System for Unicondylar Knee Arthroplasty. International Society of Computer Assisted Orthopaedic Surgery (2014) 11. Weber P, Crispin A, Schmidutz F, Utzschneider S, Pietschmann MF, Jansson V, Müller PE. Improved accuracy in computer-assisted unicondylar knee arthroplasty: a meta-analysis Knee Surg Sports Traumatol Arthrosc Nov;21(11): Lombardi AV, Berend KR, Walter CA, Aziz-Jacobo J, Cheney NA. Is recovery faster for mobile bearing unicompartmental than total knee arthroplasty? Clin Orthop Relat Res. 2009;467: Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc Jul 31. doi: /s [Epub ahead of print] 14. Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten year follow-up study. J Bone Joint Surg Am. 2002;84: Berger RA, Meneghine RM, Jacobs JJ, Sheinkop MB, Della Valle CJ, Rosenberg AG, Galante JO. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg Am. 2005;87: Cartier P, Sanouiller JL, Grelsamer RP. Unicompartmental knee arthroplasty surgery: 10-year minimum follow-up period. J Arthroplasty. 1996;11: Australian Orthopaedic Association National Joint Replacement Registry. Available at: Accessed September 13, National Joint Registry. Available at: njrcentre/portals/0/documents/england/reports/10th_annual_ report/ NJR%2010th%20Annual%20Report%202013%20B.pdf. Accessed April 24, New Zealand Joint Registry. Available at: news/new-zealand-joint-registry-thirteen-year-report. Accessed September 13, Norwegian Arthroplasty Register. Available at: ihelse.net/eng/report_2010.pdf. Accessed September 13, 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 Jan;473(1):