An Experienced Surgeon Can Meet or Exceed Robotic Accuracy in Manual Unicompartmental Knee Arthroplasty

Ashleigh N. Bush, Mary Ziemba-Davis, Evan R. Deckard, R. Meneghini

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Reports in the literature indicate that implant placement is more accurate with robotic-assisted unicompartmental knee arthroplasty (UKA); however, these studies have not always accounted for surgeon experience. The purpose of the present study was to compare the accuracy of tibial component alignment in UKA between an experienced high-volume surgeon and the published data on robotic-assisted surgery. METHODS: The radiographs made before and after 128 consecutive medial UKAs performed manually by a single surgeon using a cemented fixed-bearing implant were reviewed. Native tibial and tibial implant slope and varus alignment of the tibial implant were measured on preoperative and postoperative lateral and anteroposterior radiographs, respectively. The percentages of knees in which the postoperative measurements were within preoperative targets and the root mean square (RMS) error rates between the planned and achieved targets were compared with published robotic-assisted-UKA data. RESULTS: In the present study, the proportion of manual UKAs in which the tibial component alignment was within the preoperative target was 66% (85 of 128), which exceeded published values in a study comparing robotic (58%) with manual (41%) UKA. The RMS error for tibial component alignment in the present study (1.48°) was less than published RMS error rates for robotic UKAs (range, 1.8° to 5°). Fifty-eight percent (74) of the 128 study UKAs were within the surgeon's preoperative goal for tibial slope, which was closer to the published value of 80% for robotic UKAs than is the published rate of 22% for manual UKAs. The RMS error for tibial slope in the study UKAs (1.50°) was smaller than the published RMS error rates for tibial slope in robotic UKAs (range, 1.6° to 1.9°). CONCLUSIONS: Accurate implant alignment is important in UKA. In this study, an experienced surgeon achieved or exceeded robotic accuracy of tibial implant alignment in UKA. However, the relationship between implant position and patient outcomes is unknown, and a consensus on ideal surgical targets for optimal implant survivorship has yet to be established. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1479-1484
Number of pages6
JournalThe Journal of bone and joint surgery. American volume
Volume101
Issue number16
DOIs
StatePublished - Aug 21 2019

Fingerprint

Knee Replacement Arthroplasties
Robotics
Surgeons
Knee
Survival Rate

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

An Experienced Surgeon Can Meet or Exceed Robotic Accuracy in Manual Unicompartmental Knee Arthroplasty. / Bush, Ashleigh N.; Ziemba-Davis, Mary; Deckard, Evan R.; Meneghini, R.

In: The Journal of bone and joint surgery. American volume, Vol. 101, No. 16, 21.08.2019, p. 1479-1484.

Research output: Contribution to journalArticle

@article{fca09bcb3b9643478159dab523f19c47,
title = "An Experienced Surgeon Can Meet or Exceed Robotic Accuracy in Manual Unicompartmental Knee Arthroplasty",
abstract = "BACKGROUND: Reports in the literature indicate that implant placement is more accurate with robotic-assisted unicompartmental knee arthroplasty (UKA); however, these studies have not always accounted for surgeon experience. The purpose of the present study was to compare the accuracy of tibial component alignment in UKA between an experienced high-volume surgeon and the published data on robotic-assisted surgery. METHODS: The radiographs made before and after 128 consecutive medial UKAs performed manually by a single surgeon using a cemented fixed-bearing implant were reviewed. Native tibial and tibial implant slope and varus alignment of the tibial implant were measured on preoperative and postoperative lateral and anteroposterior radiographs, respectively. The percentages of knees in which the postoperative measurements were within preoperative targets and the root mean square (RMS) error rates between the planned and achieved targets were compared with published robotic-assisted-UKA data. RESULTS: In the present study, the proportion of manual UKAs in which the tibial component alignment was within the preoperative target was 66{\%} (85 of 128), which exceeded published values in a study comparing robotic (58{\%}) with manual (41{\%}) UKA. The RMS error for tibial component alignment in the present study (1.48°) was less than published RMS error rates for robotic UKAs (range, 1.8° to 5°). Fifty-eight percent (74) of the 128 study UKAs were within the surgeon's preoperative goal for tibial slope, which was closer to the published value of 80{\%} for robotic UKAs than is the published rate of 22{\%} for manual UKAs. The RMS error for tibial slope in the study UKAs (1.50°) was smaller than the published RMS error rates for tibial slope in robotic UKAs (range, 1.6° to 1.9°). CONCLUSIONS: Accurate implant alignment is important in UKA. In this study, an experienced surgeon achieved or exceeded robotic accuracy of tibial implant alignment in UKA. However, the relationship between implant position and patient outcomes is unknown, and a consensus on ideal surgical targets for optimal implant survivorship has yet to be established. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.",
author = "Bush, {Ashleigh N.} and Mary Ziemba-Davis and Deckard, {Evan R.} and R. Meneghini",
year = "2019",
month = "8",
day = "21",
doi = "10.2106/JBJS.18.00906",
language = "English (US)",
volume = "101",
pages = "1479--1484",
journal = "Journal of Bone and Joint Surgery - Series A",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "16",

}

TY - JOUR

T1 - An Experienced Surgeon Can Meet or Exceed Robotic Accuracy in Manual Unicompartmental Knee Arthroplasty

AU - Bush, Ashleigh N.

AU - Ziemba-Davis, Mary

AU - Deckard, Evan R.

AU - Meneghini, R.

PY - 2019/8/21

Y1 - 2019/8/21

N2 - BACKGROUND: Reports in the literature indicate that implant placement is more accurate with robotic-assisted unicompartmental knee arthroplasty (UKA); however, these studies have not always accounted for surgeon experience. The purpose of the present study was to compare the accuracy of tibial component alignment in UKA between an experienced high-volume surgeon and the published data on robotic-assisted surgery. METHODS: The radiographs made before and after 128 consecutive medial UKAs performed manually by a single surgeon using a cemented fixed-bearing implant were reviewed. Native tibial and tibial implant slope and varus alignment of the tibial implant were measured on preoperative and postoperative lateral and anteroposterior radiographs, respectively. The percentages of knees in which the postoperative measurements were within preoperative targets and the root mean square (RMS) error rates between the planned and achieved targets were compared with published robotic-assisted-UKA data. RESULTS: In the present study, the proportion of manual UKAs in which the tibial component alignment was within the preoperative target was 66% (85 of 128), which exceeded published values in a study comparing robotic (58%) with manual (41%) UKA. The RMS error for tibial component alignment in the present study (1.48°) was less than published RMS error rates for robotic UKAs (range, 1.8° to 5°). Fifty-eight percent (74) of the 128 study UKAs were within the surgeon's preoperative goal for tibial slope, which was closer to the published value of 80% for robotic UKAs than is the published rate of 22% for manual UKAs. The RMS error for tibial slope in the study UKAs (1.50°) was smaller than the published RMS error rates for tibial slope in robotic UKAs (range, 1.6° to 1.9°). CONCLUSIONS: Accurate implant alignment is important in UKA. In this study, an experienced surgeon achieved or exceeded robotic accuracy of tibial implant alignment in UKA. However, the relationship between implant position and patient outcomes is unknown, and a consensus on ideal surgical targets for optimal implant survivorship has yet to be established. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - BACKGROUND: Reports in the literature indicate that implant placement is more accurate with robotic-assisted unicompartmental knee arthroplasty (UKA); however, these studies have not always accounted for surgeon experience. The purpose of the present study was to compare the accuracy of tibial component alignment in UKA between an experienced high-volume surgeon and the published data on robotic-assisted surgery. METHODS: The radiographs made before and after 128 consecutive medial UKAs performed manually by a single surgeon using a cemented fixed-bearing implant were reviewed. Native tibial and tibial implant slope and varus alignment of the tibial implant were measured on preoperative and postoperative lateral and anteroposterior radiographs, respectively. The percentages of knees in which the postoperative measurements were within preoperative targets and the root mean square (RMS) error rates between the planned and achieved targets were compared with published robotic-assisted-UKA data. RESULTS: In the present study, the proportion of manual UKAs in which the tibial component alignment was within the preoperative target was 66% (85 of 128), which exceeded published values in a study comparing robotic (58%) with manual (41%) UKA. The RMS error for tibial component alignment in the present study (1.48°) was less than published RMS error rates for robotic UKAs (range, 1.8° to 5°). Fifty-eight percent (74) of the 128 study UKAs were within the surgeon's preoperative goal for tibial slope, which was closer to the published value of 80% for robotic UKAs than is the published rate of 22% for manual UKAs. The RMS error for tibial slope in the study UKAs (1.50°) was smaller than the published RMS error rates for tibial slope in robotic UKAs (range, 1.6° to 1.9°). CONCLUSIONS: Accurate implant alignment is important in UKA. In this study, an experienced surgeon achieved or exceeded robotic accuracy of tibial implant alignment in UKA. However, the relationship between implant position and patient outcomes is unknown, and a consensus on ideal surgical targets for optimal implant survivorship has yet to be established. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=85071550986&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071550986&partnerID=8YFLogxK

U2 - 10.2106/JBJS.18.00906

DO - 10.2106/JBJS.18.00906

M3 - Article

C2 - 31436656

AN - SCOPUS:85071550986

VL - 101

SP - 1479

EP - 1484

JO - Journal of Bone and Joint Surgery - Series A

JF - Journal of Bone and Joint Surgery - Series A

SN - 0021-9355

IS - 16

ER -