Abstract
AimsThe objective of this study was to compare early postoperative functional outcomes and time to hospital discharge between conventional jig-based total knee arthroplasty (TKA) and robotic-arm assisted TKA.Patients and MethodsThis prospective cohort study included 40 consecutive patients undergoing conventional jig-based TKA followed by 40 consecutive patients receiving robotic-arm assisted TKA. All surgical procedures were performed by a single surgeon using the medial parapatellar approach with identical implant designs and standardized postoperative inpatient rehabilitation. Inpatient functional outcomes and time to hospital discharge were collected in all study patients.ResultsThere were no systematic differences in baseline characteristics between the conventional jig-based TKA and robotic-arm assisted TKA treatment groups with respect to age (p = 0.32), gender (p = 0.50), body mass index (p = 0.17), American Society of Anesthesiologists score (p = 0.88), and preoperative haemoglobin level (p = 0.82). Robotic-arm assisted TKA was associated with reduced postoperative pain (p < 0.001), decreased analgesia requirements (p < 0.001), decreased reduction in postoperative haemoglobin levels (p < 0.001), shorter time to straight leg raise (p < 0.001), decreased number of physiotherapy sessions (p < 0.001) and improved maximum knee flexion at discharge (p < 0.001) compared with conventional jig-based TKA. Median time to hospital discharge in robotic-arm assisted TKA was 77 hours (interquartile range (IQR) 74 to 81) compared with 105 hours (IQR 98 to 126) in conventional jig-based TKA (p < 0.001).ConclusionRobotic-arm assisted TKA was associated with decreased pain, improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based TKA.Cite this article: Bone Joint J 2018;100-B:930–7.
Highlights
Robotic-arm assisted total knee arthroplasty (TKA) was associated with decreased pain, improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based TKA
Developments in minimally invasive surgery, pain management, anaesthesia, deep vein thrombosis prophylaxis, antibiotic prophylaxis, implant design and manufacturing and enhanced rehabilitation techniques, have all focussed on optimizing postoperative recovery and duration of inpatient stay following TKA.[2,3]
Robotic-arm assisted TKA was associated with reduced postoperative pain, decreased analgesia requirements, smaller drop in haemoglobin concentration, shorter time to be able to perform a straight leg raise, improved maximum knee flexion at discharge and decreased length of stay compared with conventional jig-based TKA
Summary
This prospective cohort study included 40 consecutive patients undergoing conventional jig-based TKA followed by 40 consecutive patients receiving robotic-arm assisted TKA. This study included 80 patients with symptomatic knee osteoarthritis undergoing primary TKA at the same treatment centre between January 2016 and September 2017 This included 40 consecutive robotic-arm assisted TKAs and the preceding 40 consecutive conventional jig-based TKAs. All operative procedures were performed by the senior author (FSH) who was experienced in performing conventional jigbased and computer-navigated TKA, and had undergone cadaveric training on robotic-arm assisted TKA. Inclusion criteria for this study included the following: patients with knee osteoarthritis undergoing primary TKA; patient between 18 and 80 years of age; surgery using the conventional jig-based or robotic-arm assisted technique; surgery performed by the senior author (FSH). The objective was to achieve neutral mechanical alignment
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