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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2023

09-08-2023 | Periprosthetic Fracture | KNEE

NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study

Authors: Jim Vandenberk, Jan Mievis, Jorien Deferm, Daniël Janssen, Peter Bollars, Hilde Vandenneucker

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2023

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Abstract

Purpose

Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA.

Methods

This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann–Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test.

Results

There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p = .144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p = .044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p = .038 and 0.6% vs 4.3%, p = .001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend.

Conclusions

This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA.

Level of evidence

Level III (therapeutic retrospective cohort study).
Literature
1.
Aglietti P, Baldini A, Vena LM, Abbate R, Fedi S, Falciani M (2000) Effect of tourniquet use on activation of coagulation in total knee replacement. Clin Orthop 371:169–177CrossRef
2.
Ayers DC, Yousef M, Zheng H, Yang W, Franklin PD (2022) The Prevalence and predictors of patient dissatisfaction 5-years following primary total knee arthroplasty. J Arthroplasty 37(6):S121–S128CrossRefPubMed
3.
Bell C, Grau L, Orozco F, Ponzio D, Post Z, Czymek M, Ong A (2022) The successful implementation of the Navio robotic technology required 29 cases. J Robot Surg 16(3):495–499CrossRefPubMed
4.
Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, Della Valle CJ (2018) Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty 33(7):2256-2262.e4CrossRefPubMed
5.
Bollars P, Boeckxstaens A, Mievis J, Kalaai S, Schotanus MGM, Janssen D (2020) Preliminary experience with an image-free handheld robot for total knee arthroplasty: 77 cases compared with a matched control group. Eur J Orthop Surg Traumatol 30(4):723–729CrossRefPubMed
6.
Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KDJ (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop 468(1):57–63CrossRefPubMed
7.
Cho MR, Jun CM, Song SK, Choi WK (2021) Natural course of hemoglobin level after total knee arthroplasty and the benefit of tranexamic acid injection in the joint. Medicine (Baltimore) 100(35):e27097CrossRefPubMed
8.
Elliott J, Shatrov J, Fritsch B, Parker D (2021) Robotic-assisted knee arthroplasty: an evolution in progress. A concise review of the available systems and the data supporting them. Arch Orthop Trauma Surg 141(12):2099–2117CrossRefPubMed
9.
Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32(12):3854–3860CrossRefPubMed
10.
Held MB, Gazgalis A, Neuwirth AL, Shah RP, Cooper HJ, Geller JA (2022) Imageless robotic-assisted total knee arthroplasty leads to similar 24-month WOMAC scores as compared to conventional total knee arthroplasty: a retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 30(8):2631–2638CrossRefPubMed
11.
Held MB, Grosso MJ, Gazgalis A, Sarpong NO, Boddapati V, Neuwirth A, Geller JA (2021) Improved compartment balancing using robot-assisted total knee arthroplasty. Arthroplasty Today 7:130–134CrossRefPubMedPubMedCentral
12.
Ihekweazu UN, Sohn GH, Laughlin MS, Goytia RN, Mathews V, Stocks GW, Patel AR, Brinker MR (2018) Socio-demographic factors impact time to discharge following total knee arthroplasty. World J Orthop 9(12):285–291CrossRefPubMedPubMedCentral
13.
Inacio MCS, Graves SE, Pratt NL, Roughead EE, Nemes S (2017) Increase in total joint arthroplasty projected from 2014 to 2046 in Australia: a conservative local model with international implications. Clin Orthop 475(8):2130–2137CrossRefPubMedPubMedCentral
14.
Jämsen E, Huhtala H, Puolakka T, Moilanen T (2009) Risk Factors for infection after knee arthroplasty: a register-based analysis of 43,149 cases. J Bone Jt Surg-Am 91(1):38–47CrossRef
15.
Joo PY, Chen AF, Richards J, Law TY, Taylor K, Marchand K, Clark G, Collopy D, Marchand RC, Roche M, Mont MA, Malkani AL (2022) Clinical results and patient-reported outcomes following robotic-assisted primary total knee arthroplasty: a multicentre study. Bone Jt Open 3(7):589–595CrossRefPubMedPubMedCentral
16.
Khanasuk Y, Ngarmukos S, Tanavalee A (2022) Does the intramedullary femoral canal plug reduce blood loss during total knee arthroplasty? Knee Surg Relat Res 34(1):31CrossRefPubMedPubMedCentral
17.
Kort N, Stirling P, Pilot P, Müller JH (2022) Robot-assisted knee arthroplasty improves component positioning and alignment, but results are inconclusive on whether it improves clinical scores or reduces complications and revisions: a systematic overview of meta-analyses. Knee Surg Sports Traumatol Arthrosc 30(8):2639–2653CrossRefPubMed
18.
Laddha M, Gaurav S (2021) Assessment of limb alignment and component placement after all burr robotic-assisted TKA. Indian J Orthop 55(S1):69–75CrossRefPubMed
19.
Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA (2022) Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon. J Knee Surg 35(4):409–415CrossRefPubMed
20.
Mcconnell J, Dillon J, Kinninmonth A, Sarungi M, Picard F (2012) Blood loss following total knee replacement is reduced when using computer-assisted versus standard methods. J Knee Surg 78:5
21.
Mitchell J, Wang J, Bukowski B, Greiner J, Wolford B, Oyer M, Illgen RL (2021) Relative clinical outcomes comparing manual and robotic-assisted total knee arthroplasty at minimum 1-year follow-up. HSS J Musculoskelet J Hosp Spec Surg 17(3):267–273
22.
Morcos MW, Nowak L, Schemitsch E (2021) Prolonged surgical time increases the odds of complications following total knee arthroplasty. Can J Surg 64(3):E273–E279CrossRefPubMedPubMedCentral
23.
Nogalo C, Meena A, Abermann E, Fink C (2023) Complications and downsides of the robotic total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 31(3):736–750CrossRefPubMed
24.
Parvizi J, Ghanem E, Joshi A, Sharkey PF, Hozack WJ, Rothman RH (2007) Does “excessive” anticoagulation predispose to periprosthetic infection? J Arthroplasty 22(6):24–28CrossRefPubMed
25.
Patel VP, Walsh M, Sehgal B, Preston C, DeWal H (2007) Cesare PED factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Jointsurg 89:33–38CrossRef
26.
Peersman G, Laskin R, Davis J, Peterson MGE, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2(1):70–72CrossRefPubMedPubMedCentral
27.
Popat R, Albelooshi A, Mahapatra P, Bollars P, Ettinger M, Jennings S, Van den Berg J-L, Nathwani D (2022) Improved joint line and posterior offset restoration in primary total knee replacement using a robotic-assisted surgical technique: an international multi-centre retrospective analysis of matched cohorts. PLoS ONE 17(8):e0272722CrossRefPubMedPubMedCentral
28.
Prasad N, Padmanabhan V, Mullaji A (2007) Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop 31(1):39–44CrossRefPubMed
29.
Ravi B, Jenkinson R, O’Heireamhoin S, Austin PC, Aktar S, Leroux TS, Paterson M, Redelmeier DA (2019) Surgical duration is associated with an increased risk of periprosthetic infection following total knee arthroplasty: A population-based retrospective cohort study. EClinicalMedicine 16:74–80CrossRefPubMedPubMedCentral
30.
31.
Savov P, Tuecking L-R, Windhagen H, Ehmig J, Ettinger M (2021) Imageless robotic handpiece-assisted total knee arthroplasty: a learning curve analysis of surgical time and alignment accuracy. Arch Orthop Trauma Surg 141(12):2119–2128CrossRefPubMedPubMedCentral
32.
Schairer WW, Vail TP, Bozic KJ (2014) What are the rates and causes of hospital readmission after total knee arthroplasty? Clin Orthop 472(1):181–187CrossRefPubMed
33.
Schopper C, Proier P, Luger M, Gotterbarm T, Klasan A (2023) The learning curve in robotic assisted knee arthroplasty is flattened by the presence of a surgeon experienced with robotic assisted surgery. Knee Surg Sports Traumatol Arthrosc 31(3):760–767CrossRefPubMed
34.
Sicat CS, Chow JC, Kaper B, Mitra R, Xie J, Schwarzkopf R (2021) Component placement accuracy in two generations of handheld robotics-assisted knee arthroplasty. Arch Orthop Trauma Surg 141(12):2059–2067CrossRefPubMed
35.
Siddiqi A, Horan T, Molloy RM, Bloomfield MR, Patel PD, Piuzzi NS (2021) A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design. EFORT Open Rev 6(4):252–269CrossRefPubMedPubMedCentral
36.
Sloan M, Premkumar A, Sheth NP (2018) Projected Volume of Primary Total Joint Arthroplasty in the US, 2014 to 2030. J Bone Jt Surg 100(17):1455–1460CrossRef
37.
Smith TJ, Siddiqi A, Forte SA, Judice A, Sculco PK, Vigdorchik JM, Schwarzkopf R, Springer BD (2021) Periprosthetic fractures through tracking pin sites following computer navigated and robotic total and unicompartmental knee arthroplasty: a systematic review. JBJS Rev 9(1):e20CrossRef
38.
39.
Vaidya N, Jaysingani TN, Panjwani T, Patil R, Deshpande A, Kesarkar A (2022) Assessment of accuracy of an imageless hand-held robotic-assisted system in component positioning in total knee replacement: a prospective study. J Robot Surg 16(2):361–367CrossRefPubMed
40.
Vaidya NV, Deshpande AN, Panjwani T, Patil R, Jaysingani T, Patil P (2022) Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 30(2):621–626CrossRefPubMed
41.
42.
Zhang J, Ndou WS, Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND (2022) Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30(8):2677–2695CrossRefPubMed
Metadata
Title
NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study
Authors
Jim Vandenberk
Jan Mievis
Jorien Deferm
Daniël Janssen
Peter Bollars
Hilde Vandenneucker
Publication date
09-08-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07524-7

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