Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2017

01-09-2017 | Knee

Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial

Authors: Ming Han Lincoln Liow, Graham Seow-Hng Goh, Merng Koon Wong, Pak Lin Chin, Darren Keng-Jin Tay, Seng-Jin Yeo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2017

Login to get access

Abstract

Purpose

Despite reduction in radiological outliers in previous randomized trials comparing robotic-assisted versus conventional total knee arthroplasty (TKA), no differences in short-term functional outcomes were observed. The aim of this study was to determine whether there was improvement in functional outcomes and quality-of-life (QoL) measures between robotic-assisted and conventional TKA.

Methods

All 60 knees (31 robotic-assisted; 29 conventional) from a previous randomized trial were available for analysis. Differences in range of motion, Knee Society (KSS) knee and function scores, Oxford Knee scores (OKS), SF-36 subscale and summative (physical PCS/mental component scores MCS) were analysed. In addition, patient satisfaction, fulfilment of expectations and the proportion attaining a minimum clinically important difference (MCID) in KSS, OKS and SF-36 were studied.

Results

Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years. Despite having a higher rate of complications, the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures, with significant differences in SF-36 vitality (p = 0.03), role emotional (p = 0.02) and a larger proportion of patients achieving SF-36 vitality MCID (48.4 vs 13.8 %, p = 0.009). No significant differences in KSS, OKS or satisfaction/expectation rates were noted.

Conclusion

Subtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA. This finding suggests that QoL measures may be more sensitive and clinically important than surgeon-driven objective scores in detecting subtle functional improvements in robotic-assisted TKA patients.

Level of evidence

II.
Literature
1.
go back to reference Bach CM, Nogler M, Steingruber IE, Ogon M, Wimmer C, Gobel G, Krismer M (2002) Scoring systems in total knee arthroplasty. Clin Orthop Relat Res 399:184–196CrossRef Bach CM, Nogler M, Steingruber IE, Ogon M, Wimmer C, Gobel G, Krismer M (2002) Scoring systems in total knee arthroplasty. Clin Orthop Relat Res 399:184–196CrossRef
2.
go back to reference Bellemans J, Vandenneucker H, Vanlauwe J (2007) Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 464:111–116PubMed Bellemans J, Vandenneucker H, Vanlauwe J (2007) Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 464:111–116PubMed
3.
go back to reference Chun YS, Kim KI, Cho YJ, Kim YH, Yoo MC, Rhyu KH (2011) Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplasty 26(4):621–625CrossRefPubMed Chun YS, Kim KI, Cho YJ, Kim YH, Yoo MC, Rhyu KH (2011) Causes and patterns of aborting a robot-assisted arthroplasty. J Arthroplasty 26(4):621–625CrossRefPubMed
4.
go back to reference Clement ND, MacDonald D, Simpson AH (2014) The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(8):1933–1939CrossRefPubMed Clement ND, MacDonald D, Simpson AH (2014) The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(8):1933–1939CrossRefPubMed
5.
go back to reference Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B (2006) Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 88(2):188–197CrossRefPubMed Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, Barrett A, Davies B (2006) Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 88(2):188–197CrossRefPubMed
6.
go back to reference Coon TM (2009) Integrating robotic technology into the operating room. Am J Orthop (Belle Mead NJ) 38(2 Suppl):7–9 Coon TM (2009) Integrating robotic technology into the operating room. Am J Orthop (Belle Mead NJ) 38(2 Suppl):7–9
7.
go back to reference Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 89(4):871–882PubMed Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 89(4):871–882PubMed
9.
go back to reference Decking J, Theis C, Achenbach T, Roth E, Nafe B, Eckardt A (2004) Robotic total knee arthroplasty: the accuracy of CT-based component placement. Acta Orthop Scand 75(5):573–579CrossRefPubMed Decking J, Theis C, Achenbach T, Roth E, Nafe B, Eckardt A (2004) Robotic total knee arthroplasty: the accuracy of CT-based component placement. Acta Orthop Scand 75(5):573–579CrossRefPubMed
10.
go back to reference Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthr Cartil 15(3):273–280CrossRefPubMed Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I (2007) Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthr Cartil 15(3):273–280CrossRefPubMed
11.
go back to reference Goradia VK (2014) Computer-assisted and robotic surgery in orthopedics: where we are in 2014. Sports Med Arthrosc 22(4):202–205CrossRefPubMed Goradia VK (2014) Computer-assisted and robotic surgery in orthopedics: where we are in 2014. Sports Med Arthrosc 22(4):202–205CrossRefPubMed
12.
go back to reference Jacobs CA, Christensen CP (2009) Correlations between knee society function scores and functional force measures. Clin Orthop Relat Res 467(9):2414–2419CrossRefPubMedPubMedCentral Jacobs CA, Christensen CP (2009) Correlations between knee society function scores and functional force measures. Clin Orthop Relat Res 467(9):2414–2419CrossRefPubMedPubMedCentral
13.
go back to reference Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed Jeffery RS, Morris RW, Denham RA (1991) Coronal alignment after total knee replacement. J Bone Joint Surg Br 73(5):709–714PubMed
14.
go back to reference Karthik K, Colegate-Stone T, Dasgupta P, Tavakkolizadeh A, Sinha J (2015) Robotic surgery in trauma and orthopaedics: a systematic review. Bone Joint J 97-B(3):292–299CrossRefPubMed Karthik K, Colegate-Stone T, Dasgupta P, Tavakkolizadeh A, Sinha J (2015) Robotic surgery in trauma and orthopaedics: a systematic review. Bone Joint J 97-B(3):292–299CrossRefPubMed
15.
go back to reference Klit J, Jacobsen S, Rosenlund S, Sonne-Holm S, Troelsen A (2014) Total knee arthroplasty in younger patients evaluated by alternative outcome measures. J Arthroplasty 29(5):912–917CrossRefPubMed Klit J, Jacobsen S, Rosenlund S, Sonne-Holm S, Troelsen A (2014) Total knee arthroplasty in younger patients evaluated by alternative outcome measures. J Arthroplasty 29(5):912–917CrossRefPubMed
16.
go back to reference Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes G (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83-A(12):1856–1864CrossRefPubMed Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes G (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83-A(12):1856–1864CrossRefPubMed
17.
go back to reference Liow MH, Chin PL, Tay KJ, Chia SL, Lo NN, Yeo SJ (2014) Early experiences with robot-assisted total knee arthroplasty using the DigiMatch ROBODOC(R) surgical system. Singap Med J 55(10):529–534CrossRef Liow MH, Chin PL, Tay KJ, Chia SL, Lo NN, Yeo SJ (2014) Early experiences with robot-assisted total knee arthroplasty using the DigiMatch ROBODOC(R) surgical system. Singap Med J 55(10):529–534CrossRef
18.
go back to reference Liow MH, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL (2014) Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 29(12):2373–2377CrossRefPubMed Liow MH, Xia Z, Wong MK, Tay KJ, Yeo SJ, Chin PL (2014) Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty 29(12):2373–2377CrossRefPubMed
19.
go back to reference Lonner JH, Smith JR, Picard F, Hamlin B, Rowe PJ, Riches PE (2015) High degree of accuracy of a novel image-free handheld robot for unicondylar knee arthroplasty in a cadaveric study. Clin Orthop Relat Res 473(1):206–212CrossRefPubMed Lonner JH, Smith JR, Picard F, Hamlin B, Rowe PJ, Riches PE (2015) High degree of accuracy of a novel image-free handheld robot for unicondylar knee arthroplasty in a cadaveric study. Clin Orthop Relat Res 473(1):206–212CrossRefPubMed
20.
go back to reference Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L (2011) Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty 26(5):728–737CrossRefPubMed Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L (2011) Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplasty 26(5):728–737CrossRefPubMed
21.
go back to reference Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014CrossRefPubMed Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg Br 89(8):1010–1014CrossRefPubMed
23.
go back to reference Noble PC, Scuderi GR, Brekke AC, Sikorskii A, Benjamin JB, Lonner JH, Chadha P, Daylamani DA, Scott WN, Bourne RB (2012) Development of a new Knee Society scoring system. Clin Orthop Relat Res 470(1):20–32CrossRefPubMed Noble PC, Scuderi GR, Brekke AC, Sikorskii A, Benjamin JB, Lonner JH, Chadha P, Daylamani DA, Scott WN, Bourne RB (2012) Development of a new Knee Society scoring system. Clin Orthop Relat Res 470(1):20–32CrossRefPubMed
24.
go back to reference Park SE, Lee CT (2007) Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty 22(7):1054–1059CrossRefPubMed Park SE, Lee CT (2007) Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. J Arthroplasty 22(7):1054–1059CrossRefPubMed
25.
go back to reference Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92(12):2143–2149CrossRefPubMed Parratte S, Pagnano MW, Trousdale RT, Berry DJ (2010) Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements. J Bone Joint Surg Am 92(12):2143–2149CrossRefPubMed
26.
go back to reference Peersman G, Laskin R, Davis J, Peterson MG, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2(1):70–72CrossRefPubMedPubMedCentral Peersman G, Laskin R, Davis J, Peterson MG, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2(1):70–72CrossRefPubMedPubMedCentral
27.
go back to reference Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156 Ritter MA, Faris PM, Keating EM, Meding JB (1994) Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 299:153–156
28.
go back to reference Siebert W, Mai S, Kober R, Heeckt PF (2002) Technique and first clinical results of robot-assisted total knee replacement. Knee 9(3):173–180CrossRefPubMed Siebert W, Mai S, Kober R, Heeckt PF (2002) Technique and first clinical results of robot-assisted total knee replacement. Knee 9(3):173–180CrossRefPubMed
29.
go back to reference Song EK, Seon JK, Park SJ, Jung WB, Park HW, Lee GW (2011) Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 19(7):1069–1076CrossRefPubMed Song EK, Seon JK, Park SJ, Jung WB, Park HW, Lee GW (2011) Simultaneous bilateral total knee arthroplasty with robotic and conventional techniques: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 19(7):1069–1076CrossRefPubMed
30.
go back to reference Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL (2013) Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 471(1):118–126CrossRefPubMed Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL (2013) Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 471(1):118–126CrossRefPubMed
31.
go back to reference Swank ML, Alkire M, Conditt M, Lonner JH (2009) Technology and cost-effectiveness in knee arthroplasty: computer navigation and robotics. Am J Orthop (Belle Mead NJ) 38(2 Suppl):32–36 Swank ML, Alkire M, Conditt M, Lonner JH (2009) Technology and cost-effectiveness in knee arthroplasty: computer navigation and robotics. Am J Orthop (Belle Mead NJ) 38(2 Suppl):32–36
32.
go back to reference Tsai TY, Dimitriou D, Li JS, Kwon YM (2015) Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy? Int J Med Robot. doi:10.1002/rcs1663 PubMed Tsai TY, Dimitriou D, Li JS, Kwon YM (2015) Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy? Int J Med Robot. doi:10.​1002/​rcs1663 PubMed
33.
go back to reference Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33(4 Suppl):264–279 Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A (1995) Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 33(4 Suppl):264–279
34.
go back to reference Watanabe T, Abbasi AZ, Conditt MA, Christopher J, Kreuzer S, Otto JK, Banks SA (2014) In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty. J Orthop Sci 19(4):552–557CrossRefPubMed Watanabe T, Abbasi AZ, Conditt MA, Christopher J, Kreuzer S, Otto JK, Banks SA (2014) In vivo kinematics of a robot-assisted uni- and multi-compartmental knee arthroplasty. J Orthop Sci 19(4):552–557CrossRefPubMed
35.
go back to reference Weissman BN SN, Daffner RH, Bancroft L, Bennett DL, Blebea JS, Bruno MA, Fries IB, Hayes CW, Kransdorf MJ, Luchs JS, Morrison WB, Palestro CJ, Roberts CC, Stoller DW, Taljanovic MS, Tuite MJ, Ward RJ, Wise JN, Zoga AC (2011) Expert panel on musculoskeletal imaging. ACR Appropriateness Criteria®: Imaging after total knee arthroplasty. https://acsearch.acr.org/docs/69430/Narrative Weissman BN SN, Daffner RH, Bancroft L, Bennett DL, Blebea JS, Bruno MA, Fries IB, Hayes CW, Kransdorf MJ, Luchs JS, Morrison WB, Palestro CJ, Roberts CC, Stoller DW, Taljanovic MS, Tuite MJ, Ward RJ, Wise JN, Zoga AC (2011) Expert panel on musculoskeletal imaging. ACR Appropriateness Criteria®: Imaging after total knee arthroplasty. https://​acsearch.​acr.​org/​docs/​69430/​Narrative
36.
go back to reference Whitehouse SL, Blom AW, Taylor AH, Pattison GT, Bannister GC (2005) The Oxford Knee Score; problems and pitfalls. Knee 12(4):287–291CrossRefPubMed Whitehouse SL, Blom AW, Taylor AH, Pattison GT, Bannister GC (2005) The Oxford Knee Score; problems and pitfalls. Knee 12(4):287–291CrossRefPubMed
Metadata
Title
Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial
Authors
Ming Han Lincoln Liow
Graham Seow-Hng Goh
Merng Koon Wong
Pak Lin Chin
Darren Keng-Jin Tay
Seng-Jin Yeo
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4076-3

Other articles of this Issue 9/2017

Knee Surgery, Sports Traumatology, Arthroscopy 9/2017 Go to the issue