A study by Geoffrey Westrich, MD, and colleagues at Hospital for Special Surgery (HSS) found knee replacement performed with robotic assistance led to a lower complication rate in the first three months following surgery. The research, which appeared in the October issue of Arthroplasty Today, also found that the nationwide use of a robotic system in knee replacement increased more than 2,000% from 2010 to 2018.
“The use of computer-assisted navigation and robotic assistance for total knee replacement has increased tremendously and shows no sign of slowing down,” Dr. Westrich said. “Among American Association of Hip and Knee Surgeons attending the 2020 annual meeting, 77% of respondents indicated that they used technology in their surgical cases. The most common reason they cited was to increase surgical precision.”
Dr. Westrich and colleagues set out to update the literature on technology-assisted knee replacement trends. They also sought to review the 90-day complication rate requiring readmission to the hospital after surgery. “Although both computer-assisted navigation and robotic-assisted knee replacement have demonstrated increased precision with component positioning and alignment, it is unclear if this translates into improved clinical outcomes,” Dr. Westrich explained.
Using a large national database, the researchers compiled information on more than 1.3 million patients who underwent a primary, elective total knee replacement between 2010 and 2018. Patients were divided into three groups: those who had conventional surgery; individuals who had technology-assisted knee replacement with computer navigation; and patients who had robotic-assisted joint replacement surgery.
Dr. Westrich and colleagues found that the use of robotic-assisted knee replacement grew considerably from 2010 to 2018, with an increase in utilization nationwide of more than 2,200%. The largest increase took place between 2016 and 2018.
Surgery with robotic-assistance also led to a lower complication rate. “Robotic-assisted surgery had significantly lower odds of all-cause 90-day complications requiring readmission to the hospital, with a rate of 1.57%, compared to conventional knee replacement, which had a complication rate of 2.55%,” Dr. Westrich noted. “The data imply that for every 102 patients treated with robotic-assisted knee replacement, one readmission may be avoided.”
Joint replacement, whether conventional or assisted with technology, is highly successful overall in relieving arthritis pain and improving quality of life, Dr. Westrich notes. “The advantage of the robotic system is that it allows us to customize the procedure for each patient,” he explains. “It enables optimal alignment and positioning of the knee implant, as well as optimal ligament balancing, important to the long-term success of the surgery.”
Several robot-assisted knee-replacement systems are on the market. Dr. Westrich uses technology that takes a CT scan of the patient’s knee prior to surgery. The scan is then uploaded into the system software, where a 3D model of the joint is be created. The 3D model is used to plan and assist in performing the joint replacement.
In the operating room, the orthopedic surgeon controls a robotic arm that uses computer‐guided mapping software, similar to GPS, integrated into the surgical instruments to position the implant in the knee joint. The digital tracking system constantly monitors and updates the patient’s anatomy and enables the surgeon to make real‐time adjustments to optimize implant placement, alignment, ligament balance and joint motion. This provides each patient with a personalized surgery tailored to his or her individual anatomy.
“With more accurate alignment and positioning, the implant should experience less wear and friction, and it could ultimately last longer,” says Dr. Westrich. He notes that additional studies looking at long-term outcomes will be needed to see if this is the case.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 12th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2021-2022), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2021-2022). HSS is ranked world #1 in orthopedics by Newsweek (2021-2022). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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