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      Efficacy and reliability of active robotic-assisted total knee arthroplasty compared with conventional total knee arthroplasty: a systematic review and meta-analysis

      systematic-review

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          Abstract

          Background

          In the field of prosthetics, the ultimate goal is to improve the clinical outcome by using a technique that prolongs the longevity of prosthesis. Active robotic-assisted total knee arthroplasty (TKA) is one such technique that is capable of providing accurate implant position and restoring mechanical alignment. Although relevant studies have been carried out, the differences in the efficacy and reliability between active robotic-assisted TKA and conventional arthroplasty have not yet been adequately discussed.

          Methods

          We referenced articles, including randomised controlled trials and comparative retrospective research, from PubMed, Embase, Cochrane Library and Web of Science, in order to compare active robotic-assisted TKA with the conventional technique. Data extraction and quality assessment were conducted for each study. Statistical analysis was performed using Revman V. 5.3.

          Results

          Seven studies with a total of 517 knees undergoing TKA were included. Compared with conventional surgery, active robotic TKA showed better outcomes in precise mechanical alignment (mean difference, MD: − 0.82, 95% CI: −1.15 to − 0.49, p < 0.05) and implant position, with lower outliers (p < 0.05), better functional score (Western Ontario and McMaster University, Knee Society Score functional score) and less drainage (MD: − 293.28, 95% CI: − 417.77 to − 168.79, p < 0.05). No significant differences were observed when comparing the operation time, range of motion and complication rates.

          Conclusion

          The current research demonstrates that active robotic-assisted TKA surgeries are more capable of improving mechanical alignment and prosthesis implantation when compared with conventional surgery. Further studies are required to investigate the potential benefits and long-term clinical outcomes of active robotic-assisted TKA.

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          Most cited references42

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          Coronal alignment in total knee arthroplasty: just how important is it?

          A recent study has challenged the premise that well-aligned total knee arthroplasties (TKAs) have better survival than outliers. This study examines the importance of overall coronal alignment as a predictor for revision. Patients with primary TKAs were stratified into neutral, varus, and valgus alignment groups based on the postoperative tibiofemoral angle. In 6070 knees (3992 patients), there were 51 failures (0.84%): 21 (0.5%) in the neutral group, 18 (1.8%) in the varus group, and 12 (1.5%) in the valgus group. The best survival was for overall alignment between 2.4 degrees and 7.2 degrees of valgus. Varus knees failed primarily by medial tibia collapse, whereas valgus knees failed from ligament instability. Outliers in overall alignment have a higher rate of revision than well-aligned knees. The goal of TKA should be to restore alignment within 2.4 degrees to 7.2 degrees of valgus.
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            Coronal alignment after total knee replacement.

            Maquet's line passes from the centre of the femoral head to the centre of the body of the talus. The distance of this line from the centre of the knee on a long-leg radiograph provides the most accurate measure of coronal alignment. Malalignment causes abnormal forces which may lead to loosening after knee replacement. We report a series of 115 Denham knee replacements performed between 1976 and 1981 using the earliest design of components, inserted with intramedullary guide rods. Patients were assessed clinically and long-leg standing radiographs were taken before operation, soon after surgery and up to 12 years later. In two-thirds of the knees (68%) Maquet's line passed through the middle third of the prosthesis on postoperative films and the incidence of subsequent loosening was 3%. When Maquet's line was medial or lateral to this, an error of approximately +/- 3 degrees, the incidence of loosening at a median period of eight years was 24%. This difference is highly significant (p = 0.001). Accurate coronal alignment appears to be an important factor in prevention of loosening. Means of improving the accuracy of alignment and of measuring it on long-leg radiographs are discussed.
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              Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty.

              This is a randomized prospective controlled trial comparing the alignment, function, and patient quality-of-life outcomes between patients undergoing conventional (CONV) and computer-assisted (CAS) knee arthroplasty. One hundred and fifteen patients (60 CAS, 55 CONV) underwent cemented total knee arthroplasty. Three patients were lost to follow-up. Eighty-eight percent (CAS) vs 61% (CONV) of knees achieved a mechanical axis within 3 degrees of neutral (P = .003). Aligning femoral rotation with the epicondylar axis was accurately achieved in CAS and CONV with no significant difference. Patients with coronal alignment within 3 degrees of neutral had superior International Knee Society and Short-Form 12 physical scores at 6 weeks, 3 months, 6 months, and 12 months after surgery. Computer-assisted total knee arthroplasty achieves greater accuracy in implant alignment and this correlates with better knee function and improved quality of life.
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                Author and article information

                Journal
                Postgrad Med J
                Postgrad Med J
                postgradmedj
                pmj
                Postgraduate Medical Journal
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0032-5473
                1469-0756
                March 2019
                26 February 2019
                : 95
                : 1121
                : 125-133
                Affiliations
                [1 ] departmentDepartment of Orthopaedic Surgery, Peking Union Medical College Hospital , Peking Union Medical College , Beijing, China
                [2 ] departmentMolecular, Cellular and Developmental Biology Department , University of California , Santa Barbara, California, USA
                Author notes
                [Correspondence to ] Dr Bin Feng, Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China; fengbin@ 123456pumch.cn
                Author information
                http://orcid.org/0000-0003-0898-8028
                Article
                postgradmedj-2018-136190
                10.1136/postgradmedj-2018-136190
                6585281
                30808721
                132e619b-e908-47df-9be1-93b10f7c00f3
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 25 October 2018
                : 24 January 2019
                : 25 January 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81401758
                Categories
                Original Article
                1506
                Custom metadata
                unlocked

                Medicine
                total knee arthroplasty,active robotic-assisted,conventional,systematic review,meta-analysis

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