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News — The use of robotics is becoming increasingly common in joint replacement, but more research is needed to quantify its benefits. HSS investigators presented two retrospective studies at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in San Francisco analyzing outcomes in both knee and hip replacement surgeries performed with robotic assistance.

“We have found that robotic assistance leads to improved implant positioning, alignment and ligament balance, which enable us to better replicate the patient’s natural anatomy,” said , chief of the Adult Reconstruction and Joint Replacement Service at HSS. “With our vast registry of patient data and strong commitment to research, HSS is in a unique position to continue leading the evolution of robotic assistance in the operating room.”

The first study found that the use of a surgical robot during total knee replacement surgery reduced the need for manipulation under anesthesia (MUA), an outpatient procedure that may be prescribed when physical therapy (PT) after surgery becomes too painful for the patient due to joint stiffness caused by scar tissue. During the course of care, approximately 3.5% of knee replacement patients undergo MUA, according to , hip and knee surgeon at HSS and co-author of this study, typically within 90 days of their surgery. After MUA, patients are typically better able to participate in PT and progress in their recovery.

Investigators at HSS set out to determine if the use of computer navigation or robotic-arm assistance during surgery reduced the need for MUA. Previous studies have shown that the use of either tool leads to a more precise knee replacement.

The HSS researchers conducted a retrospective chart review of 21,893 knee replacement surgeries performed between April 2008 and December 2022. They found that the use of the robotic arm or computer navigation led to a significant decrease in the number of patients who needed MUA after surgery (2.7% of patients with robotic-assisted surgery; 2.8% of patients whose surgery was performed with computer navigation; 3.7% of patients whose surgery was performed without either technology).

“These results highlight the potential benefits of incorporating technological advancements into knee replacement surgery, offering improved outcomes and reducing the need for additional interventions such as MUA,” Dr. Jerabek said.

The second study compared short-term outcomes of the anterior versus the posterior approach in robotic-assisted total hip replacement (THR) surgery. “There is no consensus on which approach has a lower risk of postoperative complications,” said , a hip and knee surgeon at HSS and principal investigator of the study. “This can often lead to confusion on the part of the patient as to which approach may be best for them. Our objective was to compare rates of dislocation, re-operation, revision and patient-reported outcome measures of each approach performed with robotic assistance.”

Dr. Gausden and colleagues identified 2,040 consecutive robotic-assisted THRs for osteoarthritis in the HSS patient registry between 2017 and 2020. A total of 497 hip replacements were performed using the anterior approach; 1,542 were performed with the posterior approach.

At mean follow-up of 18 months, the researchers found no difference in the rate of dislocation, re-operation or revision surgery between the two approaches. At early follow-up of six weeks, the anterior approach was associated with a somewhat faster functional recovery. By 3 months following the THA, there were no longer significant differences between patients who had different approaches. “The take-home message is that hip replacement has excellent outcomes with each respective approach when performed by surgeons with extensive experience in that approach,” Dr. Gausden said. “While the goal of the study was not to compare robotic THA to manual THA, it is likely that the very low incidence of instability or dislocation overall can be attributed to the use of robotic technology for planning and execution.”

"As the use of robotic assistance in joint replacement surgery becomes more common, future studies should evaluate outcomes over longer periods of time,” concluded Dr. Mayman. “As a leader in the use of this technology, HSS continues to study various robotic systems to acquire the data needed to provide the evidence-based care that will benefit our patients.”  

References:

Robotic-assisted Total Knee Arthroplasty Is Associated with Decreased Manipulation under Anesthesia Compared to Manual Approach

Authors: Cale Pagan; ; ; ; ; ; Theofilos Karasavvidis, MD (HSS).

Program Number: P153 – February 14, 2024

Comparison of Short-Term Outcomes Between Direct Anterior and Posterolateral Approach in Robotic-Assisted Total Hip Arthroplasty

Authors: Nikhil Vasireddi, MHA (Case Western); Sonia Chandi, MD; Colin Neitzke; Agnes Cororaton, MS; ; ; ; (HSS).

Program Number: e076 – February 12, 2024

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