Robotic systems have been shown to improve unicompartmental knee arthroplasty (UKA) component placement accuracy compared to conventional methods when used by experienced surgeons. We aimed to determine whether inexperienced UKA surgeons can position components accurately using robotic assistance when compared to conventional methods and to demonstrate the effect repetition has on accuracy. Sixteen surgeons were randomised to an active constraint robot or conventional group performing three UKAs over three weeks. Implanted component positions and orientations were compared to planned component positions in six degrees of freedom for both femoral and tibial components. Mean procedure time decreased for both robot (37.5？mins to 25.7？mins) ( ) and conventional (33.8？mins to 21.0？mins) ( ) groups by attempt three indicating the presence of a learning curve; however, neither group demonstrated changes in accuracy. Mean compound rotational and translational errors were lower in the robot group compared to the conventional group for both components at all attempts for which rotational error differences were significant at every attempt. The conventional group’s positioning remained inaccurate even with repeated attempts although procedure time improved. In comparison, by limiting inaccuracies inherent in conventional equipment, robotic assistance enabled surgeons to achieve precision and accuracy when positioning UKA components irrespective of their experience. 1. Introduction Although the benefits of robotic systems in terms of alignment and positioning compared to conventional methods are well established in experienced users , the effect of surgical experience and training on the ability to accurately position components with robotic systems is unknown. Conventional unicompartmental knee arthroplasties (UKAs) exhibit a learning curve whereby repetition and experience can lead to improvements in surgical technique, timing, and accuracy [2, 3]. Rees et al. in 2004 demonstrated that a surgeon’s UKA performance is significantly worse in their first 10 cases compared to their subsequent 10 cases . Other studies have shown a nonsignificant improvement in accuracy with experience indicating that conventional UKAs have a long learning curve and that even with experience and training obtaining accurate results is difficult . In contrast early results of a preliminary study by Coon demonstrated that the MAKO robotic system may demonstrate a shorter learning curve and greater accuracy compared to conventional techniques . By comparing their first 36 robot
J. Cobb, J. Henckel, P. Gomes et al., “Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system,” Journal of Bone and Joint Surgery B, vol. 88, no. 2, pp. 188–197, 2006.
J. L. Rees, A. J. Price, D. J. Beard, C. A. F. Dodd, and D. W. Murray, “Minimally invasive Oxford unicompartmental knee arthroplasty: functional results at 1 year and the effect of surgical inexperience,” The Knee, vol. 11, no. 5, pp. 363–367, 2004.
M. A. Hassaballa, A. J. Porteous, and I. D. Learmonth, “Functional outcomes after different types of knee arthroplasty: kneeling ability versus descending stairs,” Medical Science Monitor, vol. 13, no. 2, pp. CR77–CR81, 2007.
J.-N. A. Argenson, Y. Chevrol-Benkeddache, and J.-M. Aubaniac, “Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study,” Journal of Bone and Joint Surgery A, vol. 84, no. 12, pp. 2235–2239, 2002.
M. B. Collier, T. H. Eickmann, F. Sukezaki, J. P. McAuley, and G. A. Engh, “Patient, implant, and alignment factors associated with revision of medial compartment unicondylar arthroplasty,” The Journal of Arthroplasty, vol. 21, no. 6, pp. 108–115, 2006.
P. E. Müller, C. Pellengahr, M. Witt, J. Kircher, H. J. Refior, and V. Jansson, “Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty,” The Journal of Arthroplasty, vol. 19, no. 3, pp. 296–301, 2004.
A. D. Pearle, D. Kendoff, V. Stueber, V. Musahl, and J. A. Repicci, “Perioperative management of unicompartmental knee arthroplasty using the MAKO robotic arm system (MAKOplasty),” American Journal of Orthopedics, vol. 38, no. 2, supplement, pp. 16–19, 2009.
W. G. Hamilton, M. B. Collier, E. Tarabee, J. P. McAuley, C. A. Engh Jr., and G. A. Engh, “Incidence and reasons for reoperation after minimally invasive unicompartmental knee arthroplasty,” The Journal of Arthroplasty, vol. 21, no. 6, pp. 98–107, 2006.
T. J. Aleto, M. E. Berend, M. A. Ritter, P. M. Faris, and R. M. Meneghini, “Early failure of unicompartmental knee arthroplasty leading to revision,” The Journal of Arthroplasty, vol. 23, no. 2, pp. 159–163, 2008.
J. Jerosch, E. Peuker, B. Philipps, and T. Filler, “Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 10, no. 3, pp. 194–197, 2002.
J.-Y. Jenny and C. Boeri, “Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement,” Acta Orthopaedica Scandinavica, vol. 75, no. 1, pp. 74–77, 2004.
J. B. Mason, T. K. Fehring, R. Estok, D. Banel, and K. Fahrbach, “Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery,” The Journal of Arthroplasty, vol. 22, no. 8, pp. 1097–1106, 2007.
N. J. Dunbar, M. W. Roche, B. H. Park, S. H. Branch, M. A. Conditt, and S. A. Banks, “Accuracy of dynamic tactile-guided unicompartmental knee arthroplasty,” The Journal of Arthroplasty, vol. 27, no. 5, pp. 803–808, 2012.
R. Sinha and M. Cutler, “Effect of cement technique on component position during robotic-arm assisted unicompartmental arthroplasty (UKA),” in Proceedings of the International Society for Technology in Arthroplasty (ISTA '10), Dubai, UAE, Octobre 2010.
A. Srivastava, G. Y. Lee, N. Steklov, C. W. Colwell Jr., K. A. Ezzet, and D. D. D'Lima, “Effect of tibial component varus on wear in total knee arthroplasty,” The Knee, vol. 19, no. 5, pp. 560–563, 2011.