A Novel Patient-Specific Instrument Design Can Deliver Robotic Level Accuracy in Unicompartmental Knee Arthroplasty

15 Pages Posted: 12 Nov 2018

See all articles by Gareth Jones

Gareth Jones

MSk Lab, Imperial College London; MSk Lab, Imperial College London

Susannah Clarke

Imperial College London

Simon Harris

Imperial College London

Martin Jaere

Imperial College London

Thunayan Aldalmani

Royal College of Surgeons in Ireland (RCSI)

Patrick de Klee

Imperial College London

Justin Cobb

Imperial College London

Date Written: August 1, 2018

Abstract

Background: A previous randomised controlled trial (RCT) by our group found that robotic assisted unicompartmental knee arthroplasty (UKA) surgery was significantly more accurate than conventional instrumentation. The aim of this study was to determine whether a low-cost novel PSI design could deliver the same level of accuracy as the robot in a more time efficient manner.

Methods: Thirty patients undergoing medial UKA took part. Tibial component position was planned using a low dose CT-scan, and compared to a day 1 postoperative CT-scan to determine the difference between the planned and achieved position. Operations were performed by one expert surgeon using PSI (Embody, London, UK). Oxford knee scores (OKS) and EQ-5D-5L were collected preoperatively and at 12 months postoperatively.

Results: The mean absolute difference between planned and achieved tibial implant position using PSI was 2 (sd 1) in the coronal plane, 1.8 (sd 1.5) in the sagittal plane, and 4.5 (sd 3.3) in the axial plane. These results were not significantly different to the thirteen historical robotic cases (mean difference 0.5, 0.5, and 1.7, p=0.1907, 0.2867 and 0.1049 respectively). PSI mean operating time was on average 62 min shorter than the robotic group (p<0.0001). There was a significant increase in mean OKS (p<0.0001) and EQ-5D-5L index (p<0.0001). No complications were reported.

Conclusions: In conclusion, this clinical trial demonstrates that for tibial component positioning in UKA, a novel design PSI guide in the hands of an expert surgeon, can safely deliver comparable accuracy to a robotic system, whilst being significantly faster.

Keywords: unicompartmental knee arthroplasty, partial knee replacement, patient specific instrumentation, PSI, robotic surgery, robot-assisted surgery

Suggested Citation

Jones, Gareth and Jones, Gareth and Clarke, Susannah and Harris, Simon and Jaere, Martin and Aldalmani, Thunayan and de Klee, Patrick and Cobb, Justin, A Novel Patient-Specific Instrument Design Can Deliver Robotic Level Accuracy in Unicompartmental Knee Arthroplasty (August 1, 2018). Available at SSRN: https://ssrn.com/abstract=3281029 or http://dx.doi.org/10.2139/ssrn.3281029

Gareth Jones (Contact Author)

MSk Lab, Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

MSk Lab, Imperial College London ( email )

7th Floor Lab Block
Charing Cross Hospital
London, W6 8RF
United Kingdom

Susannah Clarke

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Simon Harris

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Martin Jaere

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Thunayan Aldalmani

Royal College of Surgeons in Ireland (RCSI) ( email )

123 St Stephens Green
Dublin 2
Ireland

Patrick De Klee

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Justin Cobb

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

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