Clinical Comparisons of Robotically-Assisted Medial

1. Clinical Comparisons of Robotically-Assisted Medial Arthroplasties vs. Total Knee Arthroplasties Riley Hein Data Discussion Abstract With respect to the data, the survivorship and satisfaction between robot-assisted knee replacements and total knee replacements was shown to be very comparable. Among all the facets of the study that were analyzed, both the robotically-assisted medial arthroplasties and the total knee arthroplasties had very similar trends. With this in mind, it seems as if the technology behind the unicompartmentalarthroplasties is advancing and closing the gap to the level of satisfaction that total knee replacements have. However, the results obtained from the 10 year study have the potential to not show the whole story. For instance, not every component from the 10 year study results was picked to be included in the analysis. However, the robot-assisted unicompartmentalarthroplasties and total knee arthroplasties could have differed in other areas. For example, one could have scored better on the Forgotten Joint Score which is a series of questions that asks patients how their new artificial joint is feeling. Additionally, several of the patients who were picked from the 10 year study for this analysis had to be eliminated from the study pool for various reasons. Some simply did not have the information in their file that was desired and several had surgeries that were not popular enough to be included. Osteoarthritis, the most common joint disease affecting people today, is characterized by the gradual disappearance of cartilage in joints and is most present in the hip, knee, and hand joints, causing pain and stiffness in these areas. Although there is no cure for this disease, symptoms can be mitigated surgically by removing affected joints and implanting artificial joints. For the knee, there are two primary surgical options − a partial knee replacement or a total knee replacement. The merits and drawbacks of both have been debated in the medical world for the last several decades, as the partial knee replacement was thought to render less effective long term results. However, the company MAKO Surgical is now creating partial knee replacements, called MAKOplasties, that are implanted with robotic assistance, which helps to precisely implant the partial knee components. In order to help compare partial knee replacements with total knee replacements, Rebound Orthopedics and Neurosurgery Clinic has several studies that track patients with both kinds of knee replacements. This past summer, I combed through patient files in the 10 year study, and picked several pieces of information for both partial and total knee replacements, hoping to shed some light on the results of partial knee replacements versus total knee replacements. After analyzing the results, the robot-assisted partial medial knee replacements and the total knee replacements had comparable results, which suggests that partial knee replacements are beginning to produce as effective results as total knee replacements. Conclusion Though there were several possible sources of error, robot-assisted medial knee replacements and total knee replacements were shown to have very comparable results among satisfaction at 3 months, Range of Motion at 3 months, Flexion Contracture at 3 months, and the Knee Society Score at 3 months. Nonetheless, the question of whether or not a partial knee replacement can compete with the long-term satisfaction of the total knee replacement remains. To be sure, osteoarthritis will remain in the American society for the foreseeable future. I had the opportunity to observe 4 knee replacements (one robotically-assisted medial replacement and 3 total knee replacements) and one trend was especially obvious — every patient I observed was overweight. With this in mind, perhaps the most prudent and interesting future experiment that could be done, would be to compare the results of knee replacements among trim and overweight patients. Materials and Methods Patients enrolled in this on-going 10 year study at Rebound, who had already filled out a 3 month post-operation questionnaire were chosen to provide certain pieces of data, which the doctors would be able to see. These pieces of data included their pre-OP and 3 month Range of Motion results, their pre-OP and 3 month Flexion Contracture, their pre-OP and 3 month Knee Society Scores (which asks questions referring to how far they can walk, how they get up and down stairs, and if they need any kind of support when they walk), and their satisfaction with their artificial joint at 3 months post-surgery. Approximately 100 patient files, that included study questionnaires and appointment documents, were then looked over to find their answers to the above questions. The data for satisfaction at 3 months, walking distance at 3 months, and average flexion range of motion at 3 months was then put into pivot charts that displayed the information in a bar graph format. Left Total Knee Replacement Left Medial MAKOplasty Results Across the board, the results of satisfaction at 3 months, walking distance at 3 months, and average flexion range of motion at 3 months were very comparable between robot-assisted partial medial knee replacements and non robot-assisted knee replacements. Concerning the satisfaction at 3 months, the robot-assisted partial medial knee replacements and the non robot-assisted knee replacements had very comparable neutral and satisfied percentages, but the robot-assisted knee replacement had slightly more very satisfied results. The walking distance at 3 months was slightly more varied between these two categories, yet the same basic trend was present in both ⎯ approximately two thirds of the patients could walk more than 10 blocks at 3 months post-op with slightly more patients with a total knee replacement being able to walk further. The trend for average flexion range of motion was also similar among the robot-assisted partial medial knee replacements and the non robot-assisted knee replacements. However, the patients with the robot-assisted knee replacements had higher ranges of motion on average. Acknowledgements A special thanks to Pam Fairchild, Research Coordinator at Rebound Orthopedics and Neurosurgery, whose help and guidance made this project possible for me. Thanks also to the entire Rebound faculty who provided a very welcoming and engaging environment. MAKO Surgical’s RIO system for partial knee replacements