Knee

An assessment of early functional rehabilitation and hospital discharge in conventional versus robotic-arm assisted unicompartmental knee arthroplasty

a prospective cohort study

Specialist Registrar Trauma and Orthopaedics

Department of Trauma and Orthopaedics, University College London Hospital, London, UK; Princess Grace Hospital, London, UK.

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S. Konan

Consultant Orthopaedic Surgeon

Department of Trauma and Orthopaedics, University College London Hospital, London, UK; Princess Grace Hospital, London, UK.

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J. Tahmassebi

Extended Scope Practitioner

Department of Trauma and Orthopaedics, University College London Hospital, London, UK; Princess Grace Hospital, London, UK.

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F. E. Rowan

Clinical Research Fellow

Department of Trauma and Orthopaedics, University College London Hospital, London, UK; Princess Grace Hospital, London, UK.

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F. S. Haddad

Professor of Orthopaedic Surgery

University College London Hospitals; The Princess Grace Hospital; The NIHR Biomedical Research Centre at UCLH, London, UK.

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Published Online:2 Jan 2019https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0564.R2

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Abstract

Aims

The objectives of this study were to compare postoperative pain, analgesia requirements, inpatient functional rehabilitation, time to hospital discharge, and complications in patients undergoing conventional jig-based unicompartmental knee arthroplasty (UKA) versus robotic-arm assisted UKA.

Patients and Methods

This prospective cohort study included 146 patients with symptomatic medial compartment knee osteoarthritis undergoing primary UKA performed by a single surgeon. This included 73 consecutive patients undergoing conventional jig-based mobile bearing UKA, followed by 73 consecutive patients receiving robotic-arm assisted fixed bearing UKA. All surgical procedures were performed using the standard medial parapatellar approach for UKA, and all patients underwent the same postoperative rehabilitation programme. Postoperative pain scores on the numerical rating scale and opiate analgesia consumption were recorded until discharge. Time to attainment of predefined functional rehabilitation outcomes, hospital discharge, and postoperative complications were recorded by independent observers.

Results

Robotic-arm assisted UKA was associated with reduced postoperative pain (p < 0.001), decreased opiate analgesia requirements (p < 0.001), shorter time to straight leg raise (p < 0.001), decreased number of physiotherapy sessions (p < 0.001), and increased maximum knee flexion at discharge (p < 0.001) compared with conventional jig-based UKA. Mean time to hospital discharge was reduced in robotic UKA compared with conventional UKA (42.5 hours (sd 5.9)vs 71.1 hours (sd 14.6), respectively; p < 0.001). There was no difference in postoperative complications between the two groups within 90 days’ follow-up.

Conclusion

Robotic-arm assisted UKA was associated with decreased postoperative pain, reduced opiate analgesia requirements, improved early functional rehabilitation, and shorter time to hospital discharge compared with conventional jig-based UKA.

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Published online 2 January 2019

Published in print 1 January 2019

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