Study detects differences in patient-reported outcomes for robotic vs manual TKA
Click Here to Manage Email Alerts
Positive differences in patient-reported outcomes were seen for patients who underwent total knee arthroplasty with robotics vs. without robotics, a presenter said at the American Association of Hip and Knee Surgeons Annual Meeting.
Jonathan H. Shaw, MD, of Henry Ford Health System in Detroit, presented findings from an analysis of 1,158 patients in the prospective Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database who underwent either robotic-assisted TKA (259 patients) or non-robotic or manual TKA (899 patients). The goal of the study was to determine whether patients who underwent robotic-assisted TKA showed higher rates of early and intermediate postoperative improvement in minimally clinically important differences (MCIDs) for patient-reported outcomes compared with patients who underwent manual TKA.
Primary outcome measures Shaw and colleagues used were the KOOS Jr. and Patient Reported Outcomes Measurement Information System – Global Health (PROMIS-GH) scales, as well as the PROMIS physical health (PH) and mental health (MH) scales.
“Multivariate analysis showed similar short-term and intermediate MCID achievement in these patient-reported outcome systems and there are some interesting findings in the low preoperative performers vs. high preoperative performers that should be included in future studies when looking at these patient-reported outcome systems,” Shaw said.
“Exclusion criteria I want to emphasize is that any patient who did not have an early outcome was excluded from our database. Early outcomes were defined 2 to 6 weeks postoperative and intermediate outcomes were defined as 4 to 8 months postoperatively. We defined our MCID as one-half the standard deviation of the preoperative scores,” he said.
For the early KOOS Jr. scores, investigators saw a statistically significant improvement in MCID that favored manual TKA.
“However, when it came to the multivariate analysis, this did not hold true. When it comes to PROMIS physical health, you do see the similar increase in patient-reported outcome scores like you do in KOOS Jr.,” Shaw said, but he noted that trend did not hold true regarding PROMIS-MH scores.
“There was a significant improvement in mean scores for PROMIS mental health in robotic total knees compared with manual total knees, but the MCID achievement did not show any significance,” Shaw said.
Among the study limitations he cited were such confounding variables as implants, fixation and surgical techniques used.
“All of these are as important, if not more important when we’re talking about MCID achievement in the postoperative periods,” he said.
Perspective
Back to Top
The study by Jonathan H. Shaw, MD, and colleagues is yet another in the rising number of studies evaluating robotic- assisted TKA. The strengths of this study are its prospective nature, as well as highlighting MCID between the groups.
That being said, the study found a significant difference at one timepoint on one patient-reported outcome favoring robotics of all those studied. This, honestly, does not surprise me at this time.
Robotic-assisted surgery will certainly have a place in the future of TKA. I do think that outcomes presently lag a bit behind the technology. It takes years to setup well-structured randomized control trials and then more time to execute midterm length studies. More importantly, I do not think that robotic-assisted surgery in and of itself is what is going to be the paradigm shift in our ability to improve on TKA. I think it is the ability to passively collect structured data intraoperatively that will change our patients’ lives. Big improvements will come after years of this structured data being compared with individual patient profiles, as well as outcomes, and then the use of robotics to hit prescribed intraoperative goals.
As this study reports, the present state of robotic-assisted TKA is equivocal or slightly improved at best, but I do think the future is bright.
Collapse
Shaw JH, et al. Paper 22. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
Read more about
Click Here to Manage Email Alerts