Robot assisted UKA a randomised trial
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Robot assisted UKARobot assisted UKAa randomised triala randomised trial
Justin CobbJustin CobbChair of OrthopaedicsChair of Orthopaedics
Imperial CollegeImperial CollegeLondonLondon
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CT based planningCT based planning Few 5mm slices through hips and anklesFew 5mm slices through hips and ankles 1mm contiguous slices at knee1mm contiguous slices at knee
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Novel registration algorithmNovel registration algorithm Hip centreHip centre 4 initial points4 initial points 6 points in 5 zones6 points in 5 zones
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On screen feedback more helpful On screen feedback more helpful than direct visionthan direct vision
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Rest of operation is routineRest of operation is routine
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ResultsResults
Prospective Randomised Controlled TrialProspective Randomised Controlled Trial Ethics committee approvedEthics committee approved Conventional mis uka by one of 4 surgeonsConventional mis uka by one of 4 surgeons All had ct based planningAll had ct based planning Surgeon showed what he was aiming atSurgeon showed what he was aiming at Patients not told until after 6 week checkPatients not told until after 6 week check Imaging reported by blind assessorImaging reported by blind assessor
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Post-op CT vs pre-op planPost-op CT vs pre-op plan Whole bone images co-Whole bone images co-
registeredregistered White = planWhite = plan Yellow = achievedYellow = achieved
• Combination of errors:Combination of errors: registration registration bone prepbone prep implantationimplantation
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Control examples cases 1,3Control examples cases 1,3
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Control GroupControl Group
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Acrobot example 1Acrobot example 1
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Acrobot GroupAcrobot Group
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Blind assessmentBlind assessment
Group Statistics
38 .071 4.3175 .7004
26 .104 2.0348 .3991
38 -2.918 5.1591 .8369
26 .796 1.5280 .2997
38 1.129 6.2594 1.0154
26 -.492 3.7476 .7350
38 -.016 2.6912 .4366
26 .315 .9967 .1955
38 .342 2.4720 .4010
26 .665 1.0202 .2001
38 -.095 1.7205 .2791
26 -.069 .5698 .1117
C0R10
1
0
1
0
1
0
1
0
1
0
1
VARVAL
FLEXEXT
AXIALROT
MEDLAT
ANTPOST
PROXDIST
N Mean Std. DeviationStd. Error
Mean
Difference Difference in stdevin stdev
2 times2 times
3 times3 times
1.5 times1.5 times
2.5 times2.5 times
2.5 times2.5 times
3 times3 times
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Acrobot much more accurateAcrobot much more accurate
Tibio-Tibio-Femoral Femoral angleangle
Type of surgeryType of surgery
All kneesAll kneesAcrobot Acrobot SystemSystem
ConventionalConventional
2°2° 13 (100%)13 (100%) 6 (40%)6 (40%) 1919
> > 2° 2° 9 (60%)9 (60%) 99
TotalTotal 1313 1515 2828 P<0.001 (Fischer’s exact t test)P<0.001 (Fischer’s exact t test)
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Correlate accuracy and AKS scoresCorrelate accuracy and AKS scores
change in knee score vs accuracy
ACCURACY
6050403020100
120
100
80
60
40
20
0
-20
Observed
Linear
Correlations
1.000 -.522**
. .002
32 30
-.522** 1.000
.002 .
30 30
Correlation Coefficient
Sig. (1-tailed)
N
Correlation Coefficient
Sig. (1-tailed)
N
SUMVAR
KSSDIF
Spearman's rhoSUMVAR KSSDIF
Correlation is significant at the .01 level (1-tailed).**.
Correlation is significant, p=0.002
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Summary Summary
1MIS UKA will become the default operation for OA of the 1MIS UKA will become the default operation for OA of the knee, whether medial, lateral or patello-femoralknee, whether medial, lateral or patello-femoral
2 Meniscal bearing an excellent option2 Meniscal bearing an excellent option 3 Ct based modelling is an enabling technology3 Ct based modelling is an enabling technology