robot assisted uka a randomised trial
Post on 12-Jan-2016
27 Views
Preview:
DESCRIPTION
TRANSCRIPT
Robot assisted UKARobot assisted UKAa randomised triala randomised trial
Justin CobbJustin CobbChair of OrthopaedicsChair of Orthopaedics
Imperial CollegeImperial CollegeLondonLondon
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
Novel registration algorithmNovel registration algorithm Hip centreHip centre 4 initial points4 initial points 6 points in 5 zones6 points in 5 zones
On screen feedback more helpful On screen feedback more helpful than direct visionthan direct vision
Rest of operation is routineRest of operation is routine
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
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
Control examples cases 1,3Control examples cases 1,3
Control GroupControl Group
Acrobot example 1Acrobot example 1
Acrobot GroupAcrobot Group
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
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)
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
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
top related