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There’s a new frontier opening up in orthopaedics. Robotic systems are becoming increasingly more prevalent in the operating room, and total knee arthroplasty (TKA) is a domain that has been affected by the robotic revolution. In theory, robotic surgery provides better implant placement and alignment, extending the length of the prosthesis. But what does the literature say? Using our Surgical Analytics tool, we break down the evidence on robotic arthroplasty.
Major Players. Using the OE Market Analysis tool, we identified the top 5 companies dominating the academic literature on robotic TKA. THINK Surgical, creators of the ORTHODOC and ROBODOC systems, are ranked first. Stryker, Zimmer-Biomet, and Smith & Nephew also feature on the list.
Efficacy. We used the OE Meta-Analyzer to find out whether robotic TKA provides any clinical advantages over conventional TKA. We pooled 6 studies, with a total of 1,928 patients, for the outcome of composite clinical outcomes (i.e., WOMAC, KSS). Robotic-assisted TKA provided significantly better composite clinical outcomes at 6 months vs. conventional TKA.
Economics. Economic evaluations have found robotic-assisted TKA to be cost-effective in high-volume hospitals, with the high purchase cost being offset by lower revision rates and reduced post-operative costs.
Look To The Future. Stryker is the sponsor funding the most trials on robotics, signalling their intent. Other sponsors of robotic trials include Washington University, Bournemouth University, and Auxilium Pharmaceuticals.
Bottom line. While there is much interest and excitement surrounding robotic surgery, more studies will be needed to examine the safety, effectiveness, and cost-effectiveness required for wide-spread implementation.
Read the full OE Original on robotic arthroplasty here.
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Hip fractures in the elderly are a major cause of disability and death. Optimizing hip fracture surgical outcomes is key – hemiarthroplasty is one of the most common interventions, but the surgical approach is often dictated by surgeon preference, and the optimal method unclear.
The posterolateral approach (PLA) and direct lateral approach (DLA) are 2 of the most popular. The superiority of PLA has been suggested by some studies, but the evidence is conflicting and observational in nature. There’s also indication of a higher risk of dislocation and reoperation compared to the DLA and direct anterior approach. A high-quality RCT was needed to help settle the debate.
The APOLLO trial was a multicenter, joint RCT and natural experiment (NE) study conducted in the Netherlands that included a total of 843 patients with acute femoral neck fractures receiving cemented hemiarthroplasty. 555 were included in the RCT (n=283 randomized to DLA; n=272 randomized to PLA) and 288 in the NE (n=172 received DLA; n=116 received PLA). The primary outcome of interest was quality of life at 6 months. The results of the study were as follows:
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No significant differences in quality of life were observed between the DLA and PLA approaches at 6 months.
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Pain scores, the incidence of falls, and the rate of emergency department admissions were similar between the two groups.
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The odds of prosthesis dislocation were significantly higher in the PLA group (OR 16.46 [95% CI 2.16, 125.48], p<0.001).
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The results of the natural experiment were similar, finding no difference in quality of life and a higher risk of dislocation in the PLA group.
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Data fusion combining the RCT and NE data found no difference in quality of life and a greater odd of dislocation after PLA.
Bottom line. The posterolateral approach provided no benefits over the direct lateral approach and is associated with a higher rate of dislocation. Randomized and natural experiment data found similar results, which increases the robustness of the findings.
Check out the comprehensive analysis of this paper in our ACE Report. We also sat down the Dr. Rudolf Poolman, senior author of the study, for a discussion on the results and implications of this trial: you can watch it here. |
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Impacting quality of life and functional ability, shoulder pain affects around 1 in 4 people. Injection therapy has become one of the most widely utilized treatments, with corticosteroid injection a part of practice for over 50 years. But recently, PRP has drawing more and more attention. In this OE Original, we aimed to find out which one provides the best outcomes.
Using the Surgical Analytics database, we found 6 RCTs comparing PRP and corticosteroid for the treatment of shoulder pain, with a total of 382 patients. Conditions included rotator cuff disease, rotator cuff tendon lesions, rotator cuff tears, supraspinatus tears and calcific tendinitis. Our meta-analyses yielded the following results:
Composite Clinical Outcomes. In the first 6 weeks, corticosteroid provided significantly better pooled composite clinical outcome scores (ex. ASES, Constant, SPADI, WORC, DASH) compared to PRP. However, PRP resulted in significantly better pooled outcomes at 3-6 months compared to corticosteroid.
Pain. Similarly, pooled pain scores in the first 6 weeks were better in the corticosteroid group. But from 6-24 months, PRP provided significantly better pooled pain scores compared to corticosteroid.
Conversion to Surgery & Adverse Events. No differences were observed between the two groups in the pooled risk of conversion to surgery, and the pooled risk of adverse events.
Bottom line. Corticosteroid appears to provide short-term superiority in clinical outcomes, while PRP demonstrated long-term benefits for the treatment of shoulder pain. However, our GRADE analysis found the quality of evidence to be low-very low across the board, indicating the need for more research on the topic.
Read the full OE Original on PRP vs. corticosteroid for shoulder pain here. |
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EDITOR’S PICKS |
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Changes in Pelvic Fracture Management – In this OrthoJoe podcast, Dr’s Mohit Bhandari and Marc Swiontkowski sit down with Dr. Milton “Chip” Routt, orthopaedic surgeon at the University of Texas, for a discussion on the changes and innovations in pelvic fracture management. (Watch) |
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Knee Osteoarthritis Guidelines: Revisited – We sat down with Dr. Raveendhara Bannuru, Assistant Professor of Medicine at Tufts University and the Director at the Center for Treatment Comparison and Integrative Analysis, for a discussion on the differences in injectable recommendations across guidelines despite the same body of evidence informing the decisions, what interventions are supported by a strong body of evidence, and how we can sift through the noise and find the signal on the effectiveness of injectables. (Read) |
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