The Evolution of Image-Free Robotic Assistance in Unicompartmental Knee Arthroplasty
Semiautonomous robotic technology has been introduced to optimize accuracy of bone preparation, implant positioning, and soft tissue balance in unicompartmental knee arthroplasty (UKA), with the expectation that there will be a resultant improvement in implant durability and survivorship. Currently, roughly one-fifth of UKAs in the US are being performed with robotic assistance, and it is anticipated that there will be substantial growth in market penetration of robotics over the next decade. First-generation robotic technology improved substantially implant position compared to conventional methods; however, high capital costs, uncertainty regarding the value of advanced technologies, and the need for preoperative computed tomography (CT) scans were barriers to broader adoption. Newer image-free semiautonomous robotic technology optimizes both implant position and soft tissue balance, without the need for preoperative CT scans and with pricing and portability that make it suitable for use in an ambulatory surgery center setting, where approximately 40% of these systems are currently being utilized. This article will review the robotic experience for UKA, including rationale, system descriptions, and outcomes.
Conclusion
Robotics has come a long way from its humble conceptual beginnings nearly a century ago. Rapid advances in medical technology over the past 10 years have led to the development and growing popularity of RAS in orthopedic surgery, particularly during UKA. Component placement, quantified soft tissue balance, and radiographic alignment appear to be improved and the incidence of outliers reduced with the use of RAS during UKA. Further assessment is needed to determine whether the improved alignment and balance will impact clinical function and/or durability. Early results are very promising, though, creating optimism that the full benefits of RAS in UKA will be further confirmed with additional time and research.
