Robot-Assisted versus Conventional Total and Unicompartmental Knee Arthroplasty: A Meta-analysis of Radiological and Functional Outcomes.

The study aims to provide an up-to-date systematic review and meta-analysis comparing radiological and functional outcomes of total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) using either robotic assistance or conventional methods from the latest assemblage of evidence. This study was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. All studies in PubMed, EMBASE, Medline, and Cochrane that reported radiological and functional outcomes after TKA or UKA with either robotic or conventional methods were included in the review. Selected endpoints for random effects, pairwise meta-analysis included operative details, radiological outcomes (mechanical axis, component angle deviation, and outliers), and functional outcomes (American Knee Society Score, Knee Society Function Score, revision and complication rate, range of motion (ROM), Hospital for Special Surgery score, and Western Ontario and McMaster Universities Osteoarthritis Index). A total of 23 studies comprising 2,765 knees were included from the initial search. Robot-assisted TKA and UKA were associated with significantly better component angle alignment accuracy (low-to-high quality evidence) at the cost of significantly greater operation time. Robot-assisted UKA was found to have significantly better short-term functional outcomes compared with conventional UKA (moderate-to-high quality evidence). Robot-assisted TKA, however, did not exhibit significantly better short- and midterm subjective knee outcome scores compared with its conventional counterpart (high-quality evidence). Robot-assisted TKA and UKA were associated with nonstatistically significant improved ROM and lesser rates of revision. Robot-assisted total and unicompartmental knee arthroplasty leads to better radiological outcomes, with no significant differences in mid- and long-term functional outcomes compared with conventional methods for the former. Larger prospective studies with mid- and long-term outcomes are required to further substantiate findings from the present study.

Three-Dimensional Morphometric Analysis of Lumbar Vertebral End Plate Anatomy.

BACKGROUND: Information on the three-dimensional (3D) shape of vertebral end plates is lacking. Previous studies have analyzed two-dimensional shape; however, 3D data are important because they may help improve our understanding of how differences in shape are related to age, gender, race, size, and other parameters, which may subsequently help improve device design for interbody prosthesis. OBJECTIVE: To study the 3D shape of lumbar vertebral end plates from normal adult lumbar spines and correlate them with age, gender, spinal/end plate level, end plate surface area, concave depth, and size. METHODS: An in vivo analysis was undertaken of lumbar vertebral end plate 3D shape. A total of 136 patients' computed tomography scans were used to create 3D models of the lumbar spine for each patient, which were subsequently analyzed. RESULTS: The shape of the superior end plates is different compared with inferior end plates. Across the lumbar spine (L1-S1), the shape of inferior end plates is similar; however, the shape of the superior end plate varies between spinal levels significantly. There was no clear relationship between age and principal component (PC) shapes but there was a strong correlation between end plate concave depth and end plate PC shape scores. CONCLUSIONS: Future interbody (disc replacement and fusion) device designs could use the findings that inferior end plate shape is similar throughout the length of the lumbar spine, whereas superior end plate shape changes. Further, future implants could be level-specific because the present study shows that end plate shape varies through the length of the lumbar spine.