Author: Chris Wilson
Wilson, Chris, 2020 An innovative approach to the diagnosis and management and prevention of instability in total knee joint arthroplasty using state of the art robotic technology, Flinders University, College of Medicine and Public Health
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Introduction
Total Knee Arthoplasty is a highly successful procedure and considered the gold standard for the surgical treatment of osteoarthritis. However the numbers of revision knee arthroplasty are on the increase and cost the Australian Healthcare system 294 million dollars per year. Revision for TKA instability is a significant problem with many patients failing within the first 3 years post-op and sustaining a high rate of re-revision surgery.
Aims
The purpose of this thesis is to design a robust diagnostic approach to improve the. Diagnosis of TKA instability and reduce our rates of re-revision surgery. TKA revision for instability is used as a sentinel event to use the AOANJRR National registry data combined with a local Revision Registry to identify areas to improve our diagnostic and management processes.
Methods
We used data from our systematic review to design a robust diagnostic algorithm for the failing knee arthoplasty using instability as the test diagnosis. A local revision registry was designed to capture local data related to these cases and draw conclusions combined with national registry data. Our clinical data showed that PROMs satisfaction scores were low in revision TKA patients, however the use of our diagnostic algorithm had reduced re-revision rates.To try and prevent these revisions occuring in the fists place a new inovative robotic technique was introduced wich showed improved accuracy and knee ligament balaincing which will hopefully reduce revision rates in the future.
Conclusions
Review of our revision rates has shown that not only has this work improved out level and detail of diagnostic accuracy the use of a structured diagnostic and management pathway has shown a reduction in our re-revision surgery rates which is of huge benefit to our patients.
With the evolution of surgical techniques to enhance ligament gap balancing during surgery we can aim to reduce surgical error and its effect on TKA instability. Our results have shown a high level of accuracy using robotic techniques to perform ligament gap balancing. This evolution in our management process and enhanced accuracy of execution may have a profound effect on improving the outcomes of our patients in the future.
Keywords: Knee Revision, Arthroplasty, Diagnosis, Managment, Robotic
Subject: Surgery thesis
Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Medicine and Public Health
Supervisor: Prof Ruurd Jaarsma