231 / 324
with further savings achievable the private
sector [32]. As regards the applicability of
UKA, indications and contra-indications
remain a matter of some debate. Our figure of
47.6% is high, but represents the first attempt
to objectively quantify this proportion. The
Oxford Group has previously suggested that
about 25% of cases may benefit from UKA.
Others have suggested a higher figure of 36%
[32]. Our figure is objective, but based on
radiographic criteria alone, and as such may
be reduced following clinical examination of
the patient.
The use of a robot makes no impact on the cost
of the procedure, as the capital cost of the
Acrobot is offset by the sterilization costs of
the instrument trays that are not needed. The
robot does allow more operations to be perfor-
med each day, as the cases do not need the
entire instrument set, and has the attraction of
increasing the skill level of the surgeons
undertaking the surgery.
The smaller more conservative device designs
that the robot permits may substantially more
bone conservation. By upskilling the surgeon,
we are optimistic that this next generation of
devices will be cheaper and more effective than
the current generation of partial replacements.
ABSTRACT
Robot assistance is now available in unicondy-
lar knee arthroplasty (RUKA). It is becoming
an option for the management of gonarthrosis
in all units performing arthroplasty.
Conventional UKA remains an infrequently
used procedure, accounting for just 8-15% of
all knee arthroplasties. Instead this patient
group is more typically managed using total
knee arthroplasty (TKA) often for perverse
financial and technical reasons. In this paper
we show that the use of low cost robotic tech-
nology may influence usage of a conservative
approach UKA. To warrant increased usage
the outcome must be functionally superior to
that of TKA, the costs should be equivalent to
UKA and revision must be straight forward
where necessary. We show in a series of 200
knees that candidacy for UKA is widespread;
representing 48% of all knees assessed, and
the case for bicompartmental knee arthroplas-
ty is addressed. Finally, we report that RUKA
offers a substantial cost saving over TKA
(£1,545 per knee) and is more effective that
conventional UKA. RUKA should be conside-
red the primary treatment option for unicom-
partmental knee arthritis.
14
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JOURNÉES LYONNAISES DE CHIRURGIE DU GENOU
230
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