Decking Jens, Theis Christoph, Achenbach Tobias, Roth Edgar, Nafe Bernhard, Eckardt Anke
Department of Orthopaedic Surgery, University of Mainz, Germany.
Acta Orthop Scand. 2004 Oct;75(5):573-9. doi: 10.1080/00016470410001448.
Accurate alignment of the components in total knee arthroplasty is important. By use of postoperative CT controls, we studied the ability of a robotic effector to accurately place and align total knee arthroplasty (TKA) components according to a purely CT-based preoperative plan.
Robotic TKA was performed in 13 patients (6 men) with primary gonarthrosis. Locator screws were placed into femur and tibia under spinal anesthesia. A CT-scan including the femoral head, knee and ankle was performed. In the preoperative planning software, virtual components were positioned into the CT volume. In a second operation, the robot milled femur and tibia with a high-speed milling tool according to the preoperative plan. On the 10th day, CT controls were performed following the same protocol as preoperatively.
The mean deviation of the postoperative from the preoperatively planned mechanical axis was 0.2 degrees (95% CI: -0.1 degrees to 0.5 degrees ). The accuracy of angular component placement in frontal, sagittal and transverse planes was within +/-1.2 degrees , and the accuracy of linear component placement in mediolateral, dorsoventral and caudocranial directions was within +/-1.1 mm.
Robotic TKA allows placement of components with unparalleled accuracy, but further development is mandatory to integrate soft-tissue balancing into the procedure and make it faster, easier and cheaper.
全膝关节置换术中各组件的精确对准至关重要。通过术后CT对照，我们研究了一种机器人操作器根据基于CT的单纯术前计划准确放置和对准全膝关节置换术（TKA）组件的能力。
对13例（6例男性）原发性膝关节炎患者实施机器人辅助全膝关节置换术。在脊髓麻醉下将定位螺钉置入股骨和胫骨。进行包括股骨头、膝关节和踝关节的CT扫描。在术前规划软件中，将虚拟组件放置到CT容积中。在第二次手术中，机器人根据术前计划用高速铣刀对股骨和胫骨进行铣削。在第10天，按照与术前相同的方案进行CT对照。
术后机械轴与术前计划的平均偏差为0.2度（95%可信区间：-0.1度至0.5度）。组件在额面、矢状面和横断面的角向放置精度在+/-1.2度以内，在内外侧、背腹侧和头尾方向的线性放置精度在+/-1.1毫米以内。
机器人辅助全膝关节置换术能够以无与伦比的精度放置组件，但必须进一步发展以将软组织平衡纳入该手术过程，并使其更快、更简便且成本更低。
