Department of Orthopedic Surgery, Academic Teaching Hospital Feldkirch, Medical University of Graz, Feldkirch, Austria.
Department of Development Studies, University of Vienna, Vienna, Austria.
J Arthroplasty. 2018 May;33(5):1404-1411. doi: 10.1016/j.arth.2017.12.012. Epub 2017 Dec 21.
Navigated computer-assisted total knee arthroplasty (TKA) was introduced to expedite long-term survival based on improved postoperative implantation accuracy. However, long-term outcome data after 10 years or more are rare, even available meta-analyses show controversial study results.
In a prospective randomized trial, 100 conventional TKAs (group CONV) were compared with 100 computer-assisted TKAs (group NAV) after a mean follow-up of 12 years postoperatively. A long-leg weight-bearing X-ray was performed for measuring mechanical axis of the limb, lateral distal femoral angle, and medial proximal tibial angle. Tibial slope, patella alpha angle, and radiolucent lines were also observed. Clinical investigation included evaluation of 4 different scores: Insall Knee Score, Western Ontario and MacMaster University Index score, Hospital for Special Surgery Knee Score, and visual analog scale.
Based on a follow-up rate of at least 75%, no difference in TKA survival was found 12 years postoperatively: 91.5% in group CONV vs 98.2% in group NAV (P = .181). Since 5-year follow-up, no additional TKA revision had been performed in both groups. Group CONV showed a nonsignificant higher inaccuracy of neutral lower limb axis (1.8° ± 1.4°) compared to group NAV (1.6° ± 1.7°, P = .700). All X-ray assessments were not significant different within both study groups (P ≥ .068). Clinical examination showed no differences in evaluations (P ≥ .204). All collected outcome score results were similar (P ≥ .222).
Twelve years postoperatively, no differences were found in terms of long-term survival, implantation accuracy, clinical outcome or score results.
导航计算机辅助全膝关节置换术（TKA）的引入是基于提高术后植入精度来加快长期生存率。然而，超过 10 年或更长时间的长期结果数据很少，即使可用的荟萃分析也显示出有争议的研究结果。
在一项前瞻性随机试验中，100 例常规 TKA（CONV 组）与 100 例计算机辅助 TKA（NAV 组）进行比较，术后平均随访 12 年。进行长腿负重 X 线检查，以测量肢体机械轴、外侧远端股骨角和内侧近端胫骨角。还观察了胫骨倾斜角、髌骨 α 角和放射性透明线。临床研究包括评估 4 种不同的评分：Insall 膝关节评分、西安大略和麦克马斯特大学指数评分、特种外科医院膝关节评分和视觉模拟评分。
基于至少 75%的随访率，术后 12 年 TKA 生存率无差异：CONV 组为 91.5%，NAV 组为 98.2%（P=.181）。自 5 年随访以来，两组均未进行额外的 TKA 翻修。CONV 组下肢中立轴的不准确程度（1.8°±1.4°）明显高于 NAV 组（1.6°±1.7°，P=.700）。两组的所有 X 射线评估均无显著差异（P≥.068）。临床检查显示评估结果无差异（P≥.204）。所有收集的结果评分结果相似（P≥.222）。
术后 12 年，在长期生存率、植入精度、临床结果或评分结果方面均无差异。
