University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore, Singapore.
J Knee Surg. 2021 Aug;34(10):1064-1075. doi: 10.1055/s-0040-1701440. Epub 2020 Mar 17.
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.
本研究旨在提供一项最新的系统评价和荟萃分析，比较使用机器人辅助或传统方法进行全膝关节置换术（TKA）和单髁膝关节置换术（UKA）的影像学和功能结果，这是基于最新的证据综合得出的。本研究根据 PRISMA（系统评价和荟萃分析的首选报告项目）和 MOOSE（观察性研究的荟萃分析流行病学）指南进行。在 PubMed、EMBASE、Medline 和 Cochrane 中，所有报告 TKA 或 UKA 后使用机器人或传统方法的影像学和功能结果的研究均纳入了本综述。随机效应、成对荟萃分析的选择终点包括手术细节、影像学结果（机械轴、部件角度偏差和异常值）和功能结果（美国膝关节协会评分、膝关节协会功能评分、翻修和并发症率、活动范围（ROM）、特殊外科医院评分和西部安大略省和麦克马斯特大学骨关节炎指数）。从最初的搜索中，共纳入了 23 项研究，包括 2765 个膝关节。机器人辅助 TKA 和 UKA 与更好的部件角度对准准确性相关（低至高质量证据），但手术时间明显更长。与传统 UKA 相比，机器人辅助 UKA 发现具有明显更好的短期功能结果（中至高质量证据）。然而，机器人辅助 TKA 与传统 TKA 相比，在短期和中期主观膝关节结果评分方面没有表现出明显更好的结果（高质量证据）。机器人辅助 TKA 和 UKA 与非统计学上显著改善的 ROM 和较低的翻修率相关。与传统方法相比，机器人辅助全膝关节和单髁膝关节置换术在影像学结果方面表现更好，在中期和长期功能结果方面没有显著差异。需要更大的前瞻性研究来进一步证实本研究的结果。
