Clement Nicholas D, Al-Zibari Marwan, Afzal Irrum, Deehan David J, Kader Deiary
Department of Orthopaedics, Freeman Hospital, Newcastle, UK.
Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
EFORT Open Rev. 2020 May 9;5(5):319-326. doi: 10.1302/2058-5241.5.190065. eCollection 2020 May.
The aim of this systematic review was to present and assess the quality of evidence for learning curve, component positioning, functional outcomes and implant survivorship for imagefree hand-held roboticassisted knee arthroplasty.Searches of PubMed and Google Scholar were performed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The criteria for inclusion was any published fulltext article or abstract assessing imagefree hand-held robotic knee arthroplasty and reporting learning curve, implant positioning, functional outcome or implant survival for clinical or non-clinical studies.There were 22 studies included. Five studies reported the learning curve: all were for unicompartmental knee arthroplasty (UKA) - no learning curve for accuracy, operative time was reduced after five to 10 cases and a steady surgical time was achieved after eight cases.There were 16 studies reporting accuracy: rate of outliers was halved, higher rate of joint line and mechanical axis restoration, supported by low root mean square error values.Six studies reported functional outcome: all for UKA, improvement at six to 52 weeks, no difference from manual UKA except when assessed for lateral UKA which showed improved clinical outcomes.Two studies reported survivorship: one reported an unadjusted revision rate of 7% at 20 months for medial UKA and the other found a 99% two-year survival rate for UKA.There was evidence to support more accurate implant positioning for UKA, but whether this is related to superior functional outcomes or improved implant survivorship was not clear and further studies are required. Cite this article: 2020;5:319-326. DOI: 10.1302/2058-5241.5.190065.
本系统评价的目的是呈现并评估无影像手持式机器人辅助膝关节置换术的学习曲线、组件定位、功能结果和植入物生存率的证据质量。按照系统评价和Meta分析的首选报告项目声明，对PubMed和谷歌学术进行了检索。纳入标准为任何已发表的评估无影像手持式机器人膝关节置换术并报告临床或非临床研究的学习曲线、植入物定位、功能结果或植入物生存率的全文文章或摘要。共纳入22项研究。5项研究报告了学习曲线：均针对单髁膝关节置换术（UKA）——准确性方面无学习曲线，5至10例手术后手术时间缩短，8例手术后手术时间趋于稳定。16项研究报告了准确性：异常值率减半，关节线和机械轴恢复率更高，均得到较低的均方根误差值支持。6项研究报告了功能结果：均针对UKA，术后6至52周有改善，与手动UKA无差异，但外侧UKA评估时显示临床结果有所改善。2项研究报告了生存率：一项报告内侧UKA在20个月时未调整的翻修率为7%，另一项发现UKA的两年生存率为99%。有证据支持UKA植入物定位更准确，但这是否与更好的功能结果或更高的植入物生存率相关尚不清楚，需要进一步研究。引用本文：2020；5：319 - 326。DOI：10.1302/2058 - 5241.5.190065。
