Department of Orthopaedic Surgery, Athens Orthopaedic Clinc, Athens, Georgia.
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, New York.
J Knee Surg. 2022 Feb;35(3):337-344. doi: 10.1055/s-0040-1715571. Epub 2020 Aug 31.
Component position of total knee arthroplasty (TKA) has been shown to influence prosthetic survivorships and clinical outcomes. Our objective was to compare the three-dimensional accuracy to plan of robotic-arm assisted TKA (RATKA) with conventional TKA for component position. We conducted a nonrandomized, prospective study comparing 143 RATKA with 86 conventional TKA operated at four U.S. centers between July 2016 and October 2018. Computed tomography (CT) scans obtained approximately 6 weeks postoperatively were analyzed using anatomical landmarks. Absolute deviation from surgical plans were defined as the absolute value of the difference between the CT measurements and surgeons' femoral and tibial component mechanical varus/valgus alignment, tibial component posterior slope, and femoral component internal/external rotation. Differences of absolute deviations were tested using stratified Wilcoxon's tests that controlled for study center. Patient-reported outcome measures collected through 1 postoperative year were modeled using multiple regression controlling for age, sex, body mass index, study center, and the preoperative score. RATKA demonstrated greater accuracy for tibial component alignment (median [25th, 75th percentiles] absolute deviation from plan of all centers combined for conventional vs. RA, 1.7 [0.9, 2.9] vs. 0.9 [0.4, 1.9] degrees, < 0.001), femoral component rotation (1.5 [0.9, 2.5] vs. 1.3 [0.6, 2.5] degrees, = 0.015), and tibial slope (2.9 [1.5, 5.0] vs. 1.1 [0.6, 2.0] degrees, < 0.001). In multivariable analyses, RATKA showed significantly greater Veterans RAND 12-item health survey (VR-12) physical component scores (adjusted mean difference [95% confidence interval (CI)]: 2.4 [0.2, 4.5] points, = 0.034) and qualitatively greater Knee Society (KS) composite functional scores (3.5 [-1.3, 8.2] points, = 0.159), though not statistically significant. Compared with conventional instrumentation, RATKA demonstrated greater three-dimensional accuracy to plan for various component positioning parameters and clinical improvements in physical status and function with no major safety concerns during the first postoperative year. These results may be attributed to the preoperative CT scan planning, real-time intraoperative feedback, and stereotactic-guided cutting that takes into consideration patient-specific bony anatomy. These findings support the use of RATKA for enhanced arthroplasty outcomes.
全膝关节置换术（TKA）的组件位置已被证明会影响假体的存活率和临床结果。我们的目的是比较机器人辅助 TKA（RATKA）与传统 TKA 在组件位置方面的三维准确性。我们进行了一项非随机、前瞻性研究，比较了 2016 年 7 月至 2018 年 10 月在美国四个中心进行的 143 例 RATKA 和 86 例传统 TKA。术后约 6 周获得的计算机断层扫描（CT）扫描使用解剖学标志进行分析。与外科医生股骨和胫骨组件机械内翻/外翻、胫骨组件后倾和股骨组件内/外旋转的测量值相比，手术计划的绝对偏差定义为 CT 测量值与外科医生的测量值之间的绝对值差异。使用分层 Wilcoxon 检验测试绝对偏差的差异，该检验控制了研究中心。通过 1 年后的多变量回归控制年龄、性别、体重指数、研究中心和术前评分，对患者报告的结果测量值进行建模。RATKA 在胫骨组件对齐方面表现出更高的准确性（所有中心组合的常规与 RA 的从计划的偏差绝对值中位数[25 分位，75 分位]，1.7 [0.9，2.9] 与 0.9 [0.4，1.9] 度， < 0.001）、股骨组件旋转（1.5 [0.9，2.5] 与 1.3 [0.6，2.5] 度， = 0.015）和胫骨斜率（2.9 [1.5，5.0] 与 1.1 [0.6，2.0] 度， < 0.001）。在多变量分析中，RATKA 显示出更高的退伍军人 RAND 12 项健康调查（VR-12）生理成分评分（调整平均差异[95%置信区间（CI）]：2.4 [0.2，4.5] 分， = 0.034）和更高的膝关节协会（KS）综合功能评分（3.5 [-1.3，8.2] 分， = 0.159），尽管没有统计学意义。与传统器械相比，RATKA 在各种组件定位参数方面表现出更高的三维准确性，并在生理状态和功能方面有临床改善，在术后第一年没有出现重大安全问题。这些结果可能归因于术前 CT 扫描规划、术中实时反馈和立体定向引导切割，考虑到患者特定的骨骼解剖结构。这些发现支持使用 RATKA 来提高关节置换术的效果。
