Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
J Arthroplasty. 2021 Jul;36(7S):S227-S232. doi: 10.1016/j.arth.2020.11.001. Epub 2020 Nov 6.
There is debate regarding whether the use of computer-assisted technology, such as navigation and robotics, has any benefit on outcomes or patient-reported outcome measures (PROMs) following total knee arthroplasty (TKA). This study aims to report on the association between intraoperative use of technology and outcomes in patients who underwent primary TKA.
We retrospectively reviewed 7096 patients who underwent primary TKA from 2016-2020. Patients were stratified depending on the technology utilized: navigation, robotics, or no technology. Patient demographics, clinical data, Forgotten Joint Score-12 (FJS), and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) were collected at various time points up to 1-year follow-up. Demographic differences were assessed with chi-square and ANOVA. Clinical data and PROMs were compared using univariate ANCOVA, controlling for demographic differences.
A total of 287(4%) navigation, 367(5%) robotics, and 6442(91%) manual cases were included. Surgical-time significantly differed between the three groups (113.33 vs 117.44 vs 102.11; P < .001). Discharge disposition significantly differed between the three groups (P < .001), with more manual TKA patients discharged to a skilled nursing facility (12% vs 8% vs 15%; P < .001) than those who had technology utilized. FJS scores did not statistically differ at three-months (P = .067) and one-year (P = .221). We found significant statistical differences in three-month KOOS, JR scores (59.48 vs 60.10 vs 63.64; P = .001); however, one-year scores did not statistically differ between all groups (P = .320).
This study demonstrates shorter operative-time in cases with no utilization of technology and clinically similar PROMs associated with TKAs performed between all modalities. While the use of technology may aid surgeons, it has not currently translated to better short-term outcomes.
Retrospective Cohort.
关于在全膝关节置换术（TKA）后使用计算机辅助技术（如导航和机器人技术）是否对结果或患者报告的结果测量（PROM）有任何益处，存在争议。本研究旨在报告在接受初次 TKA 的患者中，术中使用技术与结果之间的关联。
我们回顾性分析了 2016 年至 2020 年期间接受初次 TKA 的 7096 例患者。根据使用的技术将患者分层：导航、机器人技术或无技术。收集患者的人口统计学数据、临床数据、遗忘关节评分 12 分（FJS）和膝关节损伤和骨关节炎结果评分-关节置换（KOOS，JR），随访时间最长为 1 年。使用卡方检验和 ANOVA 评估人口统计学差异。使用单变量协方差分析（ANCOVA）比较临床数据和 PROM，控制人口统计学差异。
共纳入 287（4%）例导航、367（5%）例机器人和 6442（91%）例手动病例。三组之间的手术时间有显著差异（113.33 分钟 vs 117.44 分钟 vs 102.11 分钟；P<.001）。三组之间的出院安置有显著差异（P<.001），与使用技术的患者相比，更多的手动 TKA 患者出院至专业护理机构（12% vs 8% vs 15%；P<.001）。三个月时 FJS 评分无统计学差异（P=0.067），一年时无统计学差异（P=0.221）。我们发现三个月时 KOOS，JR 评分有显著的统计学差异（59.48 分 vs 60.10 分 vs 63.64 分；P=0.001）；然而，所有组在一年时的评分均无统计学差异（P=0.320）。
本研究表明，在没有使用技术的情况下，手术时间更短，与所有模式下进行的 TKA 相关的 PROM 也相似。虽然技术的使用可能有助于外科医生，但目前还没有转化为更好的短期结果。
证据等级 III：回顾性队列研究。
