Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Hempstead, New York.
Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York.
J Knee Surg. 2022 Jul;35(8):849-857. doi: 10.1055/s-0040-1721123. Epub 2021 Jan 3.
Haptic robotic-arm-assisted total knee arthroplasty (RATKA) seeks to leverage three-dimensional planning, intraoperative assessment of ligament laxity, and guided bone preparation to establish and achieve patient-specific targets for implant position. We sought to compare (1) operative details, (2) knee alignment, (3) recovery of knee function, and (4) complications during adoption of this technique to our experience with manual TKA. We compared 120 RATKAs performed between December 2016 and July 2018 to 120 consecutive manual TKAs performed between May 2015 and January 2017. Operative details, lengths of stay (LOS), and discharge dispositions were collected. Tibiofemoral angles, Knee Society Scores (KSS), and ranges of motion were assessed until 3 months postoperatively. Manipulations under anesthesia, complications, and reoperations were tabulated. Mean operative times were 22 minutes longer in RATKA ( < 0.001) for this early cohort, but decreased by 27 minutes ( < 0.001) from the first 25 RATKA cases to the last 25 RATKA cases. Less articular constraint was used to achieve stability in RATKA (93 vs. 55% cruciate-retaining, < 0.001; 3 vs. 35% posterior stabilized (PS), < 0.001; and 4 vs. 10% varus-valgus constrained, _ = _0.127). RATKA had lower LOS (2.7 vs. 3.4 days, < 0.001). Discharge dispositions, tibiofemoral angles, KSS, and knee flexion angles did not differ, but manipulations were less common in RATKAs (4 vs. 17%, = 0.013). We observed less use of constraint, shorter LOS, and fewer manipulations under anesthesia in RATKA, with no increase in complications. Operative times were longer, particularly early in the learning curve, but improved with experience. All measured patient-centered outcomes were equivalent or favored the newer technique, suggesting that RATKA with patient-specific alignment targets does not compromise initial quality. Observed differences may relate to improved ligament balance or diminished need for ligament release.
触觉机器人辅助全膝关节置换术（RATKA）旨在利用三维规划、术中评估韧带松弛度以及引导骨准备来建立并实现患者特定的植入物位置目标。我们旨在将使用该技术的（1）手术细节、（2）膝关节对线、（3）膝关节功能恢复和（4）并发症与我们的手动 TKA 经验进行比较。我们将 2016 年 12 月至 2018 年 7 月期间进行的 120 例 RATKA 与 2015 年 5 月至 2017 年 1 月期间进行的 120 例连续手动 TKA 进行了比较。收集了手术细节、住院时间（LOS）和出院安排。评估了胫骨股骨角度、膝关节协会评分（KSS）和运动范围，直到术后 3 个月。记录了麻醉下的操作、并发症和再次手术。RATKA 的平均手术时间比早期队列长 22 分钟（<0.001），但从前 25 例 RATKA 到后 25 例 RATKA 减少了 27 分钟（<0.001）。在 RATKA 中，为了实现稳定性，使用了较少的关节约束（93%为保留交叉韧带，55%；3%为后稳定（PS），35%；4%为内翻-外翻约束，_=0.127）。RATKA 的 LOS 更短（2.7 比 3.4 天，<0.001）。出院安排、胫骨股骨角度、KSS 和膝关节屈曲角度没有差异，但 RATKA 中的麻醉下操作较少（4 比 17%，=0.013）。我们观察到 RATKA 中约束较少、LOS 较短、麻醉下操作较少，且并发症没有增加。手术时间较长，尤其是在学习曲线的早期，但随着经验的增加而改善。所有测量的以患者为中心的结果都是等效的，或者有利于新技术，这表明使用特定于患者的对准目标的 RATKA 不会损害初始质量。观察到的差异可能与改善的韧带平衡或减少的韧带松解需求有关。
