Held Michael B, Grosso Matthew J, Gazgalis Anastasia, Sarpong Nana O, Boddapati Venkat, Neuwirth Alexander, Geller Jeffrey A
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
Arthroplast Today. 2021 Jan 30;7:130-134. doi: 10.1016/j.artd.2020.12.022. eCollection 2021 Feb.
Robot-assisted surgery was developed to improve accuracy and outcomes in total knee arthroplasty (TKA). One important determinant of TKA success is a well-balanced knee throughout the range of motion. The purpose of this study is to determine if robot-assisted TKA (RA-TKA) results in improved intracompartmental ligament balance compared with conventional jig-based instrumentation (CM-TKA).
This retrospective cohort study included 2 cohorts-a CM-TKA (n = 49) vs RA-TKA (n = 37) cohort. Demographic and intraoperative data, including intraoperative compartment loads, were measured after final implant implantation in extension (10°), mid-flexion (45°), and full flexion (90°), using an intraoperative compartment pressure sensor. An a priori power analysis revealed our study exhibited >80% power in detecting a 5-pound (lb) difference in compartment loads in the 2 cohorts.
There was no difference between medial and lateral compartment loads in extension, mid-flexion, and full flexion for the conventional (15.1 lbs, 15.9 lbs, and 13.4 lbs, respectively) vs RA-TKA (14.2 lbs, 15.1 lbs, and 10.3 lbs, respectively). The percentage of patients with high load compartment pressure in flexion (>40 lbs) by the conclusion of the surgery was significantly greater for the conventional (18%) vs the robotic TKA cohort (3%, = .025). The percentage of patients with unbalanced knees (>20 lbs differential between medial and lateral compartments) in flexion was significantly greater in the conventional (24%) vs robotic TKA cohort (5%, = .018).
In this series, RA-TKA resulted in improved intraoperative compartment balancing in flexion with no observed difference in mid-flexion and extension compared with CM-TKA.
机器人辅助手术旨在提高全膝关节置换术（TKA）的准确性和手术效果。TKA成功的一个重要决定因素是膝关节在整个活动范围内保持良好的平衡。本研究的目的是确定与传统的基于夹具的器械辅助TKA（CM-TKA）相比，机器人辅助TKA（RA-TKA）是否能改善关节内韧带平衡。
这项回顾性队列研究包括两个队列——CM-TKA队列（n = 49）和RA-TKA队列（n = 37）。在最终植入物植入后，使用术中腔室压力传感器在伸直位（10°）、中屈曲位（45°）和全屈曲位（90°）测量人口统计学和术中数据，包括术中腔室负荷。一项预先的功效分析显示本研究在检测两个队列之间腔室负荷5磅（lb）的差异时具有>80%的功效。
传统TKA（分别为15.1磅、15.9磅和13.4磅）与RA-TKA（分别为14.2磅、15.1磅和10.3磅）在伸直位、中屈曲位和全屈曲位时，内侧和外侧腔室负荷无差异。手术结束时，屈曲时高负荷腔室压力（>40磅）的患者百分比，传统TKA队列（18%）显著高于机器人辅助TKA队列（3%，P = 0.025）。屈曲时膝关节不平衡（内侧和外侧腔室之间差异>20磅）的患者百分比，传统TKA队列（2%）显著高于机器人辅助TKA队列（5%，P = 0.018）。
在本系列研究中，与CM-TKA相比，RA-TKA在屈曲时改善了术中腔室平衡，在中屈曲位和伸直位未观察到差异。
