Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York.
CUNY School of Medicine, New York, New York.
J Knee Surg. 2022 Dec;35(14):1587-1594. doi: 10.1055/s-0041-1729548. Epub 2021 May 1.
Advanced imaging used in robotic-assisted total knee arthroplasty (TKA), such as computed tomography (CT)-based three-dimensional (3D) planning, may provide an accurate means of implant sizing preoperatively. The purpose of this study was to examine preoperative CT-based implant planning accuracy for robotic-assisted TKA in patients who have (1) varus deformities, (2) valgus deformities, (3) neutral alignment, and (4) retained hardware. A total of 393 patients underwent a robotic-assisted TKA by a single surgeon received preoperative CT scans. The surgeon reviewed the CT-based model preoperatively and recorded the expected size of the components. The final implants used in each case were recorded and compared with the surgeon's preoperative plan. In all groups of patients, the surgeon's CT-based implant plan was within one size of the implant utilized 100% of the time for both the tibiae and femora. Overall, the surgeon was exactly matched in 319 (81%) and 315 (80%) cases for the femoral and tibial components, respectively. For the femoral component, the mean age for patients in whom the original plan was exactly matched was younger than those whose implants were upsized and older than patients those implants were downsized ( = 0.024). Other patient demographics and preoperative knee alignment were not associated with predictive accuracy for femoral or tibial components. Our results demonstrate how preoperative CT-based, 3D planning for robotic-assisted TKA is accurate to within one size of the components in every case (100%), and exactly matched in 80%. The results of this study are important because they demonstrate how CT-based preoperative implant planning for TKA is reliable and accurate across all native knee alignments and other patient-specific factors. In addition, they build on a previous study by the same single surgeon, demonstrating that predictive ability can improve over time. This may be important as we move toward more outpatient surgery with less ability for prostheses inventory at ambulatory sites.
在机器人辅助全膝关节置换术（TKA）中使用的高级成像技术，如基于计算机断层扫描（CT）的三维（3D）规划，可以提供术前植入物尺寸的准确方法。本研究的目的是检查机器人辅助 TKA 术前 CT 基础植入物规划准确性，包括（1）内翻畸形、（2）外翻畸形、（3）中立对线和（4）保留内固定物的患者。共有 393 例由同一位外科医生进行机器人辅助 TKA 的患者接受了术前 CT 扫描。外科医生术前检查了基于 CT 的模型，并记录了组件的预期尺寸。每个病例中最终使用的植入物都被记录下来，并与外科医生的术前计划进行比较。在所有患者组中，外科医生基于 CT 的植入物计划在 100%的时间内与使用的植入物尺寸一致，无论是胫骨还是股骨。总体而言，在股骨和胫骨组件中，外科医生的原始计划完全匹配的病例分别为 319 例（81%）和 315 例（80%）。对于股骨组件，原始计划完全匹配的患者的平均年龄比植入物被放大的患者年轻，比植入物被缩小的患者年长（ = 0.024）。其他患者人口统计学和术前膝关节对线与股骨或胫骨组件的预测准确性无关。我们的结果表明，机器人辅助 TKA 的术前基于 CT 的 3D 规划在每种情况下（100%）都能准确到组件尺寸的 1 个尺寸内，并且在 80%的情况下完全匹配。这项研究的结果很重要，因为它们表明 TKA 的基于 CT 的术前植入物规划在所有自然膝关节对线和其他患者特定因素下都是可靠和准确的。此外，它们建立在同一位外科医生的先前研究基础上，表明预测能力可以随着时间的推移而提高。随着我们向更多的门诊手术发展，在门诊场所对假体库存的能力减少，这可能很重要。
