Zak Stephen Gerard, Yeroushalmi David, Tang Alex, Meftah Morteza, Schnaser Erik, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, New York.
Desert Orthopedic Center, Eisenhower Medical Center, Rancho Mirage, California.
J Knee Surg. 2023 Mar;36(4):439-444. doi: 10.1055/s-0041-1735313. Epub 2021 Sep 16.
The use of intraoperative technology (IT), such as computer-assisted navigation (CAN) and robot-assisted surgery (RA), in total knee arthroplasty (TKA) is increasingly popular due to its ability to enhance surgical precision and reduce radiographic outliers. There is disputing evidence as to whether IT leads to better clinical outcomes and reduced postoperative pain. The purpose of this study was to determine if use of CAN or RA in TKA improves pain outcomes. This is a retrospective review of a multicenter randomized control trial of 327 primary TKAs. Demographics, surgical time, IT use (CAN/RA), length of stay (LOS), and opioid consumption (in morphine milligram equivalents) were collected. Analysis was done by comparing IT ( = 110) to a conventional TKA cohort ( = 217). When accounting for demographic differences and the use of a tourniquet, the IT cohort had shorter surgical time (88.77 ± 18.57 vs. 98.12 ± 22.53 minutes; = 0.005). While postoperative day 1 pain scores were similar ( = 0.316), the IT cohort has less opioid consumption at 2 weeks ( = 0.006) and 1 month ( = 0.005) postoperatively, but not at 3 months ( = 0.058). When comparing different types of IT, CAN, and RA, we found that they had similar surgical times ( = 0.610) and pain scores ( = 0.813). Both cohorts had similar opioid consumption at 2 weeks ( = 0.092), 1 month ( = 0.058), and 3 months ( = 0.064) postoperatively. The use of IT in TKA does not yield a clinically significant reduction in pain outcomes. There was also no difference in pain or perioperative outcomes between CAN and RA technology used in TKA.
在全膝关节置换术（TKA）中，诸如计算机辅助导航（CAN）和机器人辅助手术（RA）等术中技术（IT）的应用越来越普遍，因为其能够提高手术精度并减少影像学异常情况。关于IT是否能带来更好的临床效果和减轻术后疼痛，存在有争议的证据。本研究的目的是确定在TKA中使用CAN或RA是否能改善疼痛结局。这是一项对327例初次TKA的多中心随机对照试验的回顾性研究。收集了人口统计学数据、手术时间、IT使用情况（CAN/RA）、住院时间（LOS）和阿片类药物消耗量（以吗啡毫克当量计）。通过将IT组（n = 110）与传统TKA队列（n = 217）进行比较来进行分析。在考虑人口统计学差异和止血带使用情况后，IT组的手术时间更短（88.77 ± 18.57分钟 vs. 98.12 ± 22.53分钟；P = 0.005）。虽然术后第1天的疼痛评分相似（P = 0.316），但IT组在术后2周（P = 0.006）和1个月（P = 0.005）时的阿片类药物消耗量较少，但在3个月时没有差异（P = 0.058）。在比较不同类型的IT、CAN和RA时，我们发现它们的手术时间相似（P = 0.610）且疼痛评分相似（P = 0.813）。两组在术后2周（P = 0.
