Doan Gary W, Courtis R Patrick, Wyss Joseph G, Green Eric W, Clary Chadd W
Center for Orthopaedic Biomechanics, University of Denver, Denver, CO.
DePuy-Synthes, Raynham, MA.
J Arthroplasty. 2022 Apr;37(4):795-801. doi: 10.1016/j.arth.2021.12.035. Epub 2022 Jan 1.
Improving resection accuracy and eliminating outliers in total knee arthroplasty (TKA) is important to improving patient outcomes regardless of alignment philosophy. Robotic-assisted surgical systems improve resection accuracy and reproducibility compared to conventional instrumentation. Some systems require preoperative imaging while others rely on intraoperative anatomic landmarks. We hypothesized that the alignment accuracy of a novel image-free robotic-assisted surgical system would be equivalent or better than conventional instrumentation with fewer outliers.
Forty cadaveric specimens were used in this study. Five orthopedic surgeons performed 8 bilateral TKAs each, using the VELYS Robotic-Assisted System (DePuy Synthes) and conventional instrumentation on contralateral knees. Pre-resection and postresection computed tomography scans, along with optical scans of the implant positions were performed to quantify resection accuracies relative to the alignment targets recorded intraoperatively.
The robotic-assisted cohort demonstrated smaller resection errors compared to conventional instrumentation in femoral coronal alignment (0.63° ± 0.50° vs 1.39° ± 0.95°, P < .001), femoral sagittal alignment (1.21° ± 0.90° vs 3.27° ± 2.51°, P < .001), and tibial coronal alignment (0.93° ± 0.72° vs 1.65° ± 1.29°, P = .001). All other resection angle accuracies were equivalent. Similar improvements were found in the femoral implant coronal alignment (0.89° ± 0.82° vs 1.42° ± 1.15°, P = .011), femoral implant sagittal alignment (1.51° ± 1.08° vs 2.49° ± 2.10°, P = .006), and tibial implant coronal alignment (1.31° ± 0.84° vs 2.03° ± 1.44°, P = .004). The robotic-assisted cohort had fewer outliers (errors >3°) for all angular resection alignments.
This in vitro study demonstrated that image-free robotic-assisted TKA can improve alignment accuracy compared to conventional instrumentation and reduce the incidence of outliers.
无论采用何种对线理念，提高全膝关节置换术（TKA）的截骨精度并消除异常值对于改善患者预后都很重要。与传统器械相比，机器人辅助手术系统可提高截骨精度和可重复性。一些系统需要术前成像，而其他系统则依赖术中解剖标志。我们假设一种新型无图像机器人辅助手术系统的对线精度将等同于或优于传统器械，且异常值更少。
本研究使用了40个尸体标本。5名骨科医生分别使用VELYS机器人辅助系统（DePuy Synthes）和传统器械对40个对侧膝关节各进行8次双侧TKA手术。在截骨前和截骨后进行计算机断层扫描，并对植入物位置进行光学扫描，以量化相对于术中记录的对线目标的截骨精度。
与传统器械相比，机器人辅助组在股骨冠状面对线（0.63°±0.50°对1.39°±0.95°，P<.001）、股骨矢状面对线（1.21°±0.90°对3.27°±2.51°，P<.001）和胫骨冠状面对线（0.93°±0.72°对1.65°±1.29°，P=.001）方面的截骨误差更小。所有其他截骨角度精度相当。在股骨植入物冠状面对线（0.89°±0.82°对1.42°±1.15°，P=.011）、股骨植入物矢状面对线（1.51°±1.08°对2.49°±2.10°，P=.006）和胫骨植入物冠状面对线（1.31°±0.84°对2.03°±1.44°，P=.004）方面也发现了类似的改善。机器人辅助组在所有角度截骨对线中异常值（误差>3°）更少。
这项体外研究表明，与传统器械相比，无图像机器人辅助TKA可提高对线精度并降低异常值的发生率。
