技术辅助全膝关节置换术与传统全膝关节置换术的应用及短期并发症比较
A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty.
作者信息
Simcox Trevor, Singh Vivek, Oakley Christian T, Barzideh Omid S, Schwarzkopf Ran, Rozell Joshua C
机构信息
Department of Orthopedic Surgery, NYU Langone Hospital - Long Island, Mineola, NY, USA.
Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
出版信息
Knee Surg Relat Res. 2022 Mar 18;34(1):14. doi: 10.1186/s43019-022-00143-5.
BACKGROUND
While technology-assisted total knee arthroplasty (TA-TKA) improves implant positioning, whether it confers improved clinical outcomes remains inconclusive. We sought to examine national TA-TKA utilization trends and to compare outcomes between TA-TKA and unassisted TKA (U-TKA).
METHODS
Patients who underwent primary, elective TKA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Demographic, perioperative, and 30-day outcomes were collected. Patients were stratified on the basis of whether they underwent TA-TKA, which included computer navigation and robotics, or U-TKA. The proportion of patients undergoing TKA using TA-TKA was calculated. One-to-one propensity-score matching paired patients undergoing TA-TKA or U-TKA. Independent samples t-tests and Mann-Whitney U tests were used to compare continuous variables, and chi-squared tests were used to compare categorical variables.
RESULTS
Of the 402,284 TKA patients, 10,429 (2.6%) cases were performed using TA-TKA. Comparing the unmatched TA-TKA and U-TKA groups, race (p < 0.001), smoking status (p = 0.050), baseline functional status (p < 0.001), and body mass index (BMI) (p < 0.001) significantly differed. Propensity-score matching yielded 8633 TA-TKA and U-TKA pairs. The TA-TKA cohort had shorter hospital length of stay (LOS) (2.7 ± 2.5 versus 2.8 ± 1.9 days, p = 0.017) but similar operative times (92.4 ± 33.4 versus 92.6 ± 39.8 min, p = 0.670). Compared with the U-TKA group, the TA-TKA group had lower major complication (7.6% versus 9.4%, p < 0.001) and transfusion (3.9% versus 5.1%, p < 0.001) rates and higher rates of discharge to home (73.9% versus 70.4%, p < 0.001). Reoperation and readmission rates did not significantly differ between groups.
CONCLUSIONS
TA-TKA utilization remains low among orthopedic surgeons. Compared with U-TKA, TA-TKA yielded improved perioperative and 30-day outcomes. Nonetheless, surgeons must consider the benefits and drawbacks of TA-TKA when determining the proper surgical technique and technology for each patient.
LEVEL III EVIDENCE
Retrospective cohort study.
背景
虽然技术辅助全膝关节置换术（TA-TKA）可改善植入物定位，但它是否能带来更好的临床效果仍无定论。我们试图研究全国TA-TKA的使用趋势，并比较TA-TKA与非辅助全膝关节置换术（U-TKA）的效果。
方法
使用美国外科医师学会国家外科质量改进计划（NSQIP）数据库识别2010年至2018年接受初次择期全膝关节置换术的患者。收集人口统计学、围手术期和30天的结果。患者根据是否接受TA-TKA（包括计算机导航和机器人技术）或U-TKA进行分层。计算使用TA-TKA进行全膝关节置换术的患者比例。一对一倾向评分匹配使接受TA-TKA或U-TKA的患者配对。采用独立样本t检验和曼-惠特尼U检验比较连续变量，采用卡方检验比较分类变量。
结果
在402,284例全膝关节置换术患者中，10,429例（2.6%）采用TA-TKA进行手术。比较未匹配的TA-TKA组和U-TKA组，种族（p < 0.001）、吸烟状况（p = 0.050）、基线功能状态（p < 0.001）和体重指数（BMI）（p < 0.001）有显著差异。倾向评分匹配产生了8633对TA-TKA和U-TKA。TA-TKA队列的住院时间较短（2.7±2.5天对2.8±1.9天，p = 0.017），但手术时间相似（92.4±33.4分钟对92.6±39.8分钟，p = 0.670）。与U-TKA组相比，TA-TKA组的主要并发症发生率（7.6%对9.4%，p < 0.001）和输血率（3.9%对5.1%，p < 0.001）较低，出院回家率较高（73.9%对70.4%，p < 0.001）。两组之间的再次手术率和再入院率没有显著差异。
结论
骨科医生中TA-TKA的使用率仍然较低。与U-TKA相比，TA-TKA在围手术期和30天的结果方面有所改善。尽管如此，外科医生在为每位患者确定合适的手术技术和技术时，必须考虑TA-TKA的利弊。
三级证据
回顾性队列研究。
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