在接受分期双侧膝关节置换术的同一患者中，机器人辅助与手动全膝关节置换术后患者报告结局的比较。
Comparison of patient reported outcomes after robotic versus manual total knee arthroplasty in the same patient undergoing staged bilateral knee arthroplasty.
作者信息
Mulpur Praharsha, Masilamani A B Suhas, Prakash Mrinal, Annapareddy Adarsh, Hippalgaonkar Kushal, Reddy A V Gurava
机构信息
Sunshine Bone and Joint Institute, Sunshine Hospitals, Hyderabad, India.
出版信息
J Orthop. 2022 Aug 19;34:111-115. doi: 10.1016/j.jor.2022.08.014. eCollection 2022 Nov-Dec.
BACKGROUND
Robotic-assisted total knee arthroplasty (RATKA) has been proven to improve accuracy of component positioning and reducing alignment target outliers. However, the clinical benefit of robotics is often debated. Recent studies have shown reduced pain and faster recovery in the immediate post-operative period and may be associated with improved PROMs and satisfaction. The aim of this study was to assess PROMs and satisfaction in a unique patient population undergoing bilateral staged TKA to compare manual (MTKA) and RATKA in the same patient.
METHODS
55 patients underwent bilateral staged TKA, performed by a single surgeon at a single institute. Patients who underwent TKA for the first knee with manual technique and RATKA for the second side, were eligible for inclusion in the study. Primary outcome assessed was the Oxford Knee Score and secondary outcomes included the Forgotten Joint Score (FJS), patient satisfaction, mean duration for independent ambulation after TKA, and patient perspectives on recovery evaluated with a questionnaire.
RESULTS
Both RATKA and MTKA were associated with comparable PROMs. Though RATKA was associated with improved joint perception (Mean FJS after MTKA surgery was 70.3 (SD = 10.66) and significantly lower than the mean FJS after RATKA (73, SD = 10.95, p-value < 0.01), but the difference was not clinically relevant. A higher proportion of patients were more likely to be very satisfied or satisfied after RATKA. A significant proportion of patients felt the knee operated with RATKA was less painful and felt more natural compared to MTKA at final follow-up (p < 0.01). Majority of patients would undergo RATKA again and recommend robotic-TKA to others.
CONCLUSION
Robotic-assisted surgery was associated with improved patient satisfaction, faster independent ambulation compared to manual techniques. PROMs however, were comparable without clinically significant differences. Patients preferred robotic-assisted surgery, with a significantly higher proportion perceiving knee operated by RATKA felt more natural.
背景
机器人辅助全膝关节置换术（RATKA）已被证明可提高假体定位的准确性并减少对线目标异常值。然而，机器人技术的临床益处常常存在争议。最近的研究表明，在术后即刻疼痛减轻且恢复更快，这可能与改善的患者报告结局测量指标（PROMs）和满意度相关。本研究的目的是评估在接受双侧分期全膝关节置换术（TKA）的独特患者群体中，比较同一患者接受手动全膝关节置换术（MTKA）和机器人辅助全膝关节置换术（RATKA）后的PROMs和满意度。
方法
55例患者接受了双侧分期TKA，由单一机构的一名外科医生进行手术。首次膝关节行手动技术TKA，第二次行RATKA的患者符合纳入本研究的条件。评估的主要结局是牛津膝关节评分，次要结局包括遗忘关节评分（FJS）、患者满意度、TKA后独立行走的平均持续时间，以及通过问卷调查评估的患者对恢复的看法。
结果
RATKA和MTKA均与相当的PROMs相关。尽管RATKA与改善的关节感知相关（MTKA术后平均FJS为70.3（标准差=10.66），显著低于RATKA术后的平均FJS（73，标准差=10.95，p值<0.01），但差异无临床意义。更高比例的患者在RATKA术后更有可能非常满意或满意。在末次随访时，相当比例的患者感觉RATKA手术的膝关节比MTKA疼痛更轻且感觉更自然（p<0.01）。大多数患者愿意再次接受RATKA手术并向他人推荐机器人辅助TKA。
结论
与手动技术相比，机器人辅助手术与更高的患者满意度、更快的独立行走相关。然而，PROMs相当，无临床显著差异。患者更喜欢机器人辅助手术，显著更高比例的患者感觉RATKA手术的膝关节更自然。
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