Choi Byung Sun, Kim Sung Eun, Yang Myungho, Ro Du Hyun, Han Hyuk-Soo
Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):1072-1080. doi: 10.1007/s00167-022-07227-5. Epub 2022 Nov 15.
Given the improved accuracy of robot-assisted surgery, robotic-arm assisted functionally aligned total knee arthroplasty (RFA-TKA) aims to preserve the native pre-arthritic knee biomechanics, to achieve balanced flexion-extension gaps. The purpose of this study was to compare the accuracy of the implant position and short-term clinical outcomes of patients who underwent RFA-TKA vs. mechanically aligned total knee arthroplasty with manual technique (MA-TKA).
A prospectively collected database was reviewed retrospectively for patients who underwent primary TKA. Sixty patients who underwent RFA-TKA between February 2020 and July 2020 were included in the RFA-TKA group. Sixty patients who underwent MA-TKA were included via 1:1 matching for age, sex, and body mass index based on the RFA-TKA group. For radiological evaluation, knee X-rays were used to assess the functional knee phenotype and implant position accuracy by measuring the coronal and sagittal alignment, and these measurements were compared between the two groups. Patient demographic characteristics and patient-reported outcomes including Knee Society scores, Western Ontario and McMaster Universities Arthritis Index, and forgotten joint score-12 were compared between the groups.
Statistically significant differences were observed in postoperative 2-year clinical outcomes in favor of RFA-TKA group which showed greater accuracy in the tibial component sagittal alignment than MA-TKA (1.0 ± 2.3 vs. 0.7 ± 1.6, respectively; P < 0.001). However, outliers in the component positions were more common in the MA-TKA group, which was statistically significant for the femoral coronal and tibial sagittal alignments (P = 0.017 and 0.015, respectively).
Functional alignment in TKA could be accurately obtained with the assistance of a robotic arm, and the results showed greater 2 year postoperative patient-reported outcome and satisfaction than mechanically aligned TKA using manual instruments.
III.
鉴于机器人辅助手术的准确性提高，机械臂辅助功能对齐全膝关节置换术（RFA-TKA）旨在保留关节炎前膝关节的自然生物力学，以实现屈伸间隙平衡。本研究的目的是比较接受RFA-TKA与采用手动技术的机械对齐全膝关节置换术（MA-TKA）患者的植入物位置准确性和短期临床结果。
对前瞻性收集的数据库进行回顾性分析，纳入接受初次全膝关节置换术的患者。2020年2月至2020年7月期间接受RFA-TKA的60例患者纳入RFA-TKA组。基于RFA-TKA组，通过1:1匹配年龄、性别和体重指数，纳入60例接受MA-TKA的患者。对于影像学评估，使用膝关节X线片通过测量冠状面和矢状面排列来评估膝关节功能表型和植入物位置准确性，并比较两组的测量结果。比较两组患者的人口统计学特征和患者报告的结果，包括膝关节协会评分、西安大略和麦克马斯特大学关节炎指数以及遗忘关节评分-12。
观察到术后2年临床结果存在统计学显著差异，有利于RFA-TKA组，该组在胫骨部件矢状面对齐方面比MA-TKA组更准确（分别为1.0±2.3与0.7±1.6；P<0.001）。然而，MA-TKA组部件位置的异常值更常见，在股骨冠状面和胫骨矢状面对齐方面具有统计学显著性（分别为P=0.017和0.015）。
在机械臂辅助下，全膝关节置换术中的功能对齐可以准确实现，结果显示术后2年患者报告的结果和满意度高于使用手动器械的机械对齐全膝关节置换术。
III级。
