Marchand Robert C, Scholl Laura, Taylor Kelly B, Erwin Daniel J, Bhowmik-Stoker Manoshi, Chen Zhongming, Salem Hytham S, Mont Michael A
Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island.
South County Health, South Kingston, Rhode Island.
J Knee Surg. 2023 Dec;36(14):1462-1466. doi: 10.1055/s-0042-1759790. Epub 2023 Jan 19.
Computed tomography (CT) scan-based three-dimensional (3D) modeling operative technology has been shown to improve upon results of manual total knee arthroplasties (TKAs). Although there are many reports on superior precision of this CT-based technology, there has been continuing interest regarding extended clinical outcomes. The purpose of this study was to compare their clinical outcomes with manual TKAs at approximately 3-year follow-up. Specifically, we analyzed: (1) survivorship, (2) functional outcomes, (3) complications, and (4) radiographic outcomes (i.e., alignment, progressive radiolucencies). A total of 210 patients receiving CT-based TKAs performed by a single surgeon at a single center between July 1, 2016, and February 16, 2018, were compared with 210 manual TKAs completed by the same surgeon immediately preceding implementation of the CT-based technology. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) surveys were collected at ∼3 years postoperatively. Subgroup analyses of pain and physical function scores were performed. Follow-up radiographs were evaluated for alignment, loosening, and/or progressive radiolucencies. There was 100% survivorship at final follow-up. The postoperative mean pain scores for the CT-based cohort and manual cohort were 1 ± 2 (range, 0-14) and 2 ± 3 (range, 0-17), respectively ( < 0.05). The postoperative mean physical function scores for the CT-based cohort and manual cohort were 3 ± 4 (range, 0-18) and 5 ± 5 (range, 0-19), respectively ( < 0.05). The postoperative mean total WOMAC scores for the CT-based cohort and manual cohort were 5 ± 4 (range, 0-32) and 7 ± 8 (range, 0-35), respectively ( < 0.05). There were low numbers of postoperative complications at final follow-up in either cohort. None exhibited progressive radiolucencies by final follow-up. The 3-year postoperative clinical outcomes support excellent survivorship and radiographic outcomes, low complication rates, as well as improved pain, physical function, and total WOMAC scores for CT-based TKAs. Therefore, patients who undergo CT-based 3D modeling TKAs should expect to have superior long-term clinical outcomes.
基于计算机断层扫描（CT）的三维（3D）建模手术技术已被证明可改善人工全膝关节置换术（TKA）的效果。尽管有许多关于这种基于CT技术的高精度报道，但人们对其长期临床结果仍持续关注。本研究的目的是在大约3年的随访期内比较其与人工TKA的临床结果。具体而言，我们分析了：（1）假体生存率，（2）功能结果，（3）并发症，以及（4）影像学结果（即对线、进行性透亮线）。将2016年7月1日至2018年2月16日期间在单一中心由同一位外科医生进行的210例基于CT的TKA患者与在基于CT的技术实施前由同一位外科医生完成的210例人工TKA患者进行比较。在术后约3年收集西安大略和麦克马斯特大学骨关节炎指数（WOMAC）调查结果。对疼痛和身体功能评分进行亚组分析。对随访X线片进行对线、松动和/或进行性透亮线评估。最终随访时假体生存率为100%。基于CT的队列和人工队列的术后平均疼痛评分分别为1±2（范围0 - 14）和2±3（范围0 - 17）（P<0.05）。基于CT的队列和人工队列的术后平均身体功能评分分别为3±4（范围0 - 18）和5±5（范围0 - 19）（P<0.05）。基于CT的队列和人工队列的术后平均WOMAC总评分分别为5±4（范围0 - 32）和7±8（范围0 - 35）（P<0.05）。两个队列在最终随访时术后并发症数量均较少。到最终随访时，无一例出现进行性透亮线。术后3年的临床结果支持基于CT的TKA具有出色的假体生存率和影像学结果、低并发症发生率，以及在疼痛、身体功能和WOMAC总评分方面的改善。因此，接受基于CT的3D建模TKA的患者有望获得更好的长期临床结果。
