Wu Xiang-Dong, Zhou Yixin, Shao Hongyi, Yang Dejin, Guo Sheng-Jie, Huang Wei
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
EFORT Open Rev. 2023 Jan 27;8(1):18-25. doi: 10.1530/EOR-22-0105.
During the past decades, robotic-assisted technology has experienced an incredible advancement in the field of total joint arthroplasty (TJA), which demonstrated promise in improving the accuracy and precision of implantation and alignment in both primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, revision TJA remains a technically challenging procedure with issues of large-scale bone defects and damage to nearby anatomical structures. Thus, surgeons are trying to harness the abilities of robotic-assisted technology for revision TJA surgery.
PubMed, Embase, Cochrane Library, and Google Scholar were comprehensively searched to identify relevant publications that reported the application of robotic-assisted technology in revision TJA.
Overall, ten studies reported the use of the robotic system in revision TJA, including active (ROBODOC) and semi-active (MAKO and NAVIO) systems. One clinical case reported conversion from hip fusion to THA, and three studies reported revision from primary THA to revision THA. Moreover, four studies reported that robotic-assisted technology is helpful in revising unicompartmental knee arthroplasty (UKA) to TKA, and two case reports converted primary TKA to revision TKA. In this study, we present the latest evolvements, applications, and technical obstacles of robotic-assisted technology in the revision of TJA and the current state-of-the-art.
Current available evidence suggests that robotic-assisted technology may help surgeons to reproducibly perform preoperative plans and accurately achieve operative targets during revision TJA. However, concerns remain regarding preoperative metal artifacts, registration techniques, closed software platforms, further bone loss after implant removal, and whether robotic-assisted surgery will improve implant positioning and long-term survivorship.
在过去几十年中,机器人辅助技术在全关节置换术(TJA)领域取得了惊人的进展,这在初次全髋关节置换术(THA)和全膝关节置换术(TKA)中显示出提高植入和对线准确性及精度的前景。然而,翻修TJA仍然是一项技术上具有挑战性的手术,存在大规模骨缺损和附近解剖结构损伤的问题。因此,外科医生正试图利用机器人辅助技术进行翻修TJA手术。
全面检索了PubMed、Embase、Cochrane图书馆和谷歌学术,以识别报告机器人辅助技术在翻修TJA中应用的相关出版物。
总体而言,十项研究报告了机器人系统在翻修TJA中的应用,包括主动(ROBODOC)和半主动(MAKO和NAVIO)系统。一项临床病例报告了从髋关节融合转换为THA,三项研究报告了从初次THA翻修为翻修THA。此外,四项研究报告机器人辅助技术有助于将单髁膝关节置换术(UKA)翻修为TKA,两项病例报告将初次TKA转换为翻修TKA。在本研究中,我们展示了机器人辅助技术在TJA翻修中的最新进展、应用和技术障碍以及当前的技术水平。
目前可得的证据表明,机器人辅助技术可能有助于外科医生在翻修TJA期间可重复地执行术前计划并准确实现手术目标。然而,对于术前金属伪影、配准技术、封闭软件平台、植入物取出后的进一步骨丢失以及机器人辅助手术是否会改善植入物定位和长期生存率仍存在担忧。