Orthopaedic Surgery, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Orthopaedic Surgeon, Noorderhart, 3900, Pelt, Belgium.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5501-5506. doi: 10.1007/s00402-023-04834-w. Epub 2023 Mar 21.
The aim of this study was to examine if robotic-assisted total knee arthroplasty (RATKA) is cost- and time-effective in terms of implant stock and perioperative parameters, as optimizing perioperative efficiency may contribute to value-based care.
Four hundred thirty-two consecutive patients who received primary total knee arthroplasties (TKAs) from May 2017 to March 2020 in a regional hospital were included in this study. Operating room time (OR time), surgical time, number of trays, insert thickness, and length of stay (LOS) were assessed and compared for a cohort group with navigation-assisted procedures to a group with robotic-assisted procedures (MAKO, Stryker, USA). Prediction of implant size was assessed for the robotic-assisted group. The Mann-Whitney U test was used for comparisons between groups when the normality assumption was not met. Categorical variables were assessed using the Fisher's exact test. p < 0.05 was considered statistically significant.
In the RATKA group, we noticed a significant mean reduction of 11 min in total OR time (p < 0.001), the use of thinner insert (p < 0.001), and a shorter mean length of stay of 1 day (p < 0.001). Compared to the navigation group, surgical time was not significantly longer, nor clinically relevant (0.238). In 76.9% of the robotic-assisted cases, the estimated implant size was equal to the final size and in all other cases, the preoperative implant size was oversized.
The introduction of the MAKO robotic-assisted total knee arthroplasty resulted in a gain in operating room time, a thinner and more predictable insert thickness, a shorter length of stay in hospital, and less instrumentation compared to navigation-assisted procedures. Level of evidence Level III, Retrospective cohort study.
本研究旨在探讨机器人辅助全膝关节置换术（RATKA）在假体库存和围手术期参数方面是否具有成本效益和时间效益，因为优化围手术期效率可能有助于基于价值的护理。
本研究纳入了 2017 年 5 月至 2020 年 3 月在一家地区医院接受初次全膝关节置换术（TKA）的 432 例连续患者。评估并比较了一组接受导航辅助手术的患者和一组接受机器人辅助手术（MAKO，Stryker，美国）的患者的手术室时间（OR 时间）、手术时间、器械盘数、植入物厚度和住院时间（LOS）。对机器人辅助组的假体尺寸预测进行了评估。当正态性假设不成立时，使用 Mann-Whitney U 检验进行组间比较。使用 Fisher's 确切检验评估分类变量。p<0.05 被认为具有统计学意义。
在 RATKA 组中，我们注意到总 OR 时间平均减少 11 分钟（p<0.001），植入物厚度变薄（p<0.001），平均住院时间缩短 1 天（p<0.001）。与导航组相比，手术时间没有明显延长，也没有临床意义（0.238）。在 76.9%的机器人辅助病例中，估计的假体尺寸与最终尺寸相等，在所有其他病例中，术前假体尺寸过大。
与导航辅助手术相比，引入 MAKO 机器人辅助全膝关节置换术可增加手术室时间，植入物更薄且更可预测，住院时间更短，器械使用更少。证据等级 III，回顾性队列研究。
