Riantho Albert, Butarbutar John Christian Parsaoran, Fidiasrianto Kevin, Elson Elson, Irvan Irvan, Haryono Handy, Prasetio Jeremy Nathan
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia.
JB JS Open Access. 2023 May 15;8(2). doi: 10.2106/JBJS.OA.23.00010. eCollection 2023 Apr-Jun.
Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis. Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robot-assisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA.
We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models.
A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, -0.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups.
Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
全膝关节置换术（TKA）长期以来一直被视为膝关节骨关节炎的确定性治疗方法。尽管传统TKA的手术技术有了巨大改进，但由于TKA后出现中度至重度疼痛和僵硬，患者的不满意率仍然很高。机器人辅助TKA作为传统TKA的替代方法而被开发出来，目的是提高手术精度并以最小的术后并发症产生更好的临床结果。本研究的目的是比较机器人辅助TKA和传统TKA之间的影像学结果、手术持续时间和并发症发生率。
我们使用特定关键词对Medline、Scopus、ClinicalTrials.gov和Cochrane图书馆数据库进行了相关文献检索。连续变量的结果汇总为平均差异，而二分变量的结果汇总为具有95%置信区间的比值比，采用随机效应模型。
共纳入12项随机临床试验。我们的汇总分析显示，与传统TKA相比，机器人辅助TKA在髋-膝-踝（HKA）角（p < 0.0001）、股骨组件（冠状面）角（p = 0.0006）、股骨组件（矢状面）角（p = 0.009）、胫骨组件（冠状面）角（p = 0.05）和胫骨组件（矢状面）角（p = 0.01）方面的异常值较少。机器人辅助TKA组术后HKA角也明显更接近中立位（平均差异，-0.77°；p < 0.0001）。然而，两组之间的并发症发生率没有显著差异。
如几个关节角度的异常值较少所示，机器人辅助TKA可能比传统TKA产生更准确的假体组件放置和更好的关节对线精度。
治疗性I级。有关证据水平的完整描述，请参阅作者指南。
Zotero 插件
