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向采用运动学对线的机器人全膝关节置换术的转变与较短的学习曲线和相似的急性期功能恢复相关。

Transition to Robotic Total Knee Arthroplasty With Kinematic Alignment is Associated With a Short Learning Curve and Similar Acute-Period Functional Recoveries.

作者信息

Morrisey Zachary S, Barra Matthew F, Guirguis Paul G, Drinkwater Christopher J

机构信息

Orthopedic Surgery, University of Rochester School of Medicine and Dentistry, Rochester, USA.

Orthopedic Surgery, University of Rochester Medical Center, Rochester, USA.

出版信息

Cureus. 2023 May 11;15(5):e38872. doi: 10.7759/cureus.38872. eCollection 2023 May.

Abstract

Background Robotic instruments are increasingly being used in total knee arthroplasty (TKA). The adoption of robotics has allowed surgeons a new level of precision and facilitated the adoption of a kinematic approach in TKA. We sought to examine one surgeon's transition from a traditional mechanical alignment technique to a modified kinematic approach by comparing short-term recovery outcomes of robotic TKA patients with those who underwent traditionally instrumented TKAs. Methodology We examined six-week and six-month postoperative data from 99 traditionally instrumented, mechanically aligned and 66 kinematically aligned robotic TKA patients between January 2021-October 2021 and October 2021-April 2022, respectively. Robotic surgery was performed with VELYS™ (DePuy Synthes, Warsaw, IN, USA) a semi-active, imageless, table-affixed, robotic TKA solution. Results Robotic and traditionally instrumented TKAs did not differ significantly in any functional outcome measures examined, including pain scores, use of assistive devices, or range of motion at six weeks postoperatively. Robotic TKA patients had a better range of motion in knee flexion than traditional TKA patients at six months postoperatively. There were no differences in surgical complications or rates of manipulation under anesthesia within one year postoperatively. Robotic surgery tourniquet times exhibited a steep drop off and equaled traditional methods after only two robotic surgeries were performed. Conclusions Transition to a kinematic, semi-active, robotic TKA demonstrated encouraging results by demonstrating acute-period recovery of function consistent with the current standard of care, as well as a better range of motion at six months postoperatively. The learning curve of this new-to-market device was shorter than previous research on the transition to robotic TKA. Clear advantages of transitioning to robotic instrumentation by any specific functional measure are yet to be elucidated. Further randomized trials are necessary to characterize long-term outcomes.

摘要

背景 机器人器械在全膝关节置换术(TKA)中的应用越来越广泛。机器人技术的应用使外科医生达到了新的精准水平,并促进了TKA中运动学方法的采用。我们试图通过比较机器人TKA患者与接受传统器械TKA患者的短期恢复结果,来研究一位外科医生从传统机械对线技术向改良运动学方法的转变。方法 我们分别检查了2021年1月至2021年10月以及2021年10月至2022年4月期间99例接受传统器械、机械对线的TKA患者和66例运动学对线的机器人TKA患者术后六周和六个月的数据。机器人手术采用VELYS™(美国印第安纳州华沙市的DePuy Synthes公司)进行,这是一种半主动、无图像、固定于手术台的机器人TKA解决方案。结果 在任何检查的功能结局指标方面,机器人TKA和传统器械TKA之间没有显著差异,包括疼痛评分、辅助设备的使用或术后六周的活动范围。机器人TKA患者术后六个月时膝关节屈曲活动范围比传统TKA患者更好。术后一年内手术并发症或麻醉下手法治疗率没有差异。机器人手术止血带时间急剧下降,仅进行两台机器人手术后就与传统方法相当。结论 向运动学、半主动机器人TKA的转变显示出令人鼓舞的结果,其急性期功能恢复与当前护理标准一致,且术后六个月活动范围更好。这种新上市设备的学习曲线比先前关于向机器人TKA转变的研究更短。尚未阐明通过任何特定功能指标向机器人器械转变的明显优势。需要进一步的随机试验来确定长期结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f306/10257342/07885318c477/cureus-0015-00000038872-i01.jpg

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