Ollivier Britt, Vandenneucker Hilde, Vermue Hannes, Luyckx Thomas
Department of Orthopaedics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Louvain, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4747-4754. doi: 10.1007/s00167-023-07504-x. Epub 2023 Jul 18.
Strategies to further improve patient satisfaction after total knee arthroplasty include the introduction of new alignment philosophies and more precise instruments such as navigation and robotics. The aim of this study was to investigate the effect of a combination of image-based robotic assistance and the use of modern alignment strategies on the resulting joint line obliquity as well as femoral component rotation and to compare this between varus, neutral and valgus knees.
This retrospective study included 200 patients who received a robotic-assisted total knee arthroplasty (MAKO, Stryker) using functional alignment between 2018 and 2020. The patients were divided into a varus (103 patients), neutral (57 patients) and valgus (40 patients) group. The intraoperatively recorded bone cuts and resulting joint line obliquity were identified and compared to values obtained with a robotic computer simulation of kinematic alignment.
The mean femoral coronal alignment of the varus, neutral and valgus group, respectively, equalled 0.5° (± 1.1°), 1.1° (± 0.8°) and 1.6° (± 0.7°) of valgus with functional alignment and 2.1° (± 2.1°), 4.1° (± 1.7°) and 6.2° (± 1.7°) of valgus with kinematic alignment. The mean femoral axial alignment of the valgus group resulted in 0.8° (± 2.0°) of internal rotation with functional alignment and 3.9° (± 2.8°) of internal rotation with kinematic alignment. Overall, 186 knees (93%) could be balanced while respecting certain safe zones by using functional alignment as opposed to 54 knees (27% and none in the valgus group) when applying kinematic alignment. Kinematic alignment led to a combination of femoral component valgus and internal rotation of more than 3° in 22 valgus knees (55%), 10 neutral knees (18%) and 3 varus knees (3%) compared to none in each group when applying functional alignment with safe zones.
Robotic-assisted kinematic alignment leads to a combination of excessive valgus and internal rotation of the femoral component in valgus and to a lesser extent also in neutral knees when compared with functional alignment.
IV.
进一步提高全膝关节置换术后患者满意度的策略包括引入新的对线理念以及使用更精确的器械，如导航和机器人技术。本研究的目的是调查基于图像的机器人辅助与现代对线策略相结合对最终关节线倾斜度以及股骨组件旋转的影响，并在膝内翻、中立和膝外翻膝关节之间进行比较。
这项回顾性研究纳入了2018年至2020年间接受使用功能对线的机器人辅助全膝关节置换术（MAKO，史赛克）的200例患者。患者被分为膝内翻组（103例患者）、中立组（57例患者）和膝外翻组（40例患者）。识别术中记录的截骨情况及由此产生的关节线倾斜度，并与通过机器人运动学对线计算机模拟获得的值进行比较。
膝内翻、中立和膝外翻组的平均股骨冠状面对线，在功能对线时分别为外翻0.5°（±1.1°）、1.1°（±0.8°）和1.6°（±0.7°），在运动学对线时分别为外翻2.1°（±2.1°）、4.1°（±1.7°）和6.2°（±1.7°）。膝外翻组的平均股骨轴面对线在功能对线时导致内旋0.8°（±2.0°），在运动学对线时导致内旋3.9°（±2.8°）。总体而言，通过使用功能对线，在尊重某些安全区的情况下，186个膝关节（93%）能够达到平衡，而应用运动学对线时，只有54个膝关节（27%，膝外翻组无）能够达到平衡。与应用带安全区的功能对线时每组均无此情况相比，运动学对线导致22个膝外翻膝关节（55%）、10个中立膝关节（18%）和3个膝内翻膝关节（3%）出现股骨组件外翻和内旋超过3°的情况。
与功能对线相比，机器人辅助运动学对线导致膝外翻膝关节以及在较小程度上中立膝关节出现股骨组件过度外翻和内旋的情况。
四级
