Lee Jong Hwa, Jung Ho Jung, Choi Byung Sun, Ro Du Hyun, Kim Joong Il
Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea.
Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 24253, Republic of Korea.
J Clin Med. 2023 Jul 9;12(14):4570. doi: 10.3390/jcm12144570.
The transfusion rate in staged bilateral total knee arthroplasty (TKA) remains high despite the application of blood management techniques. The potential of robotic arm-assisted TKA (R-TKA) in reducing the transfusion rate in staged bilateral surgery has not yet been investigated. Therefore, we aimed to evaluate the effectiveness of R-TKA on transfusion reduction compared with conventional TKA (C-TKA) in staged bilateral surgery. This retrospective study involved two groups of patients who underwent 1-week interval staged bilateral TKA-the C-TKA group and the R-TKA group-using MAKO SmartRobotics (Stryker, Kalamazoo, MI, USA). Each group comprised 53 patients after propensity score matching and was compared in terms of nadir hemoglobin (Hb) level and transfusion rate after each stage of surgery. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb level. The R-TKA group showed a significantly higher nadir Hb level than the C-TKA group after the second TKA ( = 0.002). The transfusion rate was not significantly different between the two groups after the first TKA ( = 0.558). However, the R-TKA group showed a significantly lower transfusion rate in the TKA ( = 0.030) and overall period ( = 0.023) than the C-TKA group. Patients who undergo staged bilateral R-TKA have lower transfusion rate than those who undergo C-TKA. R-TKA may be effective in minimizing unnecessary allogeneic transfusions in staged bilateral surgery.
尽管应用了血液管理技术，但分期双侧全膝关节置换术（TKA）的输血率仍然很高。机器人手臂辅助TKA（R-TKA）在降低分期双侧手术输血率方面的潜力尚未得到研究。因此，我们旨在评估与传统TKA（C-TKA）相比，R-TKA在分期双侧手术中减少输血的有效性。这项回顾性研究纳入了两组患者，他们接受了间隔1周的分期双侧TKA——C-TKA组和R-TKA组，使用MAKO智能机器人（史赛克公司，美国密歇根州卡拉马祖）。每组在倾向得分匹配后各有53例患者，并比较了各手术阶段后的最低血红蛋白（Hb）水平和输血率。两组在年龄、性别、体重指数、美国麻醉医师协会身体状况评分和术前Hb水平等倾向匹配变量方面均无显著差异。第二次TKA后，R-TKA组的最低Hb水平显著高于C-TKA组（P = 0.002）。第一次TKA后，两组的输血率无显著差异（P = 0.558）。然而，R-TKA组在第二次TKA时（P = 0.030）和整个期间（P = 0.023）的输血率均显著低于C-TKA组。接受分期双侧R-TKA的患者输血率低于接受C-TKA的患者。R-TKA可能有效地减少分期双侧手术中不必要的异体输血。
