Vandenberk Jim, Mievis Jan, Deferm Jorien, Janssen Daniël, Bollars Peter, Vandenneucker Hilde
Department of Biomedical Sciences (Development and Regeneration), KU Leuven-University of Leuven, Herestraat 49, Box 700, 3000, Louvain, Belgium.
Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4798-4808. doi: 10.1007/s00167-023-07524-7. Epub 2023 Aug 9.
Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA.
This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann-Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test.
There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p = .144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p = .044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p = .038 and 0.6% vs 4.3%, p = .001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend.
This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA.
Level III (therapeutic retrospective cohort study).
尽管NAVIO机器人辅助全膝关节置换术（NAVIO RATKA）在临床实践中已广泛应用，但关于不良事件和并发症的临床结果仍不明确。本研究的目的是比较传统全膝关节置换术（CTKA）和NAVIO RATKA之间的不良事件、住院时间、手术时间、血红蛋白下降情况、早期再入院率和翻修率。
本单中心回顾性队列分析将230例NAVIO RATKA患者与489例CTKA患者进行比较，最小随访时间为12个月。收集了基线人口统计学和合并症参数，以及住院时间、翻修率和翻修原因、早期再入院率（<6周）和再入院原因、术后血红蛋白水平、不良事件、手术时间和手术室时间。对于非正态分布的连续数据和有序数据，使用Mann-Whitney U检验进行比较，分类变量使用卡方检验或Fisher精确检验进行比较。
两组之间在临床相关的基线人口统计学或合并症方面没有差异。CTKA的住院时间比NAVIO RATKA短（5.0天对5.4天，p = 0.010），但再手术率有升高趋势（4.1%对1.7%，p = 0.144，无统计学意义）。在血红蛋白下降、再入院率或不良事件的总体发生率方面未发现差异，但CTKA显示更多的血肿形成（1.6%对0%，p = 0.044）和假体周围关节感染（PJI）的发生率更高（1%对0%，p = 无统计学意义），而NAVIO RATKA显示更多的假体周围骨折和持续伤口引流（分别为0.4%对2.2%，p = 0.038和0.6%对4.3%，p = 0.001）。在所有230例病例中，NAVIO RATKA的手术时间仍然显著更长（87分钟对67.6分钟），并且呈持续下降趋势。
本研究进一步验证了NAVIO RATKA作为一种安全的全膝关节置换术方法的应用，在早期翻修和不良事件方面与CTKA具有可比的短期结果。外科医生应注意NAVIO RATKA中不同的不良事件特征，并相应调整患者选择以确保最佳结果。此外，使用NAVIO RATKA的外科医生应预期有一条线性学习曲线，且手术时间超过CTKA。
III级（治疗性回顾性队列研究）。
