Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India.
J Robot Surg. 2023 Dec;17(6):2919-2927. doi: 10.1007/s11701-023-01732-6. Epub 2023 Oct 13.
This study aimed to compare two alignment strategies in the same patient undergoing simultaneous bilateral robotic-assisted TKA (SB-RATKA): mechanical alignment (MA), the gold-standard, and functional alignment (FA), a balance-driven, personalized alignment strategy. The outcome measures included quantitative assessment of soft-tissue release, incidence of knee balance, and post-operative pain. This was a prospective, self-controlled, randomized-controlled trial involving 72 patients who underwent SB-RATKA using the MAKO® robotic system with comparable grades of deformity and pain in both knees. 65 patients were finally included with one alignment strategy done per knee, with the patients blinded to the strategy used. The study recorded the additional soft-tissue releases required, incidence of pre-balance, and daily post-operative VAS pain scores. The mean age of the study population was 57.95 years, with a female preponderance (N = 53, 81.6%). MA group had significantly more medial compartment tightness in both flexion (MA-15.6 ± 1.8; FA-17 ± 1.3) and extension (MA-14.9 ± 1.9; FA-17 ± 1.1) (p < 0.0001) compared to the FA group after dynamic balancing. 66% of knees in the FA group (N = 43) achieved pre-balance compared to 32.3% in the MA group (N = 21) (p < 0.0001). VAS scores showed a significant reduction in pain in the FA group up to 72 h post-surgery (p < 0.0001). The requirement for posteromedial release (PM), posterior capsular (PC) release, tibial reduction osteotomy (TRO), and superficial MCL pie crusting (sMCL) were significantly lower in FA (PM-22, PC-13, TRO-8, sMCL-2) compared to MA (PM-44, PC-29, TRO-18, sMCL-8). Functional alignment strategy consistently resulted in a higher incidence of knee balance with a significant reduction in soft-tissue releases and immediate post-operative pain when compared to MA in the same patient undergoing SB-RATKA. Therapeutic Level 1.
本研究旨在比较同一批接受双侧机器人辅助全膝关节置换术（SB-RATKA）的患者的两种对线策略：机械对线（MA），金标准，和功能对线（FA），一种平衡驱动的个性化对线策略。主要的研究结果包括对软组织松解程度的定量评估、膝关节平衡的发生率和术后疼痛。这是一项前瞻性、自身对照、随机对照试验，共纳入 72 例接受 MAKO®机器人系统行 SB-RATKA 的患者，这些患者双膝的畸形和疼痛程度相当。最终纳入 65 例患者，每侧膝关节接受一种对线策略，患者对所使用的策略不知情。研究记录了所需的额外软组织松解量、术前平衡的发生率和术后每天的 VAS 疼痛评分。研究人群的平均年龄为 57.95 岁，女性居多（N=53，81.6%）。与 FA 组相比，MA 组在膝关节屈伸时的内侧间隙紧张程度均显著更大（MA：15.6±1.8；FA：17±1.3）（p<0.0001）。在动态平衡后，FA 组 66%（N=43）的膝关节达到术前平衡，而 MA 组仅 32.3%（N=21）达到术前平衡（p<0.0001）。VAS 评分显示 FA 组术后 72 小时疼痛明显减轻（p<0.0001）。FA 组后内侧松解（PM）、后囊松解（PC）、胫骨截骨（TRO）和浅层 MCL 皮瓣切开（sMCL）的需求明显低于 MA 组（PM：22；PC：13；TRO：8；sMCL：2）。与 MA 相比，FA 策略在 SB-RATKA 中对同一患者进行时，可更频繁地实现膝关节平衡，显著减少软组织松解，并立即减轻术后疼痛。治疗等级 1。
