MacAskill Micah, Peluso Richard, Lash Jonathan, Hewett Timothy E, Bullock Matthew, Caughran Alexander
Department of Orthopaedics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
Arthroplast Today. 2023 Dec 27;25:101310. doi: 10.1016/j.artd.2023.101310. eCollection 2024 Feb.
The application of robotic-assisted arthroplasty in revision knee scenarios continues to evolve. This study compares the pre- and post-revision implant positions in series of revision total knee arthroplasties (TKA) using a robotic arm system.
Twenty-five consecutive off-label robotic-assisted revision TKA were performed. After virtual revision femoral and tibial components were positioned to achieve "balanced" medial and lateral flexion and extension gaps, the existing primary implants (PI) were removed, and bone cuts were executed with the robotic arm system. Preoperative coronal, sagittal, and axial position of the PI was compared to the final planned positions of the robotic revision implants (RRI) for each subject. A repeated measures ANOVA using the absolute difference in millimeters and degrees between the PI and RRI orientation was completed.
Intra-operatively, the virtual gaps were balanced within the planning software followed by successful execution of the plan. There was a statistically significant difference between posterior condylar offset and tibial component positioning for RRI compared to PI. There was no difference between the distal femoral component values between PI and RRI.
The sagittal alignment of the revision implants, specifically the femoral posterior condylar offset and tibial component slope, are statistically significant considerations for a stable revision TKA with off-label use of a robotic-arm system. Other potential benefits may include appropriate implant sizing which can affect the resultant ligamentous tension important for a functional revision TKA. Future research and software iterations will be needed to determine the overall accuracy and utility of robotic-assisted revision TKA.
机器人辅助关节置换术在膝关节翻修手术中的应用不断发展。本研究使用机器人手臂系统比较了一系列全膝关节置换术（TKA）翻修前后植入物的位置。
连续进行了25例非标签机器人辅助的TKA翻修手术。在虚拟翻修中将股骨和胫骨组件定位以实现“平衡”的内外侧屈伸间隙后，移除现有的初次植入物（PI），并使用机器人手臂系统进行截骨。比较了每个受试者PI的术前冠状面、矢状面和轴位与机器人翻修植入物（RRI）的最终计划位置。使用PI和RRI方向之间毫米和度数的绝对差异完成重复测量方差分析。
术中，虚拟间隙在规划软件内实现了平衡，随后计划成功执行。与PI相比，RRI的后髁偏移和胫骨组件定位存在统计学显著差异。PI和RRI之间的股骨远端组件值没有差异。
对于非标签使用机器人手臂系统的稳定TKA翻修术，翻修植入物的矢状面对齐，特别是股骨后髁偏移和胫骨组件斜率，在统计学上具有重要意义。其他潜在益处可能包括合适的植入物尺寸，这会影响对功能性TKA翻修术至关重要的韧带张力。未来需要进一步的研究和软件迭代来确定机器人辅助TKA翻修术的整体准确性和实用性。
