Yasen Zaid, Woffenden Hugo, Robinson Andrew P
Trauma and Orthopedics, Royal Free Hospital, London, GBR.
Surgery and Cancer, Imperial College London, London, GBR.
Cureus. 2023 Dec 20;15(12):e50852. doi: 10.7759/cureus.50852. eCollection 2023 Dec.
Robotic-assisted knee arthroplasty has emerged as a promising development, aiming to enhance surgical precision and patient outcomes. This literature review examines the clinical efficacy, cost implications, environmental impact, and potential of telesurgery in robotic-assisted total knee arthroplasty (RATKA) and robotic-assisted unicompartmental knee arthroplasty (RAUKA) relative to conventional techniques. A thorough literature search was conducted across medical databases. Clinical and radiological outcomes of RATKA and RAUKA were extracted and analyzed. Direct costs, operating time, surgeon learning curve, environmental implications, and the futuristic concept of telesurgery were also considered. Subjective patient assessments such as WOMAC, Oxford Knee Score, and SF-36, alongside objective measures like HSS score and KSS, were commonly used. Radiological parameters like hip-knee-ankle (HKA) and femorotibial angle provided insights into post-operative alignment. Evidence indicated sporadic high-level design studies, often with limited samples. Cost remains a major constraint with robotic systems, though high-volume cases might offset expenses. Environmental assessments revealed robotic surgeries generate a higher carbon footprint. Telesurgery, an evolving field, could transcend geographical boundaries but is not without challenges, including high costs, latency issues, and cyber threats. While robotic-assisted surgeries may hold promise in the future, substantial barriers, including acquisition costs, potential surgeon deskilling, and environmental concerns, need addressing. Greater robot utilization may drive costs down with more competitors entering the market. Continued research, especially multi-center RCTs, is pivotal to solidifying the role of robotic systems in knee arthroplasty.
机器人辅助膝关节置换术已成为一项有前景的进展，旨在提高手术精度和患者预后。本文献综述考察了机器人辅助全膝关节置换术（RATKA）和机器人辅助单髁膝关节置换术（RAUKA）相对于传统技术在临床疗效、成本影响、环境影响以及远程手术潜力方面的情况。我们在多个医学数据库中进行了全面的文献检索。提取并分析了RATKA和RAUKA的临床和放射学结果。还考虑了直接成本、手术时间、外科医生学习曲线、环境影响以及远程手术这一未来概念。常用的主观患者评估指标如WOMAC、牛津膝关节评分和SF - 36，以及诸如HSS评分和KSS等客观指标。诸如髋 - 膝 - 踝（HKA）和股胫角等放射学参数为术后对线情况提供了见解。证据表明存在一些零星的高水平设计研究，样本量往往有限。成本仍然是机器人系统的一个主要限制因素，不过大量病例可能会抵消费用。环境评估显示机器人手术产生的碳足迹更高。远程手术作为一个不断发展的领域，虽可跨越地理界限，但也面临挑战，包括成本高昂、延迟问题和网络威胁。虽然机器人辅助手术未来可能具有前景，但包括购置成本、外科医生潜在的技能退化以及环境问题等重大障碍仍需解决。随着更多竞争者进入市场，机器人使用量的增加可能会降低成本。持续的研究，尤其是多中心随机对照试验，对于巩固机器人系统在膝关节置换术中的作用至关重要。
