Richardson Mary K, DiGiovanni Ryan M, McCrae Brian K, Cooperman Wesley S, Ludington John, Heckmann Nathanael D, Oakes Daniel A
Department of Orthopaedic Surgery, School of Medicine of USC, Los Angeles, CA, USA.
The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Arthroplast Today. 2024 Feb 20;26:101320. doi: 10.1016/j.artd.2024.101320. eCollection 2024 Apr.
Robotic-assisted systems have gained popularity in total knee arthroplasty (TKA). The purpose of this study was to evaluate operative characteristics and radiographic outcomes of obese patients undergoing robotic-assisted TKA.
A retrospective review of consecutive cases performed by a single surgeon was performed from January 1, 2016, to January 31, 2022. Adult patients with body mass index ≥35 kg/m who underwent primary TKA using a computed tomography-assisted robotic system were compared to patients who underwent primary TKA using conventional instrumentation. Demographics, preoperative and postoperative radiographic measurements, and intraoperative outcomes were compared between cohorts. In total, 119 patients were identified, 60 in the robotic-assisted cohort and 59 in the conventional instrumentation cohort.
Age, body mass index, and estimated blood loss were not significantly different between the cohorts. The robotic-assisted cohort experienced longer tourniquet times (93.3 vs 75.5 minutes, < .001). Preoperative hip-knee-ankle angle (HKA) was similar between the robotic-assisted and conventional cohorts (8.4° ± 4.9° vs 9.3° ± 5.3°, = .335). Postoperative HKA was 2.0° ± 1.4° in the robotic-assisted group and 3.1° ± 3.23° in the conventional group ( = .040). The proportion of patients with postoperative HKA > 3° of varus or valgus was 9 of 60 (15.0%) in the robotic-assisted cohort compared to 18 of 59 (30.5%) using conventional instrumentation ( = .043).
Obese patients treated with robotic-assisted TKA had postoperative alignment closer to neutral and fewer postoperative radiographic outliers than patients treated with conventional instrumentation. The results of this study support use of robotic-assisted technologies in TKA, particularly in obese patients.
机器人辅助系统在全膝关节置换术（TKA）中越来越受欢迎。本研究的目的是评估接受机器人辅助TKA的肥胖患者的手术特征和影像学结果。
对2016年1月1日至2022年1月31日由单一外科医生连续进行的病例进行回顾性研究。将使用计算机断层扫描辅助机器人系统进行初次TKA的体重指数≥35 kg/m²的成年患者与使用传统器械进行初次TKA的患者进行比较。比较两组患者的人口统计学、术前和术后影像学测量以及术中结果。总共确定了119例患者，机器人辅助组60例，传统器械组59例。
两组患者的年龄、体重指数和估计失血量无显著差异。机器人辅助组的止血带使用时间更长（93.3分钟对75.5分钟，P <.001）。机器人辅助组和传统组术前的髋-膝-踝角（HKA）相似（8.4°±4.9°对9.3°±5.3°，P =.335）。机器人辅助组术后HKA为2.0°±1.4°，传统组为3.1°±3.23°（P =.040）。机器人辅助组术后HKA内翻或外翻>3°的患者比例为60例中的9例（15.0%），而使用传统器械的59例中有18例（30.5%）（P =.043）。
与使用传统器械治疗的患者相比，接受机器人辅助TKA治疗的肥胖患者术后对线更接近中立位，术后影像学异常情况更少。本研究结果支持在TKA中使用机器人辅助技术，尤其是在肥胖患者中。
