Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Department of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):685-692. doi: 10.1002/ksa.12088. Epub 2024 Feb 28.
It was hypothesized that robotic arm-assisted total knee arthroplasty (RA-TKA) using additionally a gap-balancing instrumentation will show high accuracy in executing the planning in femoral and tibial component placement throughout the range of knee motion (ROM) during TKA surgery.
Prospectively collected data were analysed for patients undergoing RA-TKA. A cruciate retaining cemented design was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded at the beginning of surgery and finally after implantation of the components. A ligament tensioner was inserted after tibial precut to measure the extension and flexion gap, and final component placement was planned based on 3D CT images. Femoral and tibial component placement was measured in all three planes.
A total of 104 patients were included (mean age 69.4 ± 9 years; 44 male, 60 female). The difference in component placement after planning and final implantation showed less valgus of 0.7° ± 1.4° (p < 0.001), less external rotation of 0.6° ± 1.9° (p = 0.001) and less flexion of 0.9° ± 1.8° (p < 0.001) for the femoral component. The tibial component was placed in more varus of 0.2° ± 0.9° (p = 0.056) and more posterior slope of 0.5° ± 0.9° (p < 0.001). The lower limb alignment in extension was 4.4° ± 5.2° of varus of the native knee and changed to 1.2° ± 1.9° of varus after TKA (p < 0.01).
Robotic-assisted TKA helps to achieve the target of alignment and component placement very close to the planning. It allows optimal component placement of off-the-shelf implants respecting patient's specific anatomy.
Level II.
假设在全膝关节置换术（TKA）中使用机器人辅助臂和间隙平衡仪器，将有助于在整个膝关节运动范围（ROM）内实现股骨和胫骨组件放置的规划，具有高精度。
前瞻性收集接受机器人辅助 TKA 的患者数据进行分析。采用 MAKO®机器人系统植入了保留十字韧带的水泥设计。在手术开始时和最后在植入组件后记录 0°、30°、45°、60°和 90°屈曲时的下肢对线。在胫骨预切后插入韧带张力器，以测量伸展和屈曲间隙，然后根据 3D CT 图像规划最终组件位置。在所有三个平面上测量股骨和胫骨组件的放置情况。
共纳入 104 例患者（平均年龄 69.4±9 岁；44 例男性，60 例女性）。规划后与最终植入组件的组件放置差异显示，股骨组件的外旋角度减少了 0.7°±1.4°（p<0.001），外侧旋转减少了 0.6°±1.9°（p=0.001），屈曲角度减少了 0.9°±1.8°（p<0.001）。胫骨组件的放置角度为内翻 0.2°±0.9°（p=0.056）和后倾角增加 0.5°±0.9°（p<0.001）。膝关节自然伸直的下肢对线为 4.4°±5.2°的内翻，TKA 后变为 1.2°±1.9°的内翻（p<0.01）。
机器人辅助 TKA 有助于实现非常接近规划的对线和组件放置目标。它允许根据患者的特定解剖结构，对现成的植入物进行最佳的组件放置。
二级。
