Agarwal Sarang, Ayeni Femi E, Sorial Rami
Department of Orthopaedics, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia.
Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.
Arthroplasty. 2024 Apr 4;6(1):15. doi: 10.1186/s42836-024-00239-1.
Mechanical alignment with total knee arthroplasty (TKA) has been widely used since the implantation of the first prosthetic knee. Multiple studies have reported 80% patient satisfaction with TKA. However, the reported patients' dissatisfaction is believed to be caused by having to convert different knee alignments to neutral alignments. It is postulated that a change in the CPAK classification of knees leads to patient dissatisfaction. Thus, we hypothesized that a change in CPAK classification with robot-assisted TKA with mechanical alignment does not significantly lead to patient dissatisfaction.
We retrospectively analyzed 134 patients who underwent robot-assisted mechanical alignment total knee arthroplasty (MA-TKA) using cementless implants and classified them into CPAK system pre- and post-operatively. One year after TKA surgery, we recorded binary responses to patients' satisfaction with the outcome of surgery and analyzed if a change in CPAK classification is associated with the outcome of surgery.
We found that 125 out of 134 patients (93.28%) were happy with the outcome of surgery. CPAK classification was changed in 116 patients (86.57%) and maintained in 18 patients (13.43%). Our results also showed that 111 (95.7%) out of 116 patients who had a change in CPAK and 14 (77.8%) out of 18 patients who maintained their CPAK post-surgery were happy with the outcome of surgery (OR = 6.3, CI 1.741-25.17, P value = 0.019).
We concluded that changing the patient's native joint line and CPAK classification does not significantly change the outcome of surgery in terms of satisfaction. The dissatisfaction rate of 20% as published by previous researchers may be confounded by other reasons and not just due to changes in alignment and joint line.
自首例人工膝关节植入以来，全膝关节置换术（TKA）中的机械对线已被广泛应用。多项研究报告称，TKA患者满意度达80%。然而，据报道患者的不满被认为是由于必须将不同的膝关节对线转换为中立对线所致。据推测，膝关节CPAK分类的改变会导致患者不满。因此，我们假设在机器人辅助的机械对线TKA中，CPAK分类的改变不会显著导致患者不满。
我们回顾性分析了134例行机器人辅助机械对线全膝关节置换术（MA-TKA）且使用非骨水泥植入物的患者，并在术前和术后将他们分为CPAK系统。TKA手术一年后，我们记录了患者对手术结果满意度的二元反应，并分析CPAK分类的改变是否与手术结果相关。
我们发现134例患者中有125例（93.28%）对手术结果满意。116例患者（86.57%）的CPAK分类发生了改变，18例患者（13.43%）保持不变。我们的结果还显示，CPAK发生改变的116例患者中有111例（95.7%）以及术后CPAK保持不变的18例患者中有14例（77.8%）对手术结果满意（OR = 6.3，CI 1.741 - 25.17，P值 = 0.019）。
我们得出结论，改变患者的原生关节线和CPAK分类在满意度方面不会显著改变手术结果。先前研究人员公布的20%的不满率可能受到其他因素的混淆，而不仅仅是由于对线和关节线的改变。
