Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA.
Knee Surg Sports Traumatol Arthrosc. 2024 Sep;32(9):2290-2296. doi: 10.1002/ksa.12228. Epub 2024 May 13.
The purpose of this study was to examine the effects of intraoperative technology use on the rate of using polyethylene liners 15 mm or greater during primary total knee arthroplasty (TKA).
There were 103,295 implants from 16,386 primary unilateral TKAs performed on 14,253 patients at a single institution between 1 January 2018, and 30 June 2022, included in the current study. Robotic assistance and navigation guidance were used in 1274 (8%) and 8345 (51%) procedures, respectively. The remaining 6767 TKAs (41%) were performed manually. Polyethylene liners were manually identified and further subcategorised by implant thickness. Patients who underwent robotic-assisted TKA were younger (p < 0.001) and more likely to be male (p < 0.001) compared to patients who underwent navigation-guided or manual TKAs.
Average polyethylene liner thickness was similar between groups (10.5 ± 1.5 mm for robotic-assisted TKAs, 10.9 ± 1.8 mm for navigation-guided TKAs and 10.8 ± 1.8 mm for manual TKAs). The proportions of polyethylene liners 15 mm or greater used were 4.9%, 3.8% and 1.9% for navigation-guided, manual and robotic-assisted procedures, respectively (p < 0.001). Multivariate regression analyses demonstrated that navigation-guided (odds ratio [OR]: 2.6, 95% confidence Interval [CI]: [1.75-4.07], p < 0.001) and manual (OR: 2.0, 95% CI: [1.34-3.20], p = 0.001) procedures were associated with an increased use of polyethylene liners 15 mm or greater.
Robotic-assisted TKA was associated with a lower proportion of polyethylene liners 15 mm or greater used compared to navigation-guided and manual TKA. These findings suggest that robotic assistance can reduce human error via a more precise cutting system, limit over-resection of the tibia and flexion-extension gap mismatch and ultimately allow for more appropriately sized implants.
Level III, retrospective cohort study.
本研究旨在探讨术中使用技术对初次全膝关节置换术（TKA）中使用 15mm 或更大聚乙烯衬垫的比例的影响。
本研究纳入了 2018 年 1 月至 2022 年 6 月在一家医疗机构接受初次单侧 TKA 的 14253 名患者的 16386 例假体，共 103295 个植入物。分别有 1274 例（8%）和 8345 例（51%）手术中使用了机器人辅助和导航引导，6767 例（41%）TKA 手术为手动操作。手动识别聚乙烯衬垫，并根据植入物厚度进一步分类。与接受导航引导或手动 TKA 的患者相比，接受机器人辅助 TKA 的患者更年轻（p<0.001）且更可能为男性（p<0.001）。
各组聚乙烯衬垫的平均厚度相似（机器人辅助 TKA 为 10.5±1.5mm，导航引导 TKA 为 10.9±1.8mm，手动 TKA 为 10.8±1.8mm）。使用 15mm 或更大的聚乙烯衬垫的比例分别为导航引导、手动和机器人辅助手术的 4.9%、3.8%和 1.9%（p<0.001）。多变量回归分析表明，导航引导（比值比[OR]：2.6，95%置信区间[CI]：[1.75-4.07]，p<0.001）和手动（OR：2.0，95%CI：[1.34-3.20]，p=0.001）手术与使用 15mm 或更大的聚乙烯衬垫的比例增加相关。
与导航引导和手动 TKA 相比，机器人辅助 TKA 使用 15mm 或更大的聚乙烯衬垫的比例较低。这些发现表明，机器人辅助可以通过更精确的切割系统减少人为错误，限制胫骨过度切除和屈伸间隙不匹配，并最终允许使用更合适尺寸的植入物。
III 级，回顾性队列研究。
