Lychagin Alexey Vladimirovich, Gritsyuk Andrey Anatolyevich, Elizarov Mikhail Pavlovich, Rukin Yaroslav Alekseevich, Gritsyuk Andrey Andreevich, Gavlovsky Maxim Yaroslavovich, Elizarov Pavel Mihailovich, Berdiyev Murat, Kalinsky Eugene Borisovich, Vyazankin Ivan Antonovich, Rosenberg Nahum
Department of Traumatology, Orthopedics, and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, Sechenov University, Moscow 119991, Russia.
Specialists Center, National Insurance Institute, Haifa 3109601, Israel.
J Clin Med. 2024 May 26;13(11):3125. doi: 10.3390/jcm13113125.
Total Knee Arthroplasty (TKA) is a prevalent surgical procedure for treating severe knee arthritis, aiming to alleviate pain and restore function. Recent advancements have introduced computer-assisted (CAS) and robot-assisted (RA-TKA) surgical techniques as alternatives to conventional methods, promising improved accuracy and patient outcomes. However, comprehensive comparative studies evaluating the short-term outcomes and prostheses survivorship among these techniques are limited. We hypothesized that the outcome of RA-TKA and/or CAS- TKA is advantageous in function and prosthesis survivorship compared to manually implanted prostheses. This prospective controlled study compared the short-term outcomes and prostheses survivorship following TKA using conventional, CAS, and RA-TKA techniques. One hundred seventy-eight patients requiring TKA were randomly assigned to one of the three surgical groups. The primary outcomes were knee function (KSS knee score) and functional recovery (KSS function score), which were assessed before surgery three years postoperatively. Secondary outcomes included prosthesis alignment, knee range of movements, and complication rates. Survivorship analysis was conducted using Kaplan-Meier curves, with revision surgery as the endpoint. While all three groups showed significant improvements in knee function postoperatively ( < 0.001), the CAS and RA-TKA groups demonstrated superior prosthetic alignment and higher survivorship rates than the conventional group (100%, 97%, and 96%, respectively). However, although the RA-TKA group had a maximal 100% survivorship rate, its knee score was significantly lower than following CAS and conventional techniques (mean 91 ± 3SD vs. mean 93 ± 3SD, = 0.011). The RA-TKA technique offers advantages over conventional and CAS methods regarding alignment accuracy and short-term survivorship of TKA prostheses. Since short-term prosthesis survivorship indicates the foreseen rates of mid- and long-term survivorship, the current data have a promising indication of the improved TKA prosthesis's long-term survivorship by implementing RA-TKA. According to the presented data, although the survival rates were 100%, 97%, and 96% in the three study groups, no clinical difference in the functional outcome was found despite the better mechanical alignment and higher survivorship in the group of patients treated by the RA-TKA.
全膝关节置换术（TKA）是治疗重度膝关节炎的一种常见外科手术，旨在减轻疼痛并恢复功能。最近的进展引入了计算机辅助（CAS）和机器人辅助（RA-TKA）手术技术作为传统方法的替代方案，有望提高准确性和改善患者预后。然而，评估这些技术短期疗效和假体生存率的全面比较研究有限。我们假设，与手动植入假体相比，RA-TKA和/或CAS-TKA在功能和假体生存率方面的疗效更佳。这项前瞻性对照研究比较了采用传统、CAS和RA-TKA技术进行TKA后的短期疗效和假体生存率。178例需要进行TKA的患者被随机分配到三个手术组之一。主要结局指标为膝关节功能（KSS膝关节评分）和功能恢复情况（KSS功能评分），在术前、术后三年进行评估。次要结局指标包括假体对线、膝关节活动范围和并发症发生率。采用Kaplan-Meier曲线进行生存率分析，以翻修手术作为终点。虽然所有三组术后膝关节功能均有显著改善（<0.001），但CAS组和RA-TKA组的假体对线优于传统组，生存率更高（分别为100%、97%和96%）。然而，尽管RA-TKA组的最高生存率为100%，但其膝关节评分显著低于CAS组和传统技术组（平均91±3标准差 vs. 平均93±3标准差，P = 0.011）。RA-TKA技术在TKA假体对线准确性和短期生存率方面优于传统和CAS方法。由于短期假体生存率表明了中长期生存率的预期比率，目前的数据有望表明通过实施RA-TKA可提高TKA假体的长期生存率。根据所呈现的数据，尽管三个研究组的生存率分别为100%、97%和96%，但在接受RA-TKA治疗的患者组中，尽管机械对线更好且生存率更高，但在功能结局方面未发现临床差异。
