达到最小临床重要差异的时间和速率比较：机器人辅助与手动单髁膝关节置换术
Comparison of Time and Rate of Achieving Minimal Clinically Important Difference: Robotic Versus Manual Unicompartmental Knee Arthroplasty.
作者信息
Lim Perry L, Sayeed Zain, Gonzalez Marcos R, Melnic Christopher M, Bedair Hany S
机构信息
From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Lim, Sayeed, Gonzalez, Melnic, and Bedair), and the Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA (Lim, Sayeed, Gonzalez, Melnic, and Bedair).
出版信息
J Am Acad Orthop Surg. 2025 Mar 1;33(5):231-241. doi: 10.5435/JAAOS-D-24-00380. Epub 2024 Jul 30.
BACKGROUND
Robotics in unicompartmental knee arthroplasty (UKA) continues to increase with the ever-growing demand to use technology in the surgical setting. However, no studies have used minimal clinically important difference (MCID) to compare patient-reported outcome measures (PROMs) between robotic UKA (rUKA) and manual UKA (mUKA). This study aimed to compare the rate of achieving MCID for improvement (MCID-I) and worsening (MCID-W) and the time to achieving MCID.
METHODS
We conducted a retrospective analysis of robotic and manual UKAs performed between 2016 and 2022. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function Short-Form 10a (PF-10a), and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-Form (KOOS-PS) scores were collected. Patients were stratified on reaching MCID-I, MCID-W, or "no notable change" (score between MCID-W and MCID-I). Survival curves with and without interval censoring were used to assess the time to achieving the MCID. Log-rank and weighted log-rank tests were used to compare groups.
RESULTS
A total of 256 UKAs (64 robotic and 192 manual) were analyzed. No differences were observed in the proportion of patients achieving MCID-I or MCID-W across all three PROMs. Similarly, median time to achieving MCID showed no significant differences between rUKA and mUKA for PROMIS Global Physical (3.3 versus 4.9 months, P = 0.44), PROMIS PF-10a (7.7 versus 8.3 months, P = 0.93), and KOOS-PS (3.0 versus 6.0 months, P = 0.055) scores, both with and without interval censoring.
DISCUSSION
This study indicates that rUKA and mUKA exhibit comparable rates of achieving MCID-I and MCID-W, along with similar median time to reach MCID. These findings offer valuable patient-centric insights into the effectiveness of rUKA. Additional studies evaluating the long-term outcomes of rUKA are needed to determine its long-term advantages.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
背景
随着手术环境中对技术使用的需求不断增长，单髁膝关节置换术（UKA）中的机器人技术应用持续增加。然而，尚无研究使用最小临床重要差异（MCID）来比较机器人辅助单髁膝关节置换术（rUKA）和手动单髁膝关节置换术（mUKA）之间患者报告的结局指标（PROMs）。本研究旨在比较达到改善的MCID（MCID-I）和恶化的MCID（MCID-W）的发生率以及达到MCID的时间。
方法
我们对2016年至2022年间进行的机器人辅助和手动UKA手术进行了回顾性分析。收集术前和术后患者报告结局测量信息系统（PROMIS）总体身体状况、PROMIS身体功能简表10a（PF-10a）以及膝关节损伤和骨关节炎结局评分-身体功能简表（KOOS-PS）的评分。根据达到MCID-I、MCID-W或“无显著变化”（评分在MCID-W和MCID-I之间）对患者进行分层。使用有和没有区间删失的生存曲线来评估达到MCID的时间。采用对数秩检验和加权对数秩检验对组间进行比较。
结果
共分析了256例UKA手术（64例机器人辅助和192例手动）。在所有三项PROMs中，达到MCID-I或MCID-W的患者比例未观察到差异。同样，对于PROMIS总体身体状况（3.3个月对4.9个月，P = 0.44）、PROMIS PF-10a（7.7个月对8.3个月，P = 0.93）和KOOS-PS（3.0个月对6.0个月，P = 0.055）评分，无论有无区间删失，rUKA和mUKA达到MCID的中位时间均无显著差异。
讨论
本研究表明，rUKA和mUKA在达到MCID-I和MCID-W的发生率以及达到MCID的中位时间方面表现相当。这些发现为rUKA的有效性提供了以患者为中心的有价值见解。需要进一步开展评估rUKA长期结局的研究，以确定其长期优势。
证据级别
III级，回顾性比较研究。
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