Nagarkatti Ahana, Strecker Sara, Nagarkatti Durgesh, Witmer Dan
Holy Cross, Worcester, MA, USA.
Orthopedics, Bone & Joint Institute, Hartford Hospital, Hartford, CT, USA.
Arthroplast Today. 2024 Jul 20;28:101455. doi: 10.1016/j.artd.2024.101455. eCollection 2024 Aug.
While total knee arthroplasty (TKA) is highly successful, 15%-20% of patients are not satisfied postoperatively, which may be due to alignment of the TKA components. Imageless computer navigation was developed to increase implant alignment accuracy and precision, but controversy surrounds the patient benefit of this technology. The target of femoral sagittal alignment and its role in patient-reported outcomes (PROMs) after TKA using assistive technology has not been well-defined.
Femoral sagittal alignment, 30-day complications, and PROMs through 1 year were collected retrospectively from unilateral elective TKA patients who underwent surgery between July 2020 and February 2023. Two surgeons equally versed in conventional and imageless navigation techniques participated in patient record identification. Students -tests and chi-square tests of proportion were used to compare outcomes, 30-day complications, and alignment.
Completed PROMs were available for 387 patients; 181 in the computer navigation group and 206 in the conventional arthroplasty group. PROMs were statistically significantly different between groups, favoring computer navigation ( = .014 at 12 months). Lateral femoral angle measurements were greater in females who underwent TKA with computer navigation ( < .001). Of note, 14 patients in the conventional technique group returned to the emergency department within 30 days, as compared to 4 in the navigation group ( = .033).
PROMs are improved in the navigation group compared to the conventional technique group. Fewer patients in the navigation group returned to the emergency department. Navigation appeared to provide a small benefit compared to conventional techniques, though final lateral femoral angle was not predictive of outcomes. Additional surgical characteristics may need to be examined to determine the reasons for the differences in outcomes between these techniques.
虽然全膝关节置换术（TKA）非常成功，但15%-20%的患者术后不满意，这可能归因于TKA组件的对线情况。无影像计算机导航技术的出现旨在提高植入物对线的准确性和精确性，但该技术对患者的益处仍存在争议。使用辅助技术进行TKA后，股骨矢状面对线的目标及其在患者报告结局（PROMs）中的作用尚未明确界定。
回顾性收集2020年7月至2023年2月期间接受单侧择期TKA手术患者的股骨矢状面对线情况、30天并发症及1年内的PROMs。两名精通传统和无影像导航技术的外科医生参与患者记录识别。采用t检验和比例卡方检验比较结果、30天并发症及对线情况。
387例患者有完整的PROMs数据；计算机导航组181例，传统关节置换组206例。两组间PROMs有统计学显著差异，计算机导航组更具优势（12个月时P = 0.014）。接受计算机导航TKA的女性患者股骨外侧角测量值更大（P < 0.001）。值得注意的是，传统技术组有14例患者在30天内返回急诊科，而导航组为4例（P = 0.033）。
与传统技术组相比，导航组的PROMs有所改善。导航组返回急诊科的患者较少。与传统技术相比，导航似乎有轻微益处，尽管最终股骨外侧角不能预测结局。可能需要检查其他手术特征，以确定这些技术之间结局差异的原因。
