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机器人辅助全膝关节置换术的真实世界准确性及其对加速康复的影响。

Real-world accuracy of robotic-assisted total knee arthroplasty and its impact on expedited recovery.

机构信息

Department of Orthopaedics and Traumatology, Hospital Ampang, Jalan Mewah Utara, Taman Pandan Mewah, 68000, Ampang, Selangor, Malaysia.

Clinical Research Centre, Sunway Medical Centre, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.

出版信息

J Robot Surg. 2024 Aug 6;18(1):309. doi: 10.1007/s11701-024-02059-6.

Abstract

Despite total knee arthroplasty (TKA) being the gold standard for end-stage knee osteoarthritis, 20% of patients remain dissatisfied. Robotic-assisted arthroplasty promises unparalleled control of the accuracy of bone cuts, implant positioning, control of gap balance, and resultant hip-knee-ankle (HKA) axis. Patients underwent clinical and radiological assessments, including knee CT scans and patient-reported outcome measures (PROMs), preoperatively. Follow-up assessments were conducted at 2 weeks, 6 weeks, and 3 months post-operatively, with imaging repeated at 6 weeks. A total of 155 patients underwent robotic-assisted TKA and have completed 3 months of follow-up. Mean pre-operative HKA axis was 7.39 ± 5.52 degrees varus, improving to 1.34 ± 2.22 degrees varus post-operatively. Restoration of HKA axis was 0.76 ± 1.9 degrees from intra-operative planning (p < 0.0005). Implant placement accuracy in the coronal plane was 0.08 ± 1.36 degrees (p = 0.458) for the femoral component and 0.71 ± 1.3 degrees (p < 0.0005) for the tibial component. Rotational alignment mean deviation was 0.39 ± 1.49 degrees (p = 0.001). Most patients (98.1%) had ≤ 2 mm difference in extension-flexion gaps. PROM scores showed improvement and exceeded pre-operative scores by 6 weeks post-surgery. Robotic-assisted knee arthroplasty provides precise control over traditionally subjective factors, demonstrating excellent early post-operative outcomes.Level of evidence Prospective observational study-II.

摘要

尽管全膝关节置换术(TKA)是治疗晚期膝关节骨关节炎的金标准,但仍有 20%的患者不满意。机器人辅助关节置换术承诺对骨切精度、植入物定位、间隙平衡控制以及由此产生的髋膝踝(HKA)轴具有无与伦比的控制。患者在术前接受了临床和影像学评估,包括膝关节 CT 扫描和患者报告的结果测量(PROM)。术后 2 周、6 周和 3 个月进行随访评估,6 周时重复影像学检查。共有 155 例患者接受了机器人辅助 TKA,并完成了 3 个月的随访。术前 HKA 轴的平均角度为 7.39±5.52 度,术后改善至 1.34±2.22 度。与术中计划相比,HKA 轴的恢复度为 0.76±1.9 度(p<0.0005)。冠状面植入物放置精度股骨组件为 0.08±1.36 度(p=0.458),胫骨组件为 0.71±1.3 度(p<0.0005)。旋转对线平均偏差为 0.39±1.49 度(p=0.001)。大多数患者(98.1%)的伸展-屈曲间隙差值≤2mm。PROM 评分显示术后 6 周开始改善,超过术前评分。机器人辅助膝关节置换术对传统上的主观因素具有精确的控制,显示出极好的早期术后结果。证据水平前瞻性观察研究-II。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a0b1/11303575/de4a21e2ca41/11701_2024_2059_Fig1_HTML.jpg

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