Department of Clinical Orthopedics, A.O.U. Careggi CTO, University of Florence, Florence, Italy.
Articon Spezialpraxis für Gelenkchirurgie, Bern, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2024 Dec;32(12):3299-3307. doi: 10.1002/ksa.12415. Epub 2024 Aug 8.
Robotic-assisted technology in medial unicompartmental knee arthroplasty (mUKA) allows for customized adjustments of joint laxity through virtual preoperative component positioning before bone preparation. Nevertheless, the optimal balancing curve has yet to be delineated. This study sought to investigate if varying intraoperative knee laxity patterns had any impact on postoperative patient outcomes.
A retrospective analysis was conducted on prospectively collected data from 326 fixed-bearing RAUKA procedures performed between 2018 and 2022 with a minimum 2-year follow-up. Patients were categorized into three cohorts based on intraoperative joint laxity patterns (millimetres of joint gap during valgus stress) imparted at 20°, 60°, 90° and 120° of knee flexion: cohort 1 < +0.5 mm (tight); cohort 2 between 0.6 and 1.9 mm (physiologic); cohort 3 > 2 mm (loose). Wilcoxon and Kruskal-Wallis tests were conducted to assess patient-reported outcome measure (PROM) improvements and preoperative and postoperative differences across the cohorts. A Spearman's test evaluated the correlation between knee balance at all degrees of flexion and preoperative and postoperative HKA.
No differences in preoperative and postoperative PROMs were identified across the cohorts (p > 0.05). All three cohorts with different joint laxity patterns showed a significant improvement in the postoperative PROMS (p < 0.05). The preoperative or postoperative limb alignment did not significantly affect clinical outcomes relative to different laxity patterns.
No differences were found in the outcomes across different joint laxity patterns in robotic-assisted medial UKA using fixed-bearing mUKAs. There was no evident advantage for maintaining a closer to physiologic laxity compared to tighter or looser balancing.
Level III, therapeutic study.
机器人辅助技术在膝关节单髁置换术（mUKA）中可通过虚拟术前组件定位在骨准备前对关节松弛度进行定制调整。然而，最佳平衡曲线尚未确定。本研究旨在探讨术中膝关节松弛度模式的变化是否对术后患者结局有任何影响。
对 2018 年至 2022 年间行 326 例固定衬垫 RAUKA 手术的前瞻性收集数据进行回顾性分析，随访时间至少 2 年。根据膝关节在 20°、60°、90°和 120° 屈曲时施加的术中关节松弛度模式（外翻应力下的关节间隙毫米数）将患者分为三组：组 1＜+0.5mm（紧）；组 2为 0.6-1.9mm（生理）；组 3＞2mm（松）。采用 Wilcoxon 和 Kruskal-Wallis 检验评估各组患者报告的结果测量（PROM）改善情况以及术前和术后差异。Spearman 检验评估了所有屈曲度下膝关节平衡与术前和术后 HKA 的相关性。
三组间（p＞0.05）术前和术后 PROM 无差异。所有三组具有不同关节松弛度模式的患者在术后 PROM 均有显著改善（p＜0.05）。与不同松弛模式相比，术前或术后肢体对线并未显著影响临床结局。
在使用固定衬垫 mUKA 的机器人辅助内侧 UKA 中，不同关节松弛度模式的结果无差异。与更紧或更松的平衡相比，保持更接近生理松弛度并没有明显优势。
III 级，治疗性研究。
