Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, P.R. China.
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China.
Arch Orthop Trauma Surg. 2024 Nov;144(11):4827-4838. doi: 10.1007/s00402-024-05569-y. Epub 2024 Sep 19.
This study conducted a Bayesian network meta-analysis (NMA) to compare the imaging and functional outcomes of patient-specific instrument-assisted unicompartmental knee arthroplasty (P-UKA), robot-assisted unicompartmental knee arthroplasty (R-UKA), and conventional unicompartmental knee arthroplasty (C-UKA).
A comprehensive search was performed on five electronic databases and major orthopedic journals as of September 24, 2023. We included randomized controlled studies featuring at least two interventions of P-UKA, R-UKA, or C-UKA. Primary outcomes encompassed the deviation angle of hip-knee-ankle angle, as well as the coronal and sagittal plane alignment of femoral and tibial components. Secondary outcomes included patient-reported outcome measures (PROM), surgery time, revision rate, and complication rate. Bayesian framework was employed for risk ratio (RR) or mean deviation (MD) analysis, and treatment hierarchy was established based on rank probabilities.
This NMA included 871 knees from 12 selected studies. In sagittal plane, R-UKA exhibited a significantly reduced deviation angle of femoral component compared to P-UKA (MD: 4.16, 95% CI: 0.21, 8.07), and of tibial component in comparison to C-UKA (MD: -2.45, 95% CI: -4.20, -0.68). Notably, the surgery time was significantly longer in R-UKA than in C-UKA (MD: 15.98, 95% CI: 3.11, 28.88). However, no significant differences were observed in other outcomes.
Compared with P-UKA or C-UKA, R-UKA significantly improves the femoral and tibial component alignment in the sagittal plane, although this does not translate into discernible differences in functional outcomes. Comprehensive considerations of economic and learning costs are imperative for the judicious selection of the appropriate procedure.
本研究采用贝叶斯网状荟萃分析（NMA）比较了个体化辅助单间膝关节置换术（P-UKA）、机器人辅助单间膝关节置换术（R-UKA）和传统单间膝关节置换术（C-UKA）的影像学和功能结果。
截至 2023 年 9 月 24 日，我们对五个电子数据库和主要骨科期刊进行了全面检索，纳入了至少两种 P-UKA、R-UKA 或 C-UKA 干预的随机对照研究。主要结局包括髋膝踝角的偏差角，以及股骨和胫骨组件的冠状面和矢状面排列。次要结局包括患者报告的结果测量（PROM）、手术时间、翻修率和并发症率。采用贝叶斯框架进行风险比（RR）或平均偏差（MD）分析，并根据秩概率建立治疗层次。
本 NMA 纳入了 12 项研究的 871 个膝关节。在矢状面，R-UKA 与 P-UKA 相比，股骨组件的偏差角显著减小（MD：4.16，95%CI：0.21，8.07），与 C-UKA 相比，胫骨组件的偏差角也显著减小（MD：-2.45，95%CI：-4.20，-0.68）。值得注意的是，R-UKA 的手术时间明显长于 C-UKA（MD：15.98，95%CI：3.11，28.88）。然而，其他结局没有观察到显著差异。
与 P-UKA 或 C-UKA 相比，R-UKA 显著改善了矢状面股骨和胫骨组件的排列，尽管这并没有转化为功能结局的明显差异。在明智选择合适的手术方法时，必须综合考虑经济和学习成本。
