Bourgeault-Gagnon Yoan, Salmon Lucy J, Lyons Matthew C
North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, NSW, Australia.
University of Notre Dame Medical School, Sydney, NSW, Australia.
Arthroplast Today. 2024 Oct 16;30:101489. doi: 10.1016/j.artd.2024.101489. eCollection 2024 Dec.
Increased accuracy and lower rates of component positioning outliers have been associated with better long-term survival and functional outcomes of total knee arthroplasty (TKA). This study investigates the accuracy of robotic-assisted TKA compared to navigation-assisted and manual instrumentation techniques, using polyethylene tibial insert thickness as a surrogate.
Consecutive primary TKA by a single surgeon were retrospectively reviewed and divided in 3 groups: manual instrumentation, navigation-assisted, and robotic-assisted (RA-TKA). Polyethylene insert thickness, deviation from planned thickness, and rate of outliers were compared between the 3 groups using nonparametric analysis of variance, Kruskal-Wallis tests, and Bonferroni corrections. Logistic regression analysis was performed to identify predictors of polyethylene thickness ≥9 mm. The learning curve for RA-TKA was evaluated with a box plot graph of groups of 10 consecutive cases.
There were 474 patients in manual instrumentation TKA, 257 in navigation-assisted TKA and 225 in RA-TKA, with median polyethylene thicknesses of 6.0 (interquartile range 5.0-7.0), 6.0 (interquartile range 5.0-7.0), and 5.0 (interquartile range 5.0-6.0) millimeters, respectively (P˂0.001 RA-TKA compared to both other groups). Polyethylene inserts with a thickness ≥9 mm were used in 28 (5.9%) manual instrumentation TKA, 13 (5.1%) navigation-assisted TKA, and 1 (0.4%) RA-TKA ( = .004). Independent predictors for polyethylene thickness ≥9 mm included surgical technique, left side, and male sex. A learning curve of <30 cases was observed before consistent polyethylene thickness was achieved in RA-TKA.
Tibial polyethylene insert thickness, as a surrogate of surgical accuracy, is more reproducible in robotic-assisted than in navigation-assisted or manual-instrumentation TKA. The learning curve to reach high levels of reproducibility with this technique is relatively short.
全膝关节置换术（TKA）中，更高的准确性和更低的假体定位异常率与更好的长期生存率及功能预后相关。本研究以聚乙烯胫骨衬垫厚度作为替代指标，调查机器人辅助TKA与导航辅助及手动器械技术相比的准确性。
回顾性分析由同一位外科医生连续进行的初次TKA病例，并分为3组：手动器械组、导航辅助组和机器人辅助组（RA-TKA）。使用非参数方差分析、Kruskal-Wallis检验和Bonferroni校正比较3组之间的聚乙烯衬垫厚度、与计划厚度的偏差以及异常值发生率。进行逻辑回归分析以确定聚乙烯厚度≥9mm的预测因素。通过连续10例病例组的箱线图评估RA-TKA的学习曲线。
手动器械TKA组有474例患者，导航辅助TKA组有257例，RA-TKA组有225例，聚乙烯厚度中位数分别为6.0（四分位间距5.0 - 7.0）、6.0（四分位间距5.0 - 7.0）和5.0（四分位间距5.0 - 6.0）毫米（与其他两组相比，RA-TKA组P˂0.001）。在手动器械TKA组中，28例（5.9%）使用了厚度≥9mm的聚乙烯衬垫，导航辅助TKA组中为13例（5.1%），RA-TKA组中为1例（0.4%）（P = 0.004）。聚乙烯厚度≥9mm的独立预测因素包括手术技术、左侧和男性性别。在RA-TKA组中，在实现一致的聚乙烯厚度之前观察到学习曲线<30例。
作为手术准确性的替代指标，机器人辅助TKA中胫骨聚乙烯衬垫厚度比导航辅助或手动器械TKA更具可重复性。使用该技术达到高水平可重复性的学习曲线相对较短。
