Chamundaiah Jagadeesh P, Gupta Nirav R, Mahalingam Senthilkumar, Edwin John
Department of Orthopaedics, Kauvery Hospital, Electronic City, Bengaluru, IND.
Department of Orthopaedics, Royal Cornwall Hospital, Truro, GBR.
Cureus. 2024 Oct 25;16(10):e72398. doi: 10.7759/cureus.72398. eCollection 2024 Oct.
Correction of severe coronal plane deformities while performing a total knee arthroplasty (TKA) is challenging. The use of functional alignment (FA) strategy along with image-based robotic technology during TKA makes it possible to restore a patient's constitutional alignment with minimal or no soft tissue release. The present study aims to report the functional outcomes of robotic-assisted TKA in Indian patients with severe varus deformity.
This retrospective study included 82 primary TKA performed by a single senior arthroplasty surgeon from January 2022 to December 2022. The Visual Analogue Score for Pain (VAS-P) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) were used to assess functional outcomes. A comparison between mild and severe varus deformities was done using Student's t-test.
The mean age was 66.35 ± 9.21 years. There were 79 (96.34%) knees with a mean preoperative varus hip-knee-ankle angle (HKA) of 12.85° ± 6.03° (range = 177°-148°). Postoperative limb alignment was achieved in the range of HKA 174° to 180°, with mean HKA being 175.78° ± 1.35°. The VAS-P improved significantly from a mean of 7.87 ± 0.81 preoperatively to 1.96 ± 1.43 at 18 months. KOOS-JR improved from 41.22 ± 7.6 preoperatively to 88.44 ± 8.23 at 18 months. A total of 73 (89.02%) cases achieved the minimal clinically important difference (MCID) for VAS-P and 77 (93.9%) cases achieved the MCID for KOOS-JR in our study. Functional outcomes were comparable among the mild (<10°) and severe (>10°) varus deformity cases at 18 months follow-up (p-value > 0.05). There was a significant difference in bone resection from the medial tibial and medial distal femoral condyle (p-value < 0.05) with less bone resected in the severe varus group. The amount of bone resected from the lateral tibial, distal lateral femoral, and posterior femoral condyles was comparable among the two groups (p-value > 0.05). FA was more bone conserving even in severe varus-deformed knees when compared to mechanical alignment (MA).
The use of FA with robotic assistance to correct severe varus deformities in TKA showed a significant reduction in VAS-P scores and an improvement in KOOS-JR scores. The functional outcomes were comparable with TKA in mild varus deformities. FA helps in preserving bone from the lateral tibial condyle and distal femur.
在进行全膝关节置换术（TKA）时矫正严重的冠状面畸形具有挑战性。在TKA过程中使用功能对线（FA）策略以及基于图像的机器人技术，使得以最小程度或不进行软组织松解来恢复患者的自然对线成为可能。本研究旨在报告机器人辅助TKA在患有严重内翻畸形的印度患者中的功能结果。
这项回顾性研究纳入了2022年1月至2022年12月由一位资深关节置换外科医生进行的82例初次TKA。采用疼痛视觉模拟评分（VAS-P）和关节置换的膝关节损伤与骨关节炎结局评分（KOOS-JR）来评估功能结果。使用学生t检验对轻度和重度内翻畸形进行比较。
平均年龄为66.35±9.21岁。有79例（96.34%）膝关节，术前平均内翻髋-膝-踝角（HKA）为12.85°±6.03°（范围=177°-148°）。术后肢体对线在HKA 174°至180°范围内实现，平均HKA为175.78°±1.35°。VAS-P从术前的平均7.87±0.81显著改善至18个月时的1.96±1.43。KOOS-JR从术前的41.22±7.6改善至18个月时的88.44±8.23。在我们的研究中，共有73例（89.02%）病例达到了VAS-P的最小临床重要差异（MCID），77例（93.9%）病例达到了KOOS-JR的MCID。在18个月的随访中，轻度（<10°）和重度（>10°）内翻畸形病例的功能结果具有可比性（p值>0.05）。内侧胫骨和股骨内侧髁的骨切除量存在显著差异（p值<0.05），重度内翻组切除的骨量较少。两组之间外侧胫骨、股骨外侧远端和股骨后侧髁的骨切除量具有可比性（p值>0.05）。与机械对线（MA）相比，即使在严重内翻畸形的膝关节中，FA也更能保留骨量。
在TKA中使用FA并借助机器人辅助矫正严重内翻畸形显示VAS-P评分显著降低，KOOS-JR评分有所改善。轻度内翻畸形的功能结果与TKA相当。FA有助于保留外侧胫骨髁和股骨远端的骨量。
