Manara Jonathan R, Nixon Macdaniel, Tippett Beth, Pretty Wil, Collopy Dermot, Clark Gavin W
St John of God Healthcare, Perth, Australia.
Aneurin Bevan University Health Board, Newport, Wales.
Bone Jt Open. 2024 Dec 20;5(12):1123-1129. doi: 10.1302/2633-1462.512.BJO-2024-0086.R2.
Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) have both been shown to be effective treatments for osteoarthritis (OA) of the knee. Many studies have compared the outcomes of the two treatments, but less so with the use of robotics, or individualized TKA alignment techniques. Functional alignment (FA) is a novel technique for performing a TKA and shares many principles with UKA. Our aim was to compare outcomes from a case-matched series of robotic-assisted UKAs and robotic-assisted TKAs performed using FA.
From a prospectively collected database between April 2015 and December 2019, patients who underwent a robotic-assisted medial UKA (RA-UKA) were case-matched with patients who had undergone a FA robotic-assisted TKA (RA-TKA) during the same time period. Patients were matched for preoperative BMI, sex, age, and Forgotten Joint Score (FJS). A total of 101 matched pairs were eligible for final review. Postoperatively the groups were then compared for differences in patient-reported outcome measures (PROMs), range of motion (ROM), ability to ascend and descend stairs, and ability to kneel.
Both groups had significant improvements in mean FJS (65.1 points in the TKA group and 65.3 points in the UKA group) and mean Oxford Knee Score (OKS) (20 points in the TKA group and 18.2 in the UKA group) two years following surgery. The UKA group had superior outcomes at three months in the OKS and at one year in ROM (5°), ability to kneel (0.5 points on OKS question), and ascend (1.3 points on OKS question) and descend stairs (0.8 points on OKS question), but these were not greater than the minimal clinically important difference. There were no differences seen in FJS or OKS at one year postoperatively. There were no statistically significant differences between the groups at 24 months in all the variables assessed.
FA-RATKA and RA-UKA are both successful treatments for medial compartmental knee arthritis in this study. The UKA group showed a quicker recovery, but this study demonstrated equivalent two-year outcomes in all outcomes measured including stair ascent and descent, and kneeling.
单髁膝关节置换术（UKA）和全膝关节置换术（TKA）均已被证明是治疗膝关节骨关节炎（OA）的有效方法。许多研究比较了这两种治疗方法的结果，但较少涉及机器人技术或个性化TKA对线技术的应用。功能对线（FA）是一种用于进行TKA的新技术，与UKA有许多共同原则。我们的目的是比较一系列采用FA的机器人辅助UKA和机器人辅助TKA病例匹配后的结果。
从2015年4月至2019年12月前瞻性收集的数据库中，将接受机器人辅助内侧UKA（RA-UKA）的患者与同期接受FA机器人辅助TKA（RA-TKA）的患者进行病例匹配。患者根据术前体重指数、性别、年龄和遗忘关节评分（FJS）进行匹配。共有101对匹配患者符合最终审查条件。术后比较两组患者报告的结局指标（PROMs）、活动范围（ROM）、上下楼梯能力和下跪能力的差异。
两组患者术后两年的平均FJS（TKA组为65.1分，UKA组为65.3分）和平均牛津膝关节评分（OKS）（TKA组为20分，UKA组为18.2分）均有显著改善。UKA组在术后三个月的OKS评分、术后一年的ROM（5°）、下跪能力（OKS问题得0.5分）以及上下楼梯能力（OKS问题上楼梯得1.3分、下楼梯得0.8分）方面有更好的结果，但这些均未超过最小临床重要差异。术后一年，两组在FJS或OKS方面无差异。在评估的所有变量中，两组在24个月时无统计学显著差异。
在本研究中，FA-RATKA和RA-UKA都是治疗内侧间室膝关节关节炎的成功方法。UKA组恢复更快，但本研究表明，在包括上下楼梯和下跪在内的所有测量结果方面，两组两年的结局相当。
