Keating Timothy C, Wakelin Edgar A, Plaskos Christopher, Keggi John M, Koenig Jan A, Ponder Corey E, DeClaire Jeffrey H, Lawrence Jeffrey M, Karas Vasili
Department of Orthopaedic Surgery, Rush University Medical Center, Il, USA.
Corin Ltd, Raynham, MA, USA.
J Orthop. 2024 Dec 12;65:71-77. doi: 10.1016/j.jor.2024.12.007. eCollection 2025 Jul.
This study investigates the association between intra-operative balance and 2-year outcomes within subgroups defined by demographics and pre-operative joint balance. Our hypothesis is that patient demographics and the pre-operative state of the joint will impact patient sensitivity to post-operative balance and laxity and subsequent impact on outcome.
A retrospective analysis of prospectively captured data across 5 sites with 5 surgeons was performed. All cases completed pre-operative demographics surveys, 2-year post-operative Knee Injury and Osteoarthritis Outcome Score (KOOS) and had a robot assisted total knee arthroplasty with an integrated digital joint balancing tool. Differences in associations between intra-operative final joint balance and 2-year KOOS pain outcomes in demographic and pre-operative balance subgroups were characterized. Associations informed clinically relevant thresholds to optimize TKA treatment for subgroups.
A total of 276 patients completed 2-year KOOS scores. Subgroups were defined from Sex, Age, BMI and pre-operative extension laxity. Men prefer a tight tolerance medially in extension and mid-flexion while females prefer a tight lateral flexion gap. Patients <70 years show a strong preference for equal rectangular gaps in extension, mid-flexion, and flexion, while older patients do not show a preference. Patients with BMI ≤30 demonstrate a preference for rectangular gaps, while patients with higher BMI do not. Finally, patients with looser pre-operative extension laxity (>3 mm) preferred a TKA with increased extension laxity compared to patients with minimal preoperative laxity.
Intraoperative differences in knee balance can influence patient outcome scores among different demographic groups at two years postoperatively. This suggests further research is warranted to determine how ligament balance and laxity may be optimized based on individual patient factors.
本研究调查了在由人口统计学和术前关节平衡定义的亚组中，术中平衡与2年预后之间的关联。我们的假设是，患者人口统计学特征和关节术前状态将影响患者对术后平衡和松弛的敏感性，以及对预后的后续影响。
对来自5个地点的5位外科医生前瞻性收集的数据进行回顾性分析。所有病例均完成术前人口统计学调查、术后2年的膝关节损伤和骨关节炎疗效评分（KOOS），并接受了带有集成数字关节平衡工具的机器人辅助全膝关节置换术。对人口统计学和术前平衡亚组中术中最终关节平衡与2年KOOS疼痛预后之间的关联差异进行了表征。这些关联为优化亚组全膝关节置换术（TKA）治疗提供了临床相关阈值。
共有276例患者完成了2年KOOS评分。亚组由性别、年龄、体重指数（BMI）和术前伸直松弛度定义。男性在伸直和屈膝中期内侧更喜欢紧密的公差，而女性则更喜欢紧密的外侧屈膝间隙。70岁以下的患者在伸直、屈膝中期和屈膝时强烈倾向于相等的矩形间隙，而老年患者则没有偏好。BMI≤30的患者倾向于矩形间隙，而BMI较高的患者则没有。最后，与术前松弛度最小的患者相比，术前伸直松弛度较大（>3mm）的患者更喜欢伸直松弛度增加的TKA。
膝关节平衡的术中差异可影响术后两年不同人口统计学组的患者预后评分。这表明有必要进一步研究，以确定如何根据个体患者因素优化韧带平衡和松弛度。
