Maeda Keisuke, Mochizuki Tomoharu, Takagi Shigeru, Omori Go, Yamamoto Noriaki, Kobayashi Koichi, Kawashima Hiroyuki
Division of Orthopedic Surgery Niigata University Medical and Dental Hospital Niigata Japan.
Department of Orthopedic Surgery Niigata Rehabilitation Hospital Niigata Japan.
J Exp Orthop. 2025 Apr 13;12(2):e70239. doi: 10.1002/jeo2.70239. eCollection 2025 Apr.
Total knee arthroplasty (TKA) has demonstrated long-term durability, with a significant reduction in revisions due to polyethylene wear and component loosening. However, mid-flexion instability (MFI) is a key factor in early TKA revisions, affecting patient satisfaction and implant longevity. Recent advancements in robotic-assisted TKA (raTKA) provide precise joint line (JL) restoration and component positioning, potentially reducing MFI. This prospective study evaluated the impact of image-free raTKA on MFI and JL restoration.
This prospective cohort study included 59 knees undergoing primary TKA using the image-free robotic systems NAVIO® and CORI® and the JOURNEY II® Bi-Cruciate Stabilized knee system. Intraoperative component gap (CG) measurements at 0°, 30°, 60° and 105° of flexion were taken, and JL changes were assessed pre- and post-operatively using computed tomography (CT)-based three-dimensional (3D) models with the 3D-3D matching technique. The distal femoral JL was quantified.
Both the medial and lateral CG at 30° and 60° were significantly smaller compared to those at 0° and 105°. Post-operative JL showed distalization of 1.5 mm at the medial femur and 2.0 mm at the lateral femur compared to preoperative JL.
This study is the first to assess JL restoration in raTKA using CT-based bone landmarks, offering precise insights. Image-free raTKA facilitates precise JL restoration, optimizing knee kinematics and enhancing stability. These findings suggest that this technique contributes to improved post-operative joint function and greater patient satisfaction.
Level II, prospective cohort study.
全膝关节置换术（TKA）已显示出长期耐用性，因聚乙烯磨损和部件松动导致的翻修显著减少。然而，屈膝不稳定（MFI）是早期TKA翻修的关键因素，影响患者满意度和植入物使用寿命。机器人辅助TKA（raTKA）的最新进展提供了精确的关节线（JL）恢复和部件定位，有可能减少MFI。这项前瞻性研究评估了无图像raTKA对MFI和JL恢复的影响。
这项前瞻性队列研究包括59例接受初次TKA的膝关节，使用无图像机器人系统NAVIO®和CORI®以及JOURNEY II®双交叉稳定膝关节系统。在0°、30°、60°和105°屈膝时进行术中部件间隙（CG）测量，并使用基于计算机断层扫描（CT）的三维（3D）模型和3D-3D匹配技术在术前和术后评估JL变化。对股骨远端JL进行量化。
与0°和105°时相比，30°和60°时的内侧和外侧CG均显著更小。与术前JL相比，术后JL显示股骨内侧远端化1.5毫米，股骨外侧远端化2.0毫米。
本研究首次使用基于CT的骨标志评估raTKA中的JL恢复，提供了精确的见解。无图像raTKA有助于精确的JL恢复，优化膝关节运动学并增强稳定性。这些发现表明，该技术有助于改善术后关节功能并提高患者满意度。
二级，前瞻性队列研究。
