Ziedas Alexander C, Michaelson Jefferey, Knesek David, Laker Michael, Frush Todd, Markel David C
Henry Ford Providence Orthopaedic Residency Program, Southfield, Michigan.
J Arthroplasty. 2025 Apr 23. doi: 10.1016/j.arth.2025.04.043.
The purpose of our study was to determine whether a difference existed between cemented and cementless robotic-assisted total knee arthroplasty (RA-TKA) and manual TKA with regard to revision rates and 90-day outcomes. We hypothesized these techniques would have similar results.
A single center's data from the Michigan Arthroplasty Registry Collaborative Quality Initiative were queried for all primary TKAs from January 2012 to July 2023. The RA-TKA and manual cohorts were compared for revisions and 90-day complications, including emergency department (ED) visits, readmissions, and returns to the operating room Chi-square and Fisher's exact tests were used for categorical data, and t-tests for continuous data. Of the 7,417 cemented TKAs (mean age 67 ± 9.6 years, 70% women), 273 were RA-TKA and 7,144 were manual. Of the 2,407 cementless TKAs (mean age 65 ± 8.6 years, 53% women), 730 were RA-TKA and 1,677 were manual.
Cemented RA-TKA had more periprosthetic joint infection revisions, more 90-day ED visits, and readmissions for wound complications compared to cemented manual TKA. Cementless RA-TKA had more 90-day readmissions for wound complications, while manual TKA had more 90-day ED visits for postoperative pain. Cemented and cementless RA-TKA had longer surgical time, shorter length of stay, and shorter time to revision. There were 283 revisions performed on cemented manual TKA (nine RA-TKAs, 3.2%, 274 manual, 3.8%, (P = 0.87)). There were 56 revisions performed on cementless knees (13 RA-TKAs, 1.7%, 43 manual 2.5% (P = 0.303)). Cumulative percent revision at 5 years was 3.9% for cemented RA-TKA, 3.5% for cemented manual TKA, 1.8% for cementless RA-TKA, and 2.8% for cementless manual TKA.
Both RA-TKA and manual TKA have similar revision rates, while RA-TKA had more wound complications. Cementless RA-TKA may be beneficial in reducing postoperative pain.
我们研究的目的是确定在翻修率和90天预后方面，有骨水泥和无骨水泥的机器人辅助全膝关节置换术（RA-TKA）与手动全膝关节置换术（TKA）之间是否存在差异。我们假设这些技术会有相似的结果。
查询了密歇根关节置换登记协作质量倡议组织一个中心2012年1月至2023年7月所有初次全膝关节置换术的数据。比较RA-TKA组和手动手术组的翻修情况及90天并发症，包括急诊就诊、再入院和返回手术室的情况。分类数据采用卡方检验和Fisher精确检验，连续数据采用t检验。在7417例有骨水泥的全膝关节置换术中（平均年龄67±9.6岁，70%为女性），273例为RA-TKA，7144例为手动手术。在2407例无骨水泥的全膝关节置换术中（平均年龄65±8.6岁，53%为女性），730例为RA-TKA，1677例为手动手术。
与有骨水泥的手动全膝关节置换术相比，有骨水泥的RA-TKA有更多的假体周围关节感染翻修、更多的90天急诊就诊以及因伤口并发症而再入院的情况。无骨水泥的RA-TKA有更多因伤口并发症而90天再入院的情况，而手动TKA有更多因术后疼痛而90天急诊就诊的情况。有骨水泥和无骨水泥的RA-TKA手术时间更长、住院时间更短、翻修时间更短。有骨水泥的手动全膝关节置换术进行了283次翻修（9例RA-TKA，3.2%，274例手动手术，3.8%，（P = 0.87））。无骨水泥膝关节进行了56次翻修（13例RA-TKA，1.7%，43例手动手术，2.5%（P = 0.303））。有骨水泥的RA-TKA在5年时的累积翻修率为3.9%，有骨水泥的手动TKA为3.5%，无骨水泥的RA-TKA为1.8%，无骨水泥的手动TKA为2.8%。
RA-TKA和手动TKA的翻修率相似，而RA-TKA有更多的伤口并发症。无骨水泥的RA-TKA可能有助于减轻术后疼痛。
