Ong Michael Tim-Yun, LaCour Michael T, Yung Patrick Shu-Hang, Dessinger Garett M, Komistek Richard D
Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Mechanical, Aerospace, and Biomedical Engineering, Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, Tennessee, USA.
J Orthop Res. 2025 Jul;43(7):1284-1292. doi: 10.1002/jor.26091. Epub 2025 May 5.
Although it is well-documented that robotic-assisted total knee arthroplasty (TKA) can improve surgical precision, evaluations of the postoperative kinematics of patients implanted using robotics remain less common. The objective of this study is to analyze the weight-bearing kinematics for multiple TKAs implanted using two different surgical robots. In vivo knee kinematics were assessed using fluoroscopy for 28 subjects implanted with a Bi-Cruciate Stabilized (BCS) TKA, 23 with a Bi-Cruciate Retaining (BCR) TKA, 13 with a posterior stabilized (PS) TKA, and 22 with a cruciate retaining (CR) TKA. All subjects were implanted by the same surgeon using the respective company's surgical robot. All subjects performed a weight-bearing deep knee bend. Parameters of interest include the femoral condylar anterior/posterior motion, femorotibial axial rotation, and weight-bearing range-of-motion. The BCS TKA experienced the most posterior rollback, 13.4 ± 4.4 mm for the lateral condyle and 5.8 ± 2.5 mm for the medial condyle. These subjects also experienced the most femorotibial axial rotation, +9.3 ± 5.3°. Conversely, CR subjects experienced the least overall rollback and most anterior sliding, 0.4 ± 3.8 mm of lateral rollback and 1.9 ± 4.1 mm of medial anterior sliding. Implant design appears to play a significant role in postoperative kinematics. Improved stability is evident in TKAs that account for the ACL. However, no system behaved significantly better nor worse than previously published literature evaluating standard instrumentation. Level of Evidence: Level 3, retrospective cohort study.
尽管有充分的文献记载，机器人辅助全膝关节置换术（TKA）可提高手术精度，但对使用机器人植入的患者术后运动学的评估仍然不太常见。本研究的目的是分析使用两种不同手术机器人植入的多个TKA的负重运动学。使用荧光透视法评估了28例植入双交叉稳定（BCS）TKA、23例植入双交叉保留（BCR）TKA、13例植入后稳定（PS）TKA和22例植入交叉保留（CR）TKA患者的体内膝关节运动学。所有受试者均由同一位外科医生使用各自公司的手术机器人进行植入。所有受试者均进行了负重深屈膝。感兴趣的参数包括股骨髁的前后运动、股胫轴向旋转和负重活动范围。BCS TKA的后滚最为明显，外侧髁为13.4±4.4mm，内侧髁为5.8±2.5mm。这些受试者的股胫轴向旋转也最大，为+9.3±5.3°。相反，CR受试者的总体后滚最少，前滑最多，外侧后滚为0.4±3.8mm，内侧前滑为1.9±4.1mm。植入物设计似乎在术后运动学中起着重要作用。在考虑前交叉韧带的TKA中，稳定性得到了明显改善。然而，没有一个系统的表现明显优于或劣于先前发表的评估标准器械的文献。证据水平：3级，回顾性队列研究。
