Suhas Masilamani A B, Jayakumar Tarun, Mulpur Praharsha, Kikkuri Rajeev Reddy, Vaddiparthi Shravya, Gurava Reddy A V
Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India.
Institute of Orthopaedics & Robotic Surgery, Renova Century Hospital, Hyderabad, India.
J Robot Surg. 2025 May 27;19(1):244. doi: 10.1007/s11701-025-02405-2.
Total knee arthroplasty (TKA) significantly alleviates pain and improves functionality in patients with end-stage knee osteoarthritis. However, postoperative sleep disturbances remain a common issue affecting quality of life (QOL) and rehabilitation. This study aimed to compare postoperative sleep quality between robotic-assisted TKA (RATKA) and conventional TKA (CTKA). This observational study enrolled 200 consecutive patients undergoing primary unilateral TKA, divided equally into RATKA and CTKA cohorts. All surgeries were performed by a single surgeon using cemented TKA, either conventionally or with the MAKO® robotic system. Standardized pain management and rehabilitation protocols were followed in both cohorts. Preoperative and postoperative sleep quality were evaluated weekly for the first month and subsequently at 3 and 6 months post-operatively, utilizing the Pittsburgh Sleep Quality Index (PSQI). Pain scores were recorded using the Visual Analog Scale (VAS). Preoperative PSQI scores showed no significant differences between the RATKA (5.55 ± 2.05) and conventional TKA (5.70 ± 2.26) groups. Postoperative sleep disturbances peaked at 1 week post-surgery in both cohorts (RATKA: 12.42 ± 1.75, TKA: 12.59 ± 2.42), with gradual improvement observed over 6 months, although baseline sleep quality was not fully restored. Pain scores (VAS) were significantly lower in the RATKA cohort at all postoperative intervals (p < 0.001). No significant correlation was found between sleep quality and age, BMI, gender, or surgical approach. Both RATKA and conventional TKA resulted in similar patterns of postoperative sleep disturbances, peaking shortly after surgery and progressively improving over 6 months without fully returning to pre-operative levels. Despite significantly better pain control in the RATKA cohort, postoperative sleep quality did not differ significantly between the two surgical techniques. Future research should explore comprehensive perioperative management strategies to address the multifactorial nature of sleep disturbances post-TKA.
全膝关节置换术（TKA）可显著减轻终末期膝关节骨关节炎患者的疼痛并改善其功能。然而，术后睡眠障碍仍是一个影响生活质量（QOL）和康复的常见问题。本研究旨在比较机器人辅助全膝关节置换术（RATKA）和传统全膝关节置换术（CTKA）术后的睡眠质量。这项观察性研究纳入了200例连续接受初次单侧全膝关节置换术的患者，平均分为RATKA组和CTKA组。所有手术均由同一位外科医生使用骨水泥型全膝关节置换术进行，手术方式为传统手术或使用MAKO®机器人系统。两组均遵循标准化的疼痛管理和康复方案。使用匹兹堡睡眠质量指数（PSQI）在术后第一个月每周评估术前和术后睡眠质量，随后在术后3个月和6个月进行评估。使用视觉模拟量表（VAS）记录疼痛评分。术前PSQI评分在RATKA组（5.55±2.05）和传统全膝关节置换术组（5.70±2.26）之间无显著差异。两组术后睡眠障碍均在术后1周达到峰值（RATKA组：12.42±1.75，CTKA组：12.59±2.42），尽管基线睡眠质量未完全恢复，但在6个月内逐渐改善。在所有术后时间点，RATKA组的疼痛评分（VAS）均显著更低（p<0.001）。未发现睡眠质量与年龄、体重指数、性别或手术方式之间存在显著相关性。RATKA和传统全膝关节置换术均导致相似的术后睡眠障碍模式，术后不久达到峰值，并在6个月内逐渐改善，但未完全恢复到术前水平。尽管RATKA组的疼痛控制明显更好，但两种手术技术术后的睡眠质量无显著差异。未来的研究应探索全面的围手术期管理策略，以解决全膝关节置换术后睡眠障碍的多因素性质。
