Ziedas Alexander, Miller Adam, Biddle Elliot, Laker Michael, Michaelson Jefferey, Frush Todd, Markel David C
Henry Ford Providence Orthopaedic Residency Program, Southfield, MI, USA.
J Orthop. 2025 May 5;64:217-221. doi: 10.1016/j.jor.2025.05.002. eCollection 2025 Jun.
Historically, all patellofemoral arthroplasty (PFA) was performed manually. Recently, robotic-assisted PFA has gained popularity. The purpose of this study was to determine whether a robotic-assisted technique influenced outcomes and revision rates. We hypothesized that robotic-assisted PFA would have improved 90-day complication and revision rates.
A single center's data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) was queried for all primary PFAs from January 2014 to December 2022. Manual and robotic cohorts were compared for revisions and 90-day complications, including emergency visits, readmissions, and returns to the operating room (OR). Chi-square and Fisher's exact tests were used for categorical data and t-tests for continuous data.
Among 75 PFAs (mean age 53.0 ± 12.9 years, 78% women), 19 were manual and 56 robotic. Manual PFA experienced more 90-day complications (31% vs 10%, p = 0.0321) and a longer mean length of stay (30.9 ± 14.4 vs 20.6 ± 17.7 h, p = 0.03). No significant differences existed in age, BMI, gender, race, surgical time, 30-day complications, or revision rate. Manual PFA had no revisions, while 5% of robotic PFAs were revised for osteoarthritis progression, with a mean conversion time of 4.5 ± 2.7 years. Five-year cumulative percent revision (CPR) for all PFAs was 7.37%. Logistical regression showed manual PFA patients were more likely to experience 90-day complications (OR 3.84, p = 0.04).
Manual PFA were prone to more 90-day complications and longer hospital stays compared to robotic PFA, which may minimize complications without affecting revision rates. Importantly, the PFA revision rate herein exceeded MARCQI-reported rates for unicompartmental and total knee arthroplasty.
历史上，所有髌股关节置换术（PFA）均为手动操作。近年来，机器人辅助的PFA越来越受欢迎。本研究的目的是确定机器人辅助技术是否会影响手术结果和翻修率。我们假设机器人辅助的PFA会降低90天并发症和翻修率。
查询了密歇根关节置换登记协作质量倡议（MARCQI）中一个中心2014年1月至2022年12月期间所有初次PFA的数据。比较了手动操作组和机器人辅助组的翻修情况和90天并发症情况，包括急诊就诊、再次入院和返回手术室（OR）。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75例PFA患者中（平均年龄53.0±12.9岁，78%为女性），19例为手动操作，56例为机器人辅助。手动PFA的90天并发症更多（31%对10%，p = 0.0321），平均住院时间更长（30.9±14.4对20.6±17.7小时），p = 0.03）。在年龄、体重指数、性别、种族、手术时间、30天并发症或翻修率方面无显著差异。手动PFA无翻修病例，而5%的机器人辅助PFA因骨关节炎进展进行了翻修，平均转换时间为4.5±2.7年。所有PFA的五年累积翻修率（CPR）为7.37%。逻辑回归显示，手动PFA患者更有可能出现90天并发症（OR 3.84，p = 0.04）。
与机器人辅助的PFA相比，手动PFA更容易出现90天并发症且住院时间更长，机器人辅助的PFA可能会减少并发症而不影响翻修率。重要的是，本文中的PFA翻修率超过了MARCQI报告的单髁关节置换术和全膝关节置换术的翻修率。
