Innocenti Matteo, Leggieri Filippo, van Laarhoven Simon N, de Windt Tommy, Civinini Roberto, van Hellemondt Gijs G
Department of Clinical Orthopaedics, University of Florence, Florence, Italy.
Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2025 Oct;33(10):3606-3620. doi: 10.1002/ksa.12748. Epub 2025 Jul 24.
The aim of this systematic review was to evaluate the outcomes and complications associated with technology-assisted revision total knee arthroplasty (revTKA).
A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non-randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random-effects meta-analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the I statistic.
Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology-assisted revTKA showed fewer outliers in hip-knee-ankle angle (13.3% [95% CI, 8.7%-19.0%] vs. 26.1% [95% CI, 16.3%-38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%-92.4%] vs. 79.7% [95% CI, 68.8%-87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%-94.6%] vs. 82.6% [95% CI, 72.0%-89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15-24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology-assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.
Technology-assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.
Level IV.
本系统评价旨在评估技术辅助全膝关节置换翻修术（revTKA）的疗效和并发症。
对PubMed、EMBASE、科学引文索引和考克兰图书馆进行系统检索，检索时间从建库至2024年10月31日。纳入标准为≥10例接受机器人辅助revTKA的患者的实验性或观察性研究，评估临床和/或放射学结果及/或并发症发生率。排除标准为单纯髌骨翻修、体外研究、致编辑信、书籍章节、会议论文以及无全文可获取的研究。每项研究使用非随机研究方法学指数（MINORS）进行质量评分。纳入研究分为报告TKA翻修和单髁膝关节置换术（UKA）翻修的研究，进行定性和定量综合分析。在适当情况下进行随机效应荟萃分析。计算放射学参数的95%置信区间（CI）的平均差异。使用I统计量评估异质性。
在20项研究（795例病例）中，10项评估revTKA，10项检查revUKA。在revTKA研究中，4项为比较队列，而在revUKA研究中，7项为比较队列。技术辅助revTKA在髋-膝-踝角方面的异常值较少（13.3% [95% CI，8.7%-19.0%] 对26.1% [95% CI，16.3%-38.1%]），在股骨远端外侧角和胫骨近端内侧角±3°范围内的假体位置更佳（分别为88.4% [95% CI，83.2%-92.4%] 对79.7% [95% CI，68.8%-87.5%]，以及91.2% [95% CI，86.3%-94.6%] 对82.6% [95% CI，72.0%-89.8%]），关节线恢复更好（4 mm内为79.5%对58.3%）。手术需要额外15 - 24分钟。两组并发症发生率相当。对于UKA翻修，技术辅助和传统技术的结果总体相似，在对线准确性和临床评分方面结果不一。
与传统技术相比，技术辅助revTKA可实现最佳对线参数并减少异常值的发生。然而，这些放射学改善并未始终转化为更好的临床结果或更低的并发症发生率。
四级。
