Kwak Sang Gyu, Kwon Jae Bum, Kim Seo Hee Chan, Choi Won-Kee
Department of Medical Statistics, College of Medicine, Daegu Catholic University, Daegu, Korea.
Department of Orthopaedic Surgery, College of Medicine, Daegu Catholic University, Daegu, Korea.
Medicine (Baltimore). 2025 Aug 1;104(31):e42722. doi: 10.1097/MD.0000000000042722.
We aimed to conduct a systematic review and meta-analysis comparing perioperative blood loss between navigation or robot-assisted total knee arthroplasty (TKA), or patient-specific instrumentation (PSI), which are surgical techniques that do not violate the femoral medullary cavity, and conventional TKA.
The PICO (population, intervention, comparison, and outcome) of this study are as follows. (1) Population: patients undergoing primary unilateral TKA. (2) Intervention: navigation or robot-assisted TKA or PSI that do not violate intramedullary cavity of the femur. (3) Comparison: traditional TKA surgical techniques that violate intramedullary cavity of the femur. (4) Outcome: perioperative blood loss or hemoglobin reduction or transfusion rate during admission.
In the 16 studies, 640 participants who underwent surgery not violating intramedullary cavity of the femur (navigation or robot-assisted TKA or PSI) and 637 participants who underwent surgery violating intramedullary cavity of the femur. There was statistically significant difference in perioperative blood loss. The effect size of the perioperative blood loss for all cases by 2 groups was -150.65 (95% CI: -219.53 to -81.77, P-value < .001). The effect size of the perioperative blood loss on the second day after surgery by 2 groups was -164.29 (95% CI: -320.62 to -7.96, P-value = .040). There was statistically significant difference in hemoglobin between the 2 groups before surgery and 1 day after surgery. The effect size of the difference in hemoglobin between before surgery and 1 day after surgery by 2 groups was -0.20 (95% CI: -0.38 to -0.02, P-value = .030).
Navigation or robot-assisted TKA, or PSI, exhibited lower perioperative blood loss compared to conventional TKA. Additionally, they showed lower decreases in hemoglobin levels postoperatively. With these findings, it can be concluded that navigation or robot-assisted TKA, or PSI, may be considered as a selective option for reducing postoperative bleeding in TKA.
我们旨在进行一项系统评价和荟萃分析，比较导航或机器人辅助全膝关节置换术（TKA）或患者特异性器械（PSI）（这些手术技术不侵犯股骨髓腔）与传统TKA之间的围手术期失血量。
本研究的PICO（人群、干预措施、对照和结局）如下。（1）人群：接受初次单侧TKA的患者。（2）干预措施：不侵犯股骨髓腔的导航或机器人辅助TKA或PSI。（3）对照：侵犯股骨髓腔的传统TKA手术技术。（4）结局：住院期间的围手术期失血量、血红蛋白降低情况或输血率。
在这16项研究中，640名接受不侵犯股骨髓腔手术（导航或机器人辅助TKA或PSI）的参与者和637名接受侵犯股骨髓腔手术的参与者。围手术期失血量存在统计学显著差异。两组所有病例围手术期失血量的效应量为-150.65（95%CI：-219.53至-81.77，P值<0.001）。两组术后第二天围手术期失血量的效应量为-164.29（95%CI：-320.62至-7.96，P值=0.040）。两组术前和术后1天血红蛋白存在统计学显著差异。两组术前和术后1天血红蛋白差异的效应量为-0.20（95%CI：-0.38至-0.02，P值=0.030）。
与传统TKA相比，导航或机器人辅助TKA或PSI的围手术期失血量更低。此外，它们术后血红蛋白水平的下降也更低。基于这些发现，可以得出结论，导航或机器人辅助TKA或PSI可被视为减少TKA术后出血的一种可选方案。
