PDF(Pubmed)
Abstract：
This study aimed to compare the effect of an image-based (MAKO) system using a gap-balancing technique with an imageless (OMNIbot) robotic tool utilising a femur-first measured resection technique.
A retrospective cohort study was performed on patients undergoing primary TKA with a functional alignment philosophy performed by a single surgeon using either the MAKO or OMNIbot robotic systems. In all cases, the surgeon\'s goal was to create a balanced knee and correct sagittal deformity (eliminate any fixed flexion deformity). Intra-operative data and patient-reported outcomes (PROMS) were compared.
A total of 207 MAKO TKA and 298 OMNIbot TKAs were analysed. MAKO TKA patients were younger (67 vs 69, p=0.002) than OMNIbot patients. There were no other demographic or pre-operative alignment differences. Regarding implant positioning, in MAKO TKAs the femoral component was more externally rotated in relation to the posterior condylar axis (2.3° vs 0.1°, p<0.001), had less valgus femoral cuts (1.6° vs 2.7° valgus, p<0.001) and more varus tibial cuts (2.4° vs 1.9° varus, p<0.001), and had more bone resected compared to OMNIbot TKAs. OMNIbot cases were more likely to require tibial re-cuts than MAKO (15% vs 2%, p<0.001). There were no differences in femur recut rates, soft tissue releases, or rate of achieving target coronal and sagittal leg alignment between robotic systems. A subgroup analysis of 100 MAKO and 100 OMNIbot propensity-matched TKAs with 12-month follow-up showed no significant difference in OKS (42 vs 43, p=0.7) or OKS PASS scores (83% vs 91%, p=0.1). MAKO TKAs reported significantly better symptoms according to their KOOS symptoms score than patients that had OMNIbot TKAs (87 vs 82, p=0.02) with a higher proportion of KOOS PASS rates, at a slightly longer follow-up time (20 months vs 14 months, p<0.001). There were no other differences in PROMS.
A gap-balanced technique with an image-based robotic system (MAKO) results in different implant positioning and bone resection and reduces tibial recuts compared to a femur-first measured resection technique with an imageless robotic system (OMNIbot). Both systems achieve equal coronal and sagittal deformity correction and good patient outcomes at short-term follow-ups irrespective of these differences.
A retrospective cohort study was performed on patients undergoing primary TKA with a functional alignment philosophy performed by a single surgeon using either the MAKO or OMNIbot robotic systems. In all cases, the surgeon\'s goal was to create a balanced knee and correct sagittal deformity (eliminate any fixed flexion deformity). Intra-operative data and patient-reported outcomes (PROMS) were compared.
A total of 207 MAKO TKA and 298 OMNIbot TKAs were analysed. MAKO TKA patients were younger (67 vs 69, p=0.002) than OMNIbot patients. There were no other demographic or pre-operative alignment differences. Regarding implant positioning, in MAKO TKAs the femoral component was more externally rotated in relation to the posterior condylar axis (2.3° vs 0.1°, p<0.001), had less valgus femoral cuts (1.6° vs 2.7° valgus, p<0.001) and more varus tibial cuts (2.4° vs 1.9° varus, p<0.001), and had more bone resected compared to OMNIbot TKAs. OMNIbot cases were more likely to require tibial re-cuts than MAKO (15% vs 2%, p<0.001). There were no differences in femur recut rates, soft tissue releases, or rate of achieving target coronal and sagittal leg alignment between robotic systems. A subgroup analysis of 100 MAKO and 100 OMNIbot propensity-matched TKAs with 12-month follow-up showed no significant difference in OKS (42 vs 43, p=0.7) or OKS PASS scores (83% vs 91%, p=0.1). MAKO TKAs reported significantly better symptoms according to their KOOS symptoms score than patients that had OMNIbot TKAs (87 vs 82, p=0.02) with a higher proportion of KOOS PASS rates, at a slightly longer follow-up time (20 months vs 14 months, p<0.001). There were no other differences in PROMS.
A gap-balanced technique with an image-based robotic system (MAKO) results in different implant positioning and bone resection and reduces tibial recuts compared to a femur-first measured resection technique with an imageless robotic system (OMNIbot). Both systems achieve equal coronal and sagittal deformity correction and good patient outcomes at short-term follow-ups irrespective of these differences.
摘要：
目的：本研究旨在比较使用间隙平衡技术的基于图像（MAKO）系统与使用股骨先测量切除技术的无图像（OMNIbot）机器人工具的效果。
方法：对接受原发性TKA的患者进行了一项回顾性队列研究，由一名外科医生使用MAKO或OMNIbot机器人系统进行功能对准。在所有情况下,外科医生的目标是创造一个平衡的膝盖和正确的矢状畸形（消除任何固定的屈曲畸形）。比较了术中数据和患者报告的结果（PROMS）。
结果：共分析了207个MAKOTKA和298个OMNIbotTKA。MAKOTKA患者比OMNIbot患者年轻（67vs69，p=0.002）。没有其他人口统计学或术前对齐差异。关于植入物的定位，在MAKOTKAs中，股骨组件相对于后髁轴的外部旋转更多（2.3°vs0.1°，p<0.001)，股骨外翻切口较少(1.6°vs2.7°外翻，p<0.001)和更多的内翻胫骨切口(2.4°与1.9°内翻，p<0.001)，与OMNIbotTKAs相比，切除的骨头更多。OMNIbot病例比MAKO更可能需要胫骨重新切割(15%对2%，p<0.001)。股骨重切率没有差异，软组织释放，或机器人系统之间实现目标冠状和矢状腿对齐的速率。对100个MAKO和100个OMNIbot倾向匹配的TKA进行12个月随访的亚组分析显示，OKS（42vs43，p=0.7）或OKSPASS评分（83％vs91％，p=0.1)。根据他们的KOOS症状评分，MAKOTKAs报告的症状明显优于OMNIbotTKAs患者（87vs82，p=0.02），KOOS通过率比例较高，在稍长的随访时间（20个月比14个月，p<0.001)。在PROMS中没有其他差异。
结论：与基于图像的机器人系统（MAKO）的间隙平衡技术相比，使用无图像机器人系统（OMNIbot）的股骨先测量切除技术可导致不同的植入物定位和骨切除，并减少了胫骨再切。无论这些差异如何，两种系统在短期随访中均可实现相同的冠状和矢状畸形矫正以及良好的患者预后。
方法：对接受原发性TKA的患者进行了一项回顾性队列研究，由一名外科医生使用MAKO或OMNIbot机器人系统进行功能对准。在所有情况下,外科医生的目标是创造一个平衡的膝盖和正确的矢状畸形（消除任何固定的屈曲畸形）。比较了术中数据和患者报告的结果（PROMS）。
结果：共分析了207个MAKOTKA和298个OMNIbotTKA。MAKOTKA患者比OMNIbot患者年轻（67vs69，p=0.002）。没有其他人口统计学或术前对齐差异。关于植入物的定位，在MAKOTKAs中，股骨组件相对于后髁轴的外部旋转更多（2.3°vs0.1°，p<0.001)，股骨外翻切口较少(1.6°vs2.7°外翻，p<0.001)和更多的内翻胫骨切口(2.4°与1.9°内翻，p<0.001)，与OMNIbotTKAs相比，切除的骨头更多。OMNIbot病例比MAKO更可能需要胫骨重新切割(15%对2%，p<0.001)。股骨重切率没有差异，软组织释放，或机器人系统之间实现目标冠状和矢状腿对齐的速率。对100个MAKO和100个OMNIbot倾向匹配的TKA进行12个月随访的亚组分析显示，OKS（42vs43，p=0.7）或OKSPASS评分（83％vs91％，p=0.1)。根据他们的KOOS症状评分，MAKOTKAs报告的症状明显优于OMNIbotTKAs患者（87vs82，p=0.02），KOOS通过率比例较高，在稍长的随访时间（20个月比14个月，p<0.001)。在PROMS中没有其他差异。
结论：与基于图像的机器人系统（MAKO）的间隙平衡技术相比，使用无图像机器人系统（OMNIbot）的股骨先测量切除技术可导致不同的植入物定位和骨切除，并减少了胫骨再切。无论这些差异如何，两种系统在短期随访中均可实现相同的冠状和矢状畸形矫正以及良好的患者预后。
