PDF(Pubmed)
Abstract：
OBJECTIVE: In total knee arthroplasty (TKA), achieving soft-tissue balance while retaining acceptable lower limb alignment is sometimes difficult and may lead to patient dissatisfaction. Theoretically, patient-specific implants can bring great benefits, while the lack of precise surgical tools may hinder the improvement of outcomes. The objective of this study was to illustrate surgical techniques and evaluate kinematics and early clinical outcomes of robotic-assisted TKA using patient-specific implants.
METHODS: Based on preoperative CT scan, femoral and tibial components were 3D printed. Medial and lateral tibial liners were separate with different thicknesses, posterior slopes and conformity. TiRobot Recon Robot was used for surgery, and was armed with smart tools that quantify gap, force and femoral-tibial track. We collected data on demographics, intraoperative gap balance and femoral-tibial motion. In the follow-up, we evaluated the range of motion, Visual Analogue Scale (VAS), forgotten joint score (FJS), Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) score. Radiological data were also harvested.
RESULTS: Fifteen patients (17 knees) were enrolled with a mean age of 64.6 ± 6.4 (53-76) years. In 5 knees, we used symmetric tibial liners, the rest were asymmetric. After surgery, the average alignment was 1.6 ± 2.0 (-3-5) degrees varus. The average follow-up lasted 6.7 ± 4.2 (1-14) months. The mean visual analogue scale was 0.8 ± 0.7 (0-2), FJS was 62.4 ± 25.3 (0-87), KOOS was 86.5 ± 9.4 (57-97). 11 patients were \"very satisfied\", 3 were \"satisfied\" with the result, and one patient was neutral due to restricted extension and unsatisfactory rehabilitation at five months\' follow-up.
CONCLUSIONS: With patient-specific implants and robotics, TKA could be performed by a mathematical way, which was dubbed a \"differential\" TKA. Intraoperative kinematics was excellent in terms of gap-force balancing and femoral-tibial relative motion. Preliminary clinical outcomes were overall satisfactory.
METHODS: Based on preoperative CT scan, femoral and tibial components were 3D printed. Medial and lateral tibial liners were separate with different thicknesses, posterior slopes and conformity. TiRobot Recon Robot was used for surgery, and was armed with smart tools that quantify gap, force and femoral-tibial track. We collected data on demographics, intraoperative gap balance and femoral-tibial motion. In the follow-up, we evaluated the range of motion, Visual Analogue Scale (VAS), forgotten joint score (FJS), Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR) score. Radiological data were also harvested.
RESULTS: Fifteen patients (17 knees) were enrolled with a mean age of 64.6 ± 6.4 (53-76) years. In 5 knees, we used symmetric tibial liners, the rest were asymmetric. After surgery, the average alignment was 1.6 ± 2.0 (-3-5) degrees varus. The average follow-up lasted 6.7 ± 4.2 (1-14) months. The mean visual analogue scale was 0.8 ± 0.7 (0-2), FJS was 62.4 ± 25.3 (0-87), KOOS was 86.5 ± 9.4 (57-97). 11 patients were \"very satisfied\", 3 were \"satisfied\" with the result, and one patient was neutral due to restricted extension and unsatisfactory rehabilitation at five months\' follow-up.
CONCLUSIONS: With patient-specific implants and robotics, TKA could be performed by a mathematical way, which was dubbed a \"differential\" TKA. Intraoperative kinematics was excellent in terms of gap-force balancing and femoral-tibial relative motion. Preliminary clinical outcomes were overall satisfactory.
摘要：
目的：在全膝关节置换术（TKA）中，在保持可接受的下肢对齐的同时实现软组织平衡有时是困难的,并且可能导致患者不满意。理论上,针对患者的植入物可以带来巨大的好处，而缺乏精确的手术工具可能会阻碍结局的改善。这项研究的目的是说明手术技术和评估运动学和早期临床结果的机器人辅助TKA使用患者特定的植入物。
方法：基于术前CT扫描，股骨和胫骨组件进行3D打印。胫骨内侧和外侧衬垫分开，厚度不同，后坡和整合。TiRobotRecon机器人用于手术，并配备了量化差距的智能工具，力和股骨胫骨轨道。我们收集了人口统计数据，术中间隙平衡和股骨-胫骨运动。在后续行动中,我们评估了运动范围，视觉模拟量表(VAS),遗忘联合得分(FJS)，膝关节损伤和骨关节炎结果评分，关节置换(KOOS,JR）得分。还收集了放射学数据。
结果：纳入15例患者（17膝），平均年龄为64.6±6.4（53-76）岁。在5个膝盖，我们用了对称的胫骨衬垫,其余的是不对称的。手术后,平均比对为1.6±2.0(-3-5)度内翻。平均随访6.7±4.2(1～14)个月。平均视觉模拟评分为0.8±0.7（0-2），FJS为62.4±25.3（0-87），KOOS为86.5±9.4(57-97)。11名患者“非常满意”，3对结果“满意”，1例患者在5个月随访时由于延期受限和康复不令人满意而保持中立.
结论：使用特定于患者的植入物和机器人技术，TKA可以通过数学方法进行，被称为“差分”TKA。术中运动学在间隙力平衡和股骨胫骨相对运动方面非常出色。初步临床结果总体令人满意。
方法：基于术前CT扫描，股骨和胫骨组件进行3D打印。胫骨内侧和外侧衬垫分开，厚度不同，后坡和整合。TiRobotRecon机器人用于手术，并配备了量化差距的智能工具，力和股骨胫骨轨道。我们收集了人口统计数据，术中间隙平衡和股骨-胫骨运动。在后续行动中,我们评估了运动范围，视觉模拟量表(VAS),遗忘联合得分(FJS)，膝关节损伤和骨关节炎结果评分，关节置换(KOOS,JR）得分。还收集了放射学数据。
结果：纳入15例患者（17膝），平均年龄为64.6±6.4（53-76）岁。在5个膝盖，我们用了对称的胫骨衬垫,其余的是不对称的。手术后,平均比对为1.6±2.0(-3-5)度内翻。平均随访6.7±4.2(1～14)个月。平均视觉模拟评分为0.8±0.7（0-2），FJS为62.4±25.3（0-87），KOOS为86.5±9.4(57-97)。11名患者“非常满意”，3对结果“满意”，1例患者在5个月随访时由于延期受限和康复不令人满意而保持中立.
结论：使用特定于患者的植入物和机器人技术，TKA可以通过数学方法进行，被称为“差分”TKA。术中运动学在间隙力平衡和股骨胫骨相对运动方面非常出色。初步临床结果总体令人满意。
