目的:机器人辅助全膝关节置换术(r-TKA)有助于精确的骨切除和下肢对准,然而,严重内翻/外翻畸形的准确性和功能恢复没有得到很好的记录。研究的目的是调查与常规TKA(c-TKA)相比,r-TKA是否可以改善冠状和矢状视图中的植入物对准以及早期功能恢复。
方法:本比较研究纳入了86例症状性膝关节炎患者,他们在2021年5月1日至11月31日期间在我院接受了原发性TKA。评估的放射学参数包括髋-膝-踝角度(HKAA),股内翻-外翻角(FVVA),胫骨内翻外翻角(TVVA),胫骨后倾角(PTSA),股骨矢状角(FSA),后髁偏移比,和Insall-Salvati指数。手术时间,停留长度,和并发症从患者记录中回顾。特殊外科(HSS)医院,随访6个月,评估视觉模拟评分(VAS)和膝关节活动度。
结果:c-TKA和r-TKA组在HKAA中没有显着差异(179.73±3.76°,范围:172.10-188.90°vs.180.53±2.91°,范围:173.30-188.32°,p=0.277),FVVA(96.13±2.61°,范围:90.27-101.52°vs.96.38±2.23°,范围:90.98-100.95°,p=0.636),和TVVA(88.74±2.03°,范围:83.75-92.74°vs.89.43±1.83°,范围:85.32-94.15°,p=1.000)。与c-TKA相比,r-TKA中的机械对准发生率异常值(>3°)显着降低,17.50%(7/40)与41.30%(19/46),(p=0.017)。在轻度畸形患者中,r-TKA的PTSA仍显着低于c-TKA(p=0.009)。对于严重的内翻/外翻畸形,r-TKA的HKAA异常发生率明显较低(p=0.025),PTSA异常发生率(p=0.019),与c-TKA相比,PTSA较低(p<0.001)。在HSS方面,r-TKA功能结局优于c-TKA(93.12±1.97,范围:90-95,95CI:92.11-94.13vs.91.33±2.50,范围:85-95,95CI:90.20-92.69,p=0.036),和VAS(0.24±0.44,范围:0-1vs.0.72±0.75,范围:0-2,p=0.026),膝关节屈曲度(118.53°±8.06,范围:105-130°,95CI:114.39-122.67°vs.112.22±8.09°,范围:100-130°,95CI:108.20-116.24°,p=0.027)用于严重的内翻/外翻畸形。
结论:r-TKA改善了下肢冠状排列,矢状植入位置,严重膝关节内翻/外翻畸形患者的早期功能恢复。对于轻度内翻/外翻畸形,r-TKA在放射学和临床结果方面均未比c-TKA具有实质性优势。
OBJECTIVE: Robotic-assisted total knee arthroplasty (r-TKA) facilitates precise bone resection and lower limb alignment, yet accuracy and functional recovery for severe varus/valgus deformity is not well-documented. The aim of study was to investigate whether r-TKA improves implant alignment in the coronal and sagittal view and early functional recovery compared to conventional TKA(c-TKA).
METHODS: This comparative study included 86 patients with symptomatic knee arthritis who underwent primary TKA at our institution between 1st May and 31th November 2021. Radiological parameters evaluated included hip-knee-ankle angle (HKAA), femoral varus-valgus angle (FVVA), tibial varus-valgus angle (TVVA), posterior tibial slope angle (PTSA), femoral sagittal angle (FSA), posterior condylar offset ratio, and Insall-Salvati index. Operative time, stay length, and complications were reviewed from patient records. The hospital for special surgery (HSS), Visual Analogue Scale (VAS) and knee joint motion range were evaluated at the six-month follow-up.
RESULTS: The c-TKA and r-TKA groups had no significant differences in HKAA (179.73 ± 3.76°, range: 172.10-188.90° vs. 180.53 ± 2.91°, range: 173.30-188.32°, p = 0.277), FVVA (96.13 ± 2.61°, range: 90.27-101.52° vs. 96.38 ± 2.23°, range: 90.98-100.95°, p = 0.636), and TVVA (88.74 ± 2.03°, range: 83.75-92.74° vs. 89.43 ± 1.83°, range: 85.32-94.15°, p = 1.000). Outlier of mechanical alignment incidence (> 3°) was significantly lower in r-TKA compared with c-TKA, 17.50% (7/40) vs. 41.30% (19/46), (p = 0.017). PTSA of r-TKA remained significantly lower than c-TKA (p = 0.009) in mild-deformity patients. For severe varus/valgus deformity, r-TKA had a significantly lesser HKAA-outlier incidence (p = 0.025), PTSA-outlier incidence (p = 0.019), and lower PTSA (p < 0.001) compared with c-TKA. The r-TKA functional outcome was better than c-TKA regarding HSS (93.12 ± 1.97, range: 90-95, 95%CI:92.11-94.13 vs. 91.33 ± 2.50, range: 85-95, 95%CI:90.20-92.69, p = 0.036), and VAS (0.24 ± 0.44, range:0-1 vs. 0.72 ± 0.75, range:0-2, p = 0.026), knee joint flexion (118.53° ± 8.06, range: 105-130°, 95%CI:114.39-122.67° vs. 112.22 ± 8.09°, range: 100-130°, 95%CI:108.20-116.24° ,p = 0.027) for severe varus/valgus deformity.
CONCLUSIONS: r-TKA improved lower-limb coronal alignment, sagittal implant position, and early functional recovery for patients with severe varus/valgus deformity of the knee. r-TKA did not confer substantial advantages over c-TKA in both radiological and clinical outcomes for the mild varus/valgus deformity.