目的:本系统综述旨在比较零件定位的精度,患者报告结果测量(PROMs),并发症,幸存者,成本效益,MAKO机械臂辅助单室膝关节置换术(RAUKA)和手动内侧单室膝关节置换术(mUKA)的学习曲线。
方法:搜索PubMed,MEDLINE,GoogleScholar于2021年11月根据系统审查和系统分析的首选报告项目进行了研究。搜索词包括“机器人”,\"单室\",\"膝盖\",和“关节成形术”。发表的临床研究文章报道了MAKORAUKA的学习曲线和成本效益,和那些比较组件精度的人,功能结果,幸存者,或者MUKA的并发症,被纳入分析。
结果:从初步筛选中确定了总共179篇文章,其中14篇文章符合纳入标准,并纳入分析。分析的论文包括关于学习曲线的论文,关于植入物定位的五个,六项关于功能结果,关于并发症的五个,六个幸存者,三是成本。学习曲线的操作时间为6例,精度为零。有一致的证据表明MAKORAUKA的植入物定位更加精确。荟萃分析显示MAKORAUKA相关的总体并发症发生率较低(OR2.18(95%置信区间(CI)1.06至4.49;p=0.040),但在再干预方面无差异,感染,膝关节社会评分(KSS;平均差1.64(95%CI-3.00至6.27);p=0.490),或西安大略省和麦克马斯特大学关节炎指数(WOMAC)评分(平均差-0.58(95%CI-3.55至2.38);p=0.700)。MAKORAUKA被证明是一种具有成本效益的程序,但这与体积直接相关。
结论:MAKORAUKA与组件定位精度的提高相关,但与使用KSS和WOMAC评分的PROM的改善无关。未来的长期研究应该报告功能结果,可能使用最小上限效应和生存率的评分来评估MAKORAUKA提高的精确度是否会导致更好的结局。引用本文:骨关节J2022;104-B(5):541-548。
OBJECTIVE: This systematic review aims to compare the precision of component positioning, patient-reported outcome measures (PROMs), complications, survivorship, cost-effectiveness, and learning curves of MAKO robotic arm-assisted unicompartmental knee arthroplasty (RAUKA) with manual medial unicompartmental knee arthroplasty (mUKA).
METHODS: Searches of PubMed, MEDLINE, and Google Scholar were performed in November 2021 according to the Preferred Reporting Items for Systematic Review and Meta--Analysis statement. Search terms included \"robotic\", \"unicompartmental\", \"knee\", and \"arthroplasty\". Published clinical research articles reporting the learning curves and cost-effectiveness of MAKO RAUKA, and those comparing the component precision, functional outcomes, survivorship, or complications with mUKA, were included for analysis.
RESULTS: A total of 179 articles were identified from initial screening, of which 14 articles satisfied the inclusion criteria and were included for analysis. The papers analyzed include one on learning curve, five on implant positioning, six on functional outcomes, five on complications, six on survivorship, and three on cost. The learning curve was six cases for operating time and zero for precision. There was consistent evidence of more precise implant positioning with MAKO RAUKA. Meta-analysis demonstrated lower overall complication rates associated with MAKO RAUKA (OR 2.18 (95% confidence interval (CI) 1.06 to 4.49); p = 0.040) but no difference in re-intervention, infection, Knee Society Score (KSS; mean difference 1.64 (95% CI -3.00 to 6.27); p = 0.490), or Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (mean difference -0.58 (95% CI -3.55 to 2.38); p = 0.700). MAKO RAUKA was shown to be a cost-effective procedure, but this was directly related to volume.
CONCLUSIONS: MAKO RAUKA was associated with improved precision of component positioning but was not associated with improved PROMs using the KSS and WOMAC scores. Future longer-term studies should report functional outcomes, potentially using scores with minimal ceiling effects and survival to assess whether the improved precision of MAKO RAUKA results in better outcomes. Cite this article: Bone Joint J 2022;104-B(5):541-548.