Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty
Improved Accuracy of Component Positioning with Robotic-Assisted Unicompartmental Knee Arthroplasty
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DOI：
10.2106/jbjs.15.00664
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发表时间：
2016-04-20
影响因子：
5.3
通讯作者：
Blyth, Mark
中科院分区：
文献类型：
--
作者：
Bell, Stuart W.;Anthony, Iain;Blyth, Mark
背景资料：据报道，与接受全膝关节置换术的患者相比，接受单髁膝关节置换术的患者的翻修率更高，部件定位不良被确定为植入物失效的一个因素。已经提出了一种机器人辅助手术程序，作为提高关节成形术中部件植入准确性的方法。这项前瞻性、随机、单盲、对照试验的目的是比较机器人辅助和传统植入技术，评价单髁膝关节置换术中部件定位的准确性。方法：139名患者被随机分配接受使用MAKO机器人交互式矫形臂（RIO）的机器人辅助外科手术治疗系统或使用Oxford III期单髁膝关节置换术和传统内固定的传统外科手术。术后计算机断层扫描进行了三个月，以评估轴向，冠状面和矢状面组件positioning.Results的准确性：数据可用于120例患者，62谁经历了机器人辅助单间室膝关节置换术和58谁经历了传统的单间室膝关节置换术。所有测量的组件参数的观察者内一致性良好。通过使用机器人辅助外科手术，部件定位的准确性得到了提高，所有部件参数的均方根误差和中位误差均较低（p < 0.01）。在股骨部件矢状位方面，接受机器人辅助单间室膝关节置换术组中部件植入在目标位置2度内的患者比例显著高于接受传统单间室膝关节镜手术组（57%与26%，p = 0.0008），股骨部件冠状面位置（70%与28%，p = 0.0001），股骨部件轴向位置（53%与31%，p = 0.0163），胫骨部件矢状位（80%对比22%，p = 0.0001），胫骨部件轴向位置（48%对19%，p = 0.0009）。机器人-与传统单间室相比，使用MAKO RIO辅助外科手术可提高植入物定位的准确性膝关节置换术手术技术。
Background: Higher revision rates have been reported in patients who have undergone unicompartmental knee arthroplasty compared with patients who have undergone total knee arthroplasty, with poor component positioning identified as a factor in implant failure. A robotic-assisted surgical procedure has been proposed as a method of improving the accuracy of component implantation in arthroplasty. The aim of this prospective, randomized, single-blinded, controlled trial was to evaluate the accuracy of component positioning in unicompartmental knee arthroplasty comparing robotic-assisted and conventional implantation techniques.Methods: One hundred and thirty-nine patients were randomly assigned to treatment with either a robotic-assisted surgical procedure using the MAKO Robotic Interactive Orthopaedic Arm (RIO) system or a conventional surgical procedure using the Oxford Phase-3 unicompartmental knee replacement with traditional instrumentation. A postoperative computed tomographic scan was performed at three months to assess the accuracy of the axial, coronal, and sagittal component positioning.Results: Data were available for 120 patients, sixty-two who had undergone robotic-assisted unicompartmental knee arthroplasty and fifty-eight who had undergone conventional unicompartmental knee arthroplasty. Intraobserver agreement was good for all measured component parameters. The accuracy of component positioning was improved with the use of the robotic-assisted surgical procedure, with lower root mean square errors and significantly lower median errors in all component parameters (p < 0.01). The proportion of patients with component implantation within 2 degrees of the target position was significantly greater in the group who underwent robotic-assisted unicompartmental knee arthroplasty compared with the group who underwent conventional unicompartmental knee arthroscopy with regard to the femoral component sagittal position (57% compared with 26%, p = 0.0008), femoral component coronal position (70% compared with 28%, p = 0.0001), femoral component axial position (53% compared with 31%, p = 0.0163), tibial component sagittal position (80% compared with 22%, p = 0.0001), and tibial component axial position (48% compared with 19%, p = 0.0009).Conclusions: Robotic-assisted surgical procedures with the use of the MAKO RIO lead to improved accuracy of implant positioning compared with conventional unicompartmental knee arthroplasty surgical techniques.