Purpose To evaluate the operation and early clinical effect in primary total knee arthroplasty (TKA) about the novel combination of CT-based patient-specific three-dimensional (3D) preoperative design and conventional osteotomy instruments, compared with the conventional method. Methods After a 1:1 propensity score-matching (PSM), patients were matched to the novel technique group and the conventional group, 109 cases in each group. The conventional group adopted a preoperative design based on a full-length radiograph (FLX) and received TKA with conventional osteotomy instruments. The novel technique group used a CT-based patient-specific 3D preoperative design combined with conventional osteotomy instruments; during the surgery, the femoral entry point, femoral valgus osteotomy angle, the fix point of tibial plateau extramedullary guide pin, and the position of tibial extramedullary positioning rod were accurately selected according to the preoperative 3D design to ensure accurate intraoperative implementation. The lower limb alignment, component position, operation time, tourniquet time, hospital stay, blood loss volume, incidence of postoperative complications, visual analog scale (Vas) score, and New Knee Society Score System (NEW-KSS) at 1 day before operation and 1, 6, and 12 months after operation were recorded and compared. Results The novel technique group was significantly better than the conventional group in controlling lateral tibial component angle (LTC) (P < 0.001), and the novel technique group had lower percentages of hip-knee-ankle angle (HKA) outliers (P < 0.001) and overcorrection (P = 0.003). The operation time, tourniquet time, and hospital stay of the novel technique group was shorter (P < 0.05). In 1 month after the operation, the novel technique group achieved a significantly better VAS score (P < 0.05), but a similar NEW-KSS score (P > 0.05) when compared with the conventional group. But in 6 and 12 months after surgery, no statistical differences were seen in the above two scores (P > 0.05). Conclusion The novel technique of CT-based patient-specific 3D preoperative design combined with conventional instruments can improve the accuracy of osteotomy in primary total knee arthroplasty, with benefits of significantly reducing pain and rapid recovery during the early postoperative period, but having no obvious effect on outcome after a 1-year follow-up.
Purpose To achieve the desired alignment more accurately and improve postoperative outcomes, new techniques such as computer navigation (Navigation), patient-speciic instruments (PSI) and surgical robots (Robot) are applied in Total Knee Arthroplasty (TKA). This network meta-analysis aims to compare the radiological and clinical outcomes among the abovementioned techniques and conventional instruments (CON). Methods A PRISMA network meta-analysis was conducted and study protocol was published online at INPLASY (INPLASY202060018). Three databases (PubMed, EMBASE and Cochrane) were searched up to June 1, 2020. Randomised controlled trials (RCTs) comparing any two of the four techniques were included. A Bayesian network meta-analysis was performed focusing on radiological and clinical outcomes. The odds ratio (OR) or mean diference (MD) in various outcomes were calculated, and the interventions were ranked by the surface under the cumulative ranking area (SUCRA) value. Results Seventy-three RCTs were included, with a total of 4209 TKAs. Navigation and Robot could signiicantly reduce the occurrence of malalignment and malposition compared with PSI and CON, and Navigation could obtain higher mediumand-long-term KSS knee scores than CON. Robot had the greatest advantage in achieving the desired alignment accurately, followed by Navigation; Navigation had the greatest advantage in the KSS score. Conclusion Navigation and Robot did improve the accuracy of alignment compared with PSI and conventional instrument in TKA, but the above four techniques showed no clinical signiicance in postoperative outcomes.
Purpose Femoral bowing influences the genesis and management of knee osteoarthritis (OA). The aim of this study was to investigate the relationship between the femoral torsion angle (FTA) and femoral bowing angle (FBA) in a southern Chinese population. It was hypothesized that a greater FTA would lead to a greater lateral FBA. Methods A total of 381 lower extremities from 381 osteoarthritic patients (298 women, 83 men; 201 left, 180 right; mean age 66.5 ± 8.9 years) were retrospectively reviewed. Age, sex, body mass index (BMI), side, height, femoral length (FL), hip-knee-ankle angle (HKA) and FTA were set as FBA-related factors. The three-dimensional (3D) FBA, the angle between the anatomical axis of the proximal femur and the anatomical axis of the distal femur in the plane they form, and its projection on the coronal (lateral FBA) and sagittal (anterior FBA) planes were measured on 3D computed tomography (CT) models. The correlation of the 3D, lateral and anterior FBAs with each of the FBA-related factors was explored using multiple linear regression analysis. The correlation between the FBA and FTA was explored and verified after using propensity score matching to control for the other FBA-related factors. ResultsThe mean lateral and anterior FBAs were 5.5°, with 53.5% greater than 5°, and 12.7°, with 70.3% greater than 11°, respectively. 3D FBA was positively correlated with age (Std.Co = 0.113, P < 0.05) and HKA (Std.Co = 0.129, P < 0.05). Lateral FBA was positively correlated with age (Std.Co = 0.118, P < 0.05), female sex (Std.Co = 0.206, P < 0.05), HKA (Std. Co = 0.184, P < 0.05) and FL (Std.Co = 0.220, P < 0.05). Anterior FBA was positively correlated with age (Std.Co = 0.108, P < 0.05) and male sex (Std.Co = 0.108, P < 0.05). When the related factors were balanced between the two groups (NS), FTA did not significantly affect 3D FBA or anterior FBA (NS), while FTA was positively correlated with lateral FBA (Std. Co = 0.165, P < 0.05). Conclusion External torsion of the proximal femur increases the lateral FBA by twisting a partial anterior FBA into a lateral FBA, especially in the female population. If a patient is found to have a large lateral FBA preoperatively, one should be alert to the possibility of a concomitant large FTA, as there are implications for femoral orthopedics, TKA and patellofemoral pressure distribution. Level of evidence III.
Objective This study explored whether robotic arm‐assisted total knee arthroplasty (RATKA) has the advantage of restoring femoral rotational alignment compared to conventional total knee arthroplasty (COTKA). Methods Sixty patients (45 women and 15 men) attending our department from May 2019 to December 2020 were selected and divided into two groups, with 30 patients in each group, according to whether they underwent COTKA or RATKA. Femoral rotational alignment results, such as, posterior condylar angle (PCA), patella transverse axis‐femoral transepicondylar axis angle (PFA), radiological findings, such as, hip‐knee‐ankle angle (HKA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA), and operative data (operation time, intraoperative blood loss, tourniquet time, and length of stay (LOS), and clinical outcomes, such as maximum knee flexion angle (MKFA), Knee Society Score (KSS), and Western Ontario Mac Master University Index Score (WOMAC) were compared within and between the two groups. Results PCA and PFA in the RATKA group were (0.6 ± 0.3)° and (0.9 ± 0.3)°, respectively, which were smaller than (1.5 ± 2.0)° and (3.1 ± 1.1)° in the COTKA group ( P < 0.05), and were closer to 0°; the differences in HKA, LDFA, and MPTA were not statistically significant. With the exception of the LDFA, the HKA, MPTA, PCA, and PFA improved in both groups after surgery ( P < 0.05). The blood loss and the LOS of RATKA group were 192.3 ± 23.1 mL and 8.2 ± 1.4 days, which were less than 203.7 ± 29.8 mL and 9.3 ± 1.1 days of the COTKA group, but the operation time showed no statistically significant difference, and the tourniquet time was longer ( P < 0.05). The MKFA in the RATKA group was (123.0 ± 3.7)°, which was greater than (116.3 ± 4.6)° in the COTKA group ( P < 0.05). In terms of scores, the postoperative results were better than the preoperative results in both groups ( P < 0.05). However, there was no statistically significant difference between the groups. Conclusion The accuracy of femoral rotational alignment reconstructed achieved by RATKA is significantly better than that of COTKA and is more conducive to the recovery of knee flexion function after surgery; although RATKA reduces intraoperative blood loss and postoperative LOS, the short‐term clinical efficacy comparison has not yet demonstrated the advantages of robotic technology, and a more optimized design is needed to improve the efficiency of RATKA surgery.
Purpose Lower limb alignment is crucial in total knee arthroplasty (TKA). Previous studies have shown that robotics and personalized three-dimensional (3D) preoperative planning could improve postoperative alignment accuracy compared with conventional TKA, but comparison between the above two techniques has never been reported. The authors hypothesized that robotics may be superior to personalized 3D preoperative planning in terms of postoperative alignment in primary TKA, with similar patient-reported outcome measures (PROMs) but higher cost and longer operative time. Methods A consecutive series of patients who received TKA in our center from September 2020 to January 2021 were enrolled retrospectively. After 1:2 matching, 52 and 104 patients were included and divided into study group for robotics and control group for personalized 3D preoperative planning, respectively. Multiple postoperative alignment angles were measured, and clinical features such as operation and tourniquet time, length of hospital stay and hemoglobin (Hb) were recorded. Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to evaluate clinical results. Results Compared with control group, robotics group had significantly lower frontal femoral component angle (FFC) and frontal tibial component angle (FTC) absolute deviation (P < 0.05). It also had less outliers in hip–knee–ankle angle (HKA), FTC, lateral femoral component angle (LFC) and lateral tibial component angle (LTC) (P < 0.05). Hb loss of robotics group was significantly lower than control group (P < 0.001), while the operation and tourniquet time were longer (P < 0.001). There was no significant difference in KSS and WOMAC scores between two groups. Conclusion Compared with control group, patients in robotics group had significantly less malalignment, malposition, Hb loss, but similar PROMs. The operations in robotics group spent longer operation time and cost more compared with control group. Trial registration: The Chinese Clinical Trial Registry, ChiCTR2000036235. Registered 22 August 2020, http://www.chictr.org.cn/showproj.aspx?proj=59300. Level of evidence III.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.