Evaluation Of Early Clinical Application And Outcomes Of Robotic-arm Assisted Total Knee Arthroplasty

BackgroundTotal knee arthroplasty(TKA)is a definitive treatment for end-stage knee osteoarthritis and rheumatoid arthritis.Due to the increase of obese population and the aggravation of social population aging,the amount of TKA surgery has been increasing.Although TKA has made great advancement in surgical technique,implant design,postoperative pain management,and rehabilitation,20% of patients still report low satisfaction after TKA.With the development of artificial intelligence,it has been widely employed in medical field.Robotic-arm assisted total knee arthroplasty(RATKA)aims to improve the accuracy of surgery,postoperative clinical outcomes,patient satisfaction,and reduce the incidence of complications.RATKA is a research hotspot in medical field and has broad development prospects.PurposeThe purpose of this study was to evaluate the accuracy,learning curve,postoperative clinical efficacy and complications of RATKA through patient follow-up and postoperative radiological data analysis.The main research contents include:(1)the evaluation of the accuracy of RATKA;(2)the analysis of RATKA learning curve;(3)the assessment of clinical outcomes and postoperative complications of RATKA.MethodsThis study is a prospective study,including 94 patients who received TKA in the Affiliated Hospital of Qingdao University from December 2020 to December 2021,including 68 patients in RATKA group and 26 patients in traditional TKA group.The MAKO RIO Robotic Interactive Orthopaedic Arm(Stryker,Mahwah,NJ,USA)system was used.Inclusion criteria: diagnosed as degenerative osteoarthritis of knee joint,first received TKA,aged 18-80 years,the operation method was RATKA or TKA,and the operation was completed by the same doctor.Exclusion criteria: previous history of nervous system diseases,ipsilateral knee and hip surgery,poor bone bed conditions which is insufficient support for prosthesis,and patients with infectious arthritis.The research contents include:(1)accuracy evaluation of RATKA: record the preoperative planning of patients,collect the intraoperative and postoperative data of patients,compare the measurement results with the preoperative planning,and evaluate the accuracy of RATKA in intraoperative osteotomy,implant placement and lower limb alignment correction;(2)RATKA learning curve analysis: analyze the learning curve of RATKA in operation time,implantation,and lower limb alignment correction,and analyze the characteristics of complication in the learning process;(3)Analysis of postoperative clinical efficacy and postoperative complications of RATKA: record the characteristics of patients before operation,and analyze the differences of perioperative and early postoperative observation indexes between two groups to understand the clinical outcomes and postoperative complications of RATKA.Results(1)RATKA has high accuracy in osteotomy,prosthesis implantation,prosthesis size prediction and mechanical alignment correction.The mean absolute differences of distal femoral osteotomy(medial and lateral)and posterior femoral condyle osteotomy(medial and lateral)were 0.30 mm(0.55),0.38 mm(0.62),0.48 mm(0.69)and 0.51 mm(0.72),respectively;The mean absolute differences of tibial plateau osteotomy(medial and lateral)were 0.43 mm(0.66)and 0.45 mm(0.67),respectively.The average varus angle of femoral implant was 0.39°(0.62),the average varus angle of tibial implant was 0.45°(0.67),and the average posterior slope of tibial implant was 0.52°(0.72).The accuracy of femoral and tibial implant size prediction was 100.00% and 97.62%,respectively.The mean absolute difference of mechanical alignment after operation was 0.41°(0.64).(2)RATKA had a learning curve in terms of operation time.When the number of operation cases reached 11,the learning curve could be completed.RATKA had no learning curve in implantation and mechanical alignment correction,and there were no surgery related complications in the learning process.(3)There was no significant difference in baseline characteristics between RATKA group and traditional TKA group(P > 0.05).Compared with traditional TKA,patients with RATKA had no increased risk of perioperative blood loss and infection(P > 0.05).The VAS score of RATKA patients on the first day after operation was significantly lower than that of traditional TKA patients(P < 0.05),but there was no significant difference between the two groups on the second and third day after operation(P > 0.05).There was no significant difference in postoperative SLR time,ROM on the third day and KSS on the perioperative stage between the two groups(P > 0.05).There was no significant difference in ROM,KSS and WOMAC scores between the two groups at 1 month,3months,6 months and 1 year after operation(P > 0.05).No operation related complications occurred in the two groups during postoperative follow-up(P > 0.05).ConclusionRATKA had high surgical accuracy.It could accurately carry out intraoperative osteotomy,implantation and mechanical alignment correction according to preoperative planning,and accurately predict the size of femoral and tibial implant.The learning curve of RATKA could be completed when the operation volume reached 11 cases,but there was no learning curve in implantation and mechanical alignment correction,and the risk of complications would not be increased in the learning process.Compared with traditional TKA,RATKA patients had less postoperative pain.There was no significant difference between RATKA and traditional TKA in clinical outcomes and incidence of postoperative complications.