High accuracy of component positioning and restoration of lower limb alignment using robotic medial unicompartmental knee arthroplasty

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-10-06 DOI:10.1002/ksa.12484

Emanuele Diquattro, Jonathan Lettner, Marco Adriani, Robert Prill, Mikhail Salzmann, Roland Becker

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Abstract

Purpose

Unicondylar arthroplasty was performed using robotic medial unicompartmental knee arthroplasty (R-mUKA) and gap-balancing instrumentation. Our hypothesis was that robotic unicondylar knee arthroplasty accurately restores component positioning and lower limb alignment when compared to preoperative planning with actual implantation throughout the range of knee motion due to proper knee balancing.

Methods

Data were collected prospectively and were analysed for patients undergoing R-mUKA. A cemented UKA was implanted using the MAKO® robotic system. Lower limb alignment at 0°, 30°, 45°, 60° and 90° of flexion was recorded of the native knee, with the trial components in place and finally after component implantation. A spacer according to the femorotibial gap was introduced and the alignment was measured. The position of the final component was planned based on three-dimensional computed tomography images before making the bone cuts. The positioning of the femoral and tibial components was analysed in all three planes.

Results

A total of 52 patients were included (mean age 66.3 ± 6.7 years; 34 males, 18 females). The difference in femoral component position after planning and final implantation was 0.04° ± 0.58° more valgus in the coronal plane (p = 0.326) and 0.6° ± 1.4° more flexion relative to the sagittal plane (p = 0.034). The tibial component was placed in the coronal plane in 0.3° ± 0.8° of more varus (p = 0.113) and in the sagittal plane in 0.6° ± 1.2° of more posterior tibial slope (p = 0.001). Lower limb alignment of the native knee in extension was 5.8° ± 2.6° of varus and changed to 3° ± 2.1° varus after UKA (p ≤ 0.01).

Conclusion

R-mUKA helps to achieve the target of alignment and component position without any significant differences to the planning. Ligament balancing causes non-significant changes in component position. It allows optimal component position even for off-the-shelf implants respecting the patient's specific anatomy.

Level of Evidence

Level II.

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利用机器人内侧单室膝关节置换术实现高精度组件定位并恢复下肢对齐。

目的：使用机器人内侧单髁膝关节置换术（R-mUKA）和间隙平衡器械进行单髁关节置换术。我们的假设是，与术前计划相比，机器人单髁膝关节置换术由于适当的膝关节平衡，在整个膝关节活动范围内都能准确恢复组件定位和下肢对齐：方法：对接受RM-UKA的患者进行前瞻性数据收集和分析。使用 MAKO® 机器人系统植入骨水泥UKA。分别记录了原位膝关节在屈曲0°、30°、45°、60°和90°时的下肢对位情况，以及试验组件就位和组件植入后的下肢对位情况。根据股骨胫骨间隙引入垫片并测量对齐情况。在切骨之前，根据三维计算机断层扫描图像规划最终组件的位置。在所有三个平面上对股骨和胫骨组件的定位进行分析：共纳入 52 名患者（平均年龄为 66.3 ± 6.7 岁；34 名男性，18 名女性）。规划和最终植入后的股骨组件位置差异为：冠状面内翻0.04° ± 0.58°（p = 0.326），相对矢状面屈曲0.6° ± 1.4°（p = 0.034）。胫骨组件在冠状面上的屈曲度增加了 0.3° ± 0.8°（p = 0.113），在矢状面上的胫骨后斜度增加了 0.6° ± 1.2°（p = 0.001）。原生膝关节在伸展时的下肢对位为5.8°±2.6°外翻，UKA术后变为3°±2.1°外翻（p≤0.01）：结论：R-mUKA有助于实现对线和组件位置的目标，与规划无明显差异。韧带平衡导致组件位置无明显变化。即使是现成的种植体，R-mUKA也能在尊重患者具体解剖结构的前提下实现最佳的组件位置：证据等级：II.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).