Early clinical outcomes of robot-assisted functional alignment and manual mechanical alignment in total knee arthroplasty

doi:10.3877/ cma.j.issn.1674-134X.2024.06.003

Abstract

Abstract:

Objective

To investigate and compare the precision in terms of joint prosthesis placement， early clinical efficacy and patients satisfaction of robotic-arm assisted functionally aligned total knee arthroplasty （RFA-TKA） versus mechanically aligned total knee arthroplasty with manual technique（MA-TKA）.

Methods

Retrospective analysis was conducted on data from patients who underwent total knee arthroplasty for knee osteoarthritis （OA） at the Department of Orthopedics， the First Affiliated Hospital of Chongqing Medical University between June 2022 and October 2023， with a follow-up period exceeding three months and complete follow-up information. Patients with other diagnoses， ligament laxity， and incomplete follow-up data were excluded. Patients were categorized into RFA-TKA group and MA-TKA group based on the surgical approach. General patient characteristics were documented， body mass index （BMI） was calculated，overall surgical satisfaction was assessed， and pre-and post-operative measurements including hip-knee-ankle angle （HKA）， mechanical lateral distal femur angle （mLDFA）， mechanical medial proximal tibia angle （mMPTA）were recorded. Visual analogue scale （VAS）， the Hospital for Special Surgery knee joint score （HSS）， as well as the Western Ontario and McMaster University osteoarthritis index （WOMAC） were evaluated before surgery， at three weeks， and three months after surgery. Clinical scores with repeated measurements over three times were analyzed by repeated-measures ANOVA， measurement data were analyzed by t test， and enumeration data were analyzed by chi square test.

Results

A total of 84 patients （89 knees） were included in the study， including 47 patients （47 knees） in the RFA-TKA group and 37 patients （42 knees） in the MA-TKA group. The differences in age （t=-0.902） and BMI （t=-1.316） between the two groups were not statistically significant（both P＞0.05）.There was no statistically significant difference between the two groups in preoperative and postoperative HKA（t=0.145， -0.065）， mLDFA （t=-0.251， 0.802）， and mMPTA （t=-1.643， -0.601）（all P＞0.05）. The main effects of group and time factors on VAS score， HSS score， and WOMAC score were statistically significant（F=6.257， P=0.016； F=1076.458， P＜0.001； F=4.909， P=0.029； F=309.043； P＜0.001； F=8.856， P=0.004；F=639.542， P＜0.001）. There was an interaction effect of surgical approach and scoring time point on VAS score and WOMAC score （F=21.448， P＜0.001； F=7.504， P=0.001）. The overall surgical satisfaction of patients in the RFA-TKA group was higher （χ²=4.965， P=0.026）.

Conclusion

Both RFA-TKA and MATKA have good therapeutic effect on knee OA， while RFA-TKA has better early clinical function score and higher patient satisfaction.

Key words: Osteoarthritis， knee, Arthroplasty， replacement， knee

Yinsong Sun, Dehua Wang, Lu Zhou, Yiting Lei, Jiaying Wei, Yao He, Mingfei Dong, Chen Zhao, Wei Huang, Ke Li. Early clinical outcomes of robot-assisted functional alignment and manual mechanical alignment in total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 709-719.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2024.06.003

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2024/V18/I06/709

Figures/Tables 7

Figure 1 Anteroposterior full-length X-ray images of both lower extremities at weight-bearing position before and after surgery for coronal lower extremity image data measurement. A is the preoperative X-ray image measuring the preoperative HKA （hip-knee-ankle angle）； B is the preoperative X-ray image measuring mLDFA （mechanical lateral distal femoral angle） and mMPTA （mechanical medial proximal tibial angle）； C is the postoperative X-ray image measuring the postoperative HKA； D is the postoperative X-ray image measuring the postoperative mLDFA and mMPTA

Figure 2 Preoperative planning for RFA-TKA （robot-assisted functional alignment total knee arthroplasty）. A shows the preoperative simulation of osteotomy， with the green part indicating the osteotomy surface； B shows the preoperative simulation of joint prosthesis adaptation， with the blue part indicating the joint prosthesis

Figure 3 Intraoperative registration and osteotomy in RFATKA （robot-assisted functional alignment total knee arthroplasty）.A shows femoral registration during the operation； B shows robotassisted anterior osteotomy of the distal femur

Table 1 Comparison of general information and overall surgical satisfaction between the two groups

分组Groups	例数（例/膝） Number of cases（case/knee）	性别（%）Gender		年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	侧别（%）Side		BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	手术满意度［满意/不满意（%）］ Surgical satisfaction （yes/no）
分组Groups	例数（例/膝） Number of cases（case/knee）	男 Male	女 Female	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	左 Left	右 Right	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	手术满意度［满意/不满意（%）］ Surgical satisfaction （yes/no）
RFA-TKA组	47/47	14.9	85.1	69.3±7.6	38.3	61.7	25.9±3.8	97.9/2.1
MA-TKA组	37/42	16.2	83.8	70.7±6.8	47.6	52.4	26.9±3.7	81.1/18.9
统计值 Statistical value		χ²=0.028		t=-0.902	χ²=0.788		t=-1.316	χ²=4.965^*
P值		＞0.05		＞0.05	＞0.05		＞0.05	0.026^*

Table 1 Comparison of general information and overall surgical satisfaction between the two groups

分组Groups	例数（例/膝） Number of cases（case/knee）	性别（%）Gender		年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	侧别（%）Side		BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	手术满意度［满意/不满意（%）］ Surgical satisfaction （yes/no）
分组Groups	例数（例/膝） Number of cases（case/knee）	男 Male	女 Female	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	左 Left	右 Right	BMI［kg/m²，（ $\overset{ˉ}{x}$ ±s）］	手术满意度［满意/不满意（%）］ Surgical satisfaction （yes/no）
RFA-TKA组	47/47	14.9	85.1	69.3±7.6	38.3	61.7	25.9±3.8	97.9/2.1
MA-TKA组	37/42	16.2	83.8	70.7±6.8	47.6	52.4	26.9±3.7	81.1/18.9
统计值 Statistical value		χ²=0.028		t=-0.902	χ²=0.788		t=-1.316	χ²=4.965^*
P值		＞0.05		＞0.05	＞0.05		＞0.05	0.026^*

Table 2 Imaging data comparison between the two groups

分组 Groups	例数（例/膝） Number of cases（case/knee）	术前Before operation			术后After operation
分组 Groups	例数（例/膝） Number of cases（case/knee）	HKA	mLDFA	mMPTA	HKA	mLDFA	mMPTA
RFA-TKA组	47/47	172.4±7.9	89.1±3.2	86.0±3.9	178.1±2.3	91.0±1.5	88.9±1.6
MA-TKA组	37/42	172.2±6.5	89.3±3.1	87.4±3.8	178.2±2.5	90.7±2.5	89.2±2.1
t值		0.145	-0.251	-1.643	-0.065	0.802	-0.601
P值		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05

Table 3 Comparison of clinical scoring results at different time points between the twogroups

组别 Groups	例数（例/膝） Number of cases（case/knee）	VAS
组别 Groups	例数（例/膝） Number of cases（case/knee）	术前 Before operation	术后3周 Three weeks after operation	术后3个月 Three months after operation
RFA-TKA组	47/47	5.9±0.8	3.1±0.9^ad	1.2±0.6^bc
MA-TKA组	37/42	5.8±1.1	4.2±1.2^a	1.3±0.7^bc
F值		时间效应：1076.458
		组间效应：6.257
		交互效应：21.448
P值		时间效应：＜0.001
		组间效应：0.016
		交互效应：＜0.001
组别 Groups	例数（例/膝） Number of cases（case/knee）	HSS
组别 Groups	例数（例/膝） Number of cases（case/knee）	术前 Before operation	术后3周 Three weeks after operation	术后3个月 Three months after operation
RFA-TKA组	47/47	65.5±9.3	68.5±7.5^ad	88.9±5.6^bcd
MA-TKA组	37/42	63.0±12.1	64.1±12.3	84.6±7.5^bc
F值		时间效应：309.043
		组间效应：4.909
		交互效应：0.707
P值		时间效应：＜0.001
		组间效应：0.029
		交互效应：0.496
组别 Groups	例数（例/膝） Number of cases（case/knee）	WOMAC
组别 Groups	例数（例/膝） Number of cases（case/knee）	术前 Before operation	术后3周 Three weeks after operation	术后3个月 Three months after operation
RFA-TKA组	47/47	43.2±5.7	28.9±6.3^ad	11.7±4.5^bcd
MA-TKA组	37/42	42.9±9.5	34.5±6.6^a	16.5±8.4^bc
F值		时间效应：639.542
		组间效应：8.856
		交互效应：7.504
P值		时间效应：＜0.001
		组间效应：0.004
		交互效应：0.001

Figure 4 Schematic diagram of changes in clinical scores of the two groups. A shows the change trend of VAS scores in the two groups； B shows the change trend of HSS scores in the two groups；C shows the change trend of WOMAC scores in the two groups

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