Comparable outcomes between cruciate-substituting and posterior-stabilized inserts in robotic total knee arthroplasty under the functional alignment principles.

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-13 DOI:10.1002/ksa.12654

Christos Koutserimpas, Pietro Gregori, Luca Andriollo, Elvire Servien, Cécile Batailler, Sébastien Lustig

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引用次数: 0

Abstract

Purpose: Functional alignment (FA) has emerged as a personalized strategy in total knee arthroplasty (TKA) to optimize outcomes by accounting for patient-specific anatomical and soft tissue characteristics. Limited evidence exists on how polyethylene insert type, specifically cruciate-substituting (CS) versus posterior-stabilized (PS), impacts clinical outcomes and complications in this context.

Methods: This retrospective comparative study included 329 patients who underwent robotic-assisted TKA with FA principles with a minimum 2-year follow-up. Patients were divided into two groups: CS or PS implants. CS inserts were selected for patients with an intact posterior cruciate ligament (PCL), while PS inserts were used in cases of PCL insufficiency or significant flexion contractures. Preoperative and post-operative outcomes, including Knee Society Scores (KSS), Forgotten Joint Scores (FJS), range of motion (ROM) and complications, were assessed. Implant survivorship was analyzed using the Kaplan-Meier method.

Results: At a median follow-up of 36 months, no significant differences were observed between CS and PS groups in KSS (knee: p = 0.45; function: p = 0.4), FJS (p = 0.7) or ROM (median flexion: 130° in both groups, p = 0.52). Specific complications included intraoperative lateral condyle fractures in the PS group and femoral component revisions due to instability in the CS group. The overall complication rates and implant survivorship were comparable (p = 0.55 and p = 0.85, respectively).

Conclusion: This study is the first to evaluate polyethylene insert type in FA and demonstrates that both CS and PS inserts provide comparable outcomes and safety profiles in robotic-assisted TKA. These findings underscore the importance of patient-specific implant selection, with further research needed to assess long-term results.

Level of evidence: Level III.

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在机器人全膝关节置换术中，在功能性对齐原则下，十字韧带替代植入物与后方稳定植入物的疗效具有可比性。

目的：功能对齐（FA）已成为全膝关节置换术（TKA）中的一种个性化策略，通过考虑患者特定的解剖和软组织特征来优化结果。在这种情况下，关于聚乙烯插入物类型，特别是十字交叉取代（CS）和后稳定（PS）如何影响临床结果和并发症的证据有限。方法：这项回顾性比较研究包括329例采用FA原则的机器人辅助TKA患者，随访至少2年。患者分为两组：CS或PS种植体。后交叉韧带（PCL）完整的患者选择CS插入物，而PCL功能不全或明显屈曲挛缩的患者使用PS插入物。评估术前和术后结果，包括膝关节社会评分（KSS）、遗忘关节评分（FJS）、活动范围（ROM）和并发症。采用Kaplan-Meier法分析种植体成活率。结果：中位随访36个月时，CS组和PS组在KSS方面无显著差异(膝关节：p = 0.45；功能：p = 0.4), FJS （p = 0.7）或ROM（两组中位屈曲度：130°，p = 0.52）。具体并发症包括PS组术中外侧髁骨折，CS组因不稳定进行股骨假体翻修。总并发症发生率和种植体存活率具有可比性（p = 0.55和p = 0.85）。结论：本研究首次对FA中的聚乙烯插入物进行了评估，并证明CS和PS插入物在机器人辅助TKA中提供了相当的结果和安全性。这些发现强调了患者特异性种植体选择的重要性，需要进一步的研究来评估长期结果。证据等级：三级。

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).