Technology-assisted revision knee arthroplasty reduces radiographic outliers compared with standard revision knee surgery: A systematic review

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-07-24 DOI:10.1002/ksa.12748

Matteo Innocenti, Filippo Leggieri, Simon N. van Laarhoven, Tommy de Windt, Roberto Civinini, Gijs G. van Hellemondt

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引用次数: 0

Abstract

Purpose

The aim of this systematic review was to evaluate the outcomes and complications associated with technology-assisted revision total knee arthroplasty (revTKA).

Methods

A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non-randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random-effects meta-analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the I² statistic.

Results

Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology-assisted revTKA showed fewer outliers in hip–knee–ankle angle (13.3% [95% CI, 8.7%–19.0%] vs. 26.1% [95% CI, 16.3%–38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%–92.4%] vs. 79.7% [95% CI, 68.8%–87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%–94.6%] vs. 82.6% [95% CI, 72.0%–89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15–24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology-assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.

Conclusion

Technology-assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.

Level of Evidence

Level IV.

Abstract Image

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与标准翻修膝关节手术相比，技术辅助翻修膝关节置换术减少了影像学异常值：一项系统综述。

目的：本系统综述的目的是评估技术辅助翻修全膝关节置换术（revTKA）的预后和并发症。方法：系统检索PubMed、EMBASE、Web of Science和Cochrane Library，检索时间为2024年10月31日。纳入标准是实验或观察性研究，≥10例患者接受机器人revTKA，评估临床和/或放射预后和/或并发症发生率。排除标准是单独的髌骨翻修、体外研究、给编辑的信、书籍章节、会议论文和无法获得全文的研究。使用非随机研究的方法学指数（minor）对每项研究进行质量评分。纳入的研究分为TKA和单室膝关节置换术（UKA）两组，进行定性和定量综合。在适当的地方进行随机效应荟萃分析。计算影像学参数的95%置信区间（ci）的平均差异。采用I2统计量评估异质性。结果：在20项研究（795例）中，10项评估revvka， 10项检查revUKA。在revTKA研究中，4项是比较队列，而在revUKA研究中，7项是比较队列。技术辅助的revTKA显示髋关节-膝关节-踝关节角度的异常值较少（13.3% [95% CI, 8.7%-19.0%]对26.1% [95% CI, 16.3%-38.1%]），股骨外侧远端角度在±3°内的良好组件定位（88.4% [95% CI, 83.2%-92.4%]对79.7% [95% CI, 68.8%-87.5%]）和胫骨内侧近端角度（91.2% [95% CI, 86.3%-94.6%]对82.6% [95% CI, 72.0%-89.8%]），更好的关节线恢复（79.5%对58.3%）在4 mm内)。手术需要额外的15-24分钟。两组间并发症发生率具有可比性。对于UKA修订，技术辅助和传统技术之间的结果大致相似，在对齐准确性和临床评分方面结果不一。结论：与常规技术相比，技术辅助的revTKA获得了最佳的对准参数，减少了异常值的发生。然而，这些影像学上的改善并不能始终转化为增强的临床结果或降低的并发症发生率。证据等级：四级。

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).