高体重指数对基于图像的功能对齐机器人全膝关节置换术的影响：可比较的功能结果但更高的机械故障

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-04-08 DOI:10.1016/j.jisako.2025.100861

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

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引用次数: 0

摘要

体重指数（BMI）升高对全膝关节置换术（TKA）提出了挑战，包括更高的并发症发生率。机器人辅助的功能性膝关节定位（FKP）提供了个性化的方法来优化对齐和软组织平衡，但其对BMI升高患者的影响尚不清楚。本回顾性比较研究旨在评估肥胖及其严重程度对采用FKP原则指导的基于图像的机器人系统进行TKA的临床结果和并发症的影响。方法本回顾性比较研究纳入372例遵循FKP原则接受机器人辅助TKA的患者。根据BMI将患者分为两组(30 kg/m2；238例，≥30 kg/m2；134名患者)。结果包括膝关节社会评分（KSS），遗忘关节评分（FJS），活动范围（ROM），植入物定位和并发症，至少随访两年。结果BMI≥30 kg/m2的患者与BMI≥30 kg/m2的患者在ROM、KSS和FJS方面表现出相似的功能结局。然而，肥胖组机械故障修正率明显高于肥胖组(2.99% vs. 0.42%, p = 0.04；风险比= 6.8；95% ci, 1.09-42.31)。除了BMI升高组股骨外旋减少外，各组内植入物定位一致（p = 0.004）。结论：采用FKP原理的机器人辅助TKA在至少2年的随访中为肥胖患者取得了相当的功能结果，证明了该系统解决解剖学和功能挑战的能力。然而，肥胖仍然是机械故障的关键风险因素。证据水平ii。

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Impact of high body mass index on functionally aligned image-based robotic total knee arthroplasty: Comparable functional outcomes but higher mechanical failures

Objectives

Increased body mass index (BMI) poses challenges in total knee arthroplasty (TKA), including higher complication rates. Functional knee positioning (FKP) with robotic assistance provides a personalized approach to optimize alignment and soft-tissue balance, but its impact on patients with increased BMI remains unclear. This retrospective comparative study aims to evaluate the influence of obesity and its severity on clinical outcomes and complications in TKA performed with an image-based robotic system-guided by FKP principles.

Methods

This retrospective comparative study included 372 patients who underwent robotic-assisted TKA following FKP principles. Patients were stratified into two main groups based on BMI (<30 kg/m²; 238 patients and ≥30 kg/m²; 134 patients). Outcomes included Knee Society Scores (KSS), Forgotten Joint Scores (FJS), range of motion (ROM), implant positioning, and complications, evaluated at a minimum follow-up of two years.

Results

Patients with increased BMI (≥30 kg/m²) demonstrated similar functional outcomes to patients with BMI <30 kg/m² in terms of ROM, KSS, and FJS. However, the revision rate due to mechanical failures was significantly higher in the obese group (2.99% vs. 0.42%, p = 0.04; hazard ratio = 6.8; 95% CI, 1.09–42.31). Implant positioning was consistent across groups, except for reduced femoral external rotation in the increased BMI group (p = 0.004).

Conclusions

Robotic-assisted TKA with FKP principles achieves comparable functional outcomes for obese patients at a minimum of a 2-year follow-up, demonstrating the system's ability to address anatomical and functional challenges. However, obesity remains a critical risk factor for mechanical failures.