全腔和单腔膝关节置换术的全国趋势：2020年至2022年

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-19 DOI:10.1016/j.jcot.2025.103064

Hannah I. Travers , Darren Z. Nin , Mikhail Kuznetsov , David C. Chang , Carl T. Talmo , Eric L. Smith

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引用次数: 0

摘要

背景：全膝关节置换术（TKA）和单室膝关节置换术（UKA）是骨关节炎的基本治疗方法，各有其独特的优势。TKA和UKA的进展已经允许从住院到门诊手术设置的过渡。在这种转变之后，集成机器人辅助（RA）的新技术已经出现，但与传统技术相比，临床效益尚不确定。目的是评估技术进步和不断变化的手术环境如何影响TKA和UKA的交付和采用。方法：本回顾性队列研究利用MarketScan商业索赔数据库，确定在2020年4月1日至2022年12月31日期间因骨关节炎接受原发性单侧TKA或UKA的患者。分析了人口统计、地理和医院设置数据。使用特定的CPT代码识别RA程序，并根据术前90天内获得的CT扫描结果进一步分类。采用STATA进行统计分析。结果纳入的85265例患者中，TKA 79711例；5554 UKA)， 13194人接受了机器人辅助手术。TKA和UKA在门诊手术（ASC）中进行的手术比例均有所增加(p <；0.001)。外科医生更倾向于使用RA治疗TKA (p <；0.001)和UKA （p = 0.006）。住院患者和ASC tka更倾向于使用ct引导的RA (p <；0.05)。基于ct的机器人辅助UKA相对于时间保持稳定(p >；0.3)。结论TKA和UKA的情况正在发生变化，在ASC环境下进行的手术数量有所增加。尽管成本增加，但机器人辅助技术越来越多地集成到TKA和UKA中，这一趋势得到了支持。尽管RA UKA总体上有所增加，但ct引导下RA UKA并未明显增加。尽管机器人辅助手术预计会有所增长，但传统技术和非ct技术仍然受到广泛青睐。

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National trends in total and unicompartmental knee arthroplasty: 2020 to 2022

Background

Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are essential treatments for osteoarthritis, with each offering distinct advantages. Advances in TKA and UKA have allowed for a transition from inpatient to outpatient surgical settings. In the wake of this transition, new techniques integrating robotic assistance (RA) have arisen, but clinical benefit over conventional techniques is uncertain. The objective was to assess how technological advancements and changing surgical environments have shaped the delivery and adoption of TKA and UKA.

Methods

This retrospective cohort study utilized the MarketScan Commercial Claims Database to identify patients who underwent primary unilateral TKA or UKA for osteoarthritis between April 1, 2020–December 31, 2022. Demographic, geographic, and hospital setting data were analyzed. RA procedures were identified using specific CPT codes, and further classified based on preoperative CT scans obtained within 90 days. Statistical analyses were conducted using STATA.

Results

Among the 85,265 patients included (79,711 TKA; 5554 UKA), 13,194 underwent robotic-assisted procedures. The percentage of procedures conducted in the ambulatory surgery (ASC) setting for both TKA and UKA increased (p < 0.001). Surgeons were more likely to use RA for TKA (p < 0.001) and for UKA (p = 0.006). Inpatient and ASC TKAs were more likely to use CT-guided RA (p < 0.05). CT-based robotic assisted UKA remained stable with respect to time(p > 0.3).

Conclusion

The landscape of TKA and UKA is evolving, with a rise in the number of procedures being performed in the ASC setting. This trend has been supported by the increasing integration of robotic-assisted technology into TKA and UKA, despite increased costs. Even though RA UKA is increasing in overall, CT-guided RA UKA specifically has not increased. Despite the anticipated growth in robotic-assisted procedures, conventional techniques and non–CT-based technologies continue to be widely favored.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.