手术流程和技术变化对全膝关节置换术早期临床结果的影响

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-08-20 DOI:10.1016/j.jor.2025.08.047

Prudhvi Tej Chinimilli , Laurent D. Angibaud , Amaury Jung , Corey A. Jackson

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引用次数: 0

摘要

全膝关节置换术（TKA）包括不同的手术工作流程，不同的骨切割顺序和对齐策略。本研究评估了使用相同的计算机辅助骨科手术系统（CAOS）从股骨优先测量切除（MR）过渡到胫骨优先间隙平衡（GB）的影响。在GB采用的两个阶段评估了这种转变的临床和技术影响，以捕捉手术学习和工作流程适应的效果。方法对同一名资深外科医生实施的225例TKA病例进行回顾性分析。患者分为三个队列：(1)MR（75例），(2)GB早期（首75例），(3)GB晚期（后续75例）。所有病例使用相同的CAOS系统，GB病例使用集成在CAOS系统中的力控牵引器来获取全运动弧度的动态关节间隙数据。术前和1年随访时收集kos评分。分析术中参数，包括股骨和胫骨对齐，胫骨斜度，胫骨插入物厚度，计划和检查关节间隙。结果术后KOOS改善以GB晚期组最高（34.1±20.9），显著高于MR组（27.3±15.8,p = 0.025）和GB早期组（27.7±16.1,p = 0.036）。MR与GB早期差异无统计学意义（p = 0.89）。与MR相比，GB队列显示股骨切除参数更大的变异性，以及股骨屈曲和胫骨斜度的增加。从GB早期到GB晚期，技术有明显的改进，GB晚期表现出明显更紧密和更一致的内侧和外侧间隙。结论过渡到胫骨优先的GB工作流程和力控牵引器可以更精确和个性化的间隙管理，从而改善临床结果。虽然早期GB临床结果与MR相当，但继续使用GB技术与精细的手术执行和优越的临床结果相关。

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Impact of the surgical workflow and technology change on early clinical outcomes in total knee arthroplasty

Introduction

Total knee arthroplasty (TKA) encompasses diverse surgical workflows that vary in bone cut sequencing and alignment strategies. This study evaluates the impact of transitioning from femur-first measured resection (MR) to tibia-first gap balancing (GB) using the same computer-assisted orthopaedic surgery system (CAOS). The clinical and technical impact of this transition was assessed across two phases of GB adoption to capture effects of surgical learning and workflow adaptation.

Methods

A retrospective review was conducted on 225 TKA cases performed by a single senior surgeon. Patients were grouped into three cohorts: (1) MR (75 cases), (2) GB early (first 75 GB cases), and (3) GB late (subsequent 75 GB cases). All cases used the same CAOS system and GB cases utilized a force-controlled distractor integrated into the CAOS system to acquire dynamic joint gap data for full-arc-of-motion. KOOS Jr. scores were collected preoperatively and at one-year follow-up. Intraoperative parameters including femoral and tibial alignment, tibia slope, tibial insert thickness, and planned and checked joint gaps were analyzed.

Results

Postoperative KOOS Jrimprovement was highest in the GB late cohort (34.1 ± 20.9), significantly greater than both MR (27.3 ± 15.8, p = 0.025) and GB early (27.7 ± 16.1, p = 0.036). MR and GB early were not significantly different (p = 0.89). Compared to MR, GB cohorts showed greater variability in femoral resection parameters, along with increased femoral flexion and tibial slope. From GB early to GB late, there was a clear refinement in technique, with GB late demonstrating significantly tighter and more consistent medial and lateral gaps.

Conclusion

Transitioning to a tibia-first GB workflow with a force-controlled distractor enabled more precise and individualized gap management, leading to improved clinical outcomes. While early GB clinical outcomes were comparable to MR, continued use of the GB technique was associated with refined surgical execution and superior clinical outcomes.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.