Robotic TKA Improves Radiological Outcomes, Short-Term Inflammation & Limb Positioning for Knee OA .
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A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty
Bone Joint J. 2021 Jan;103-B(1):113-122.Thirty patients with knee osteoarthritis (OA) and undergoing a primary total knee arthroplasty (TKA) were randomized to receive a conventional jig-based TKA (n=15) or robotic-arm assisted TKA (n=15). Outcomes of interest included changes in systemic inflammatory markers (i.e. interleukin-1β [IL-1β], interleukin-6 [IL-6], tumour necrotic factor α [TNF-α], white cell count, neutrophils, lymphocytes, platelets, lactate dehydrogenase [LDH], alkaline phosphatase [ALP], cortisol levels, hemoglobin [Hb] levels, erythrocyte sedimentation rate [ESR], creatine kinase[CK], and C-reactive protein [CRP]), planned positioning of components, periarticular soft tissue injury and bone trauma using the the Macroscopic Soft Tissue Injury (MASTI) classification system, mean length of incision, mean surgical time, mean change in Hb levels, and mean knee temperature. All inflammatory markers were evaluated at 1 day, 2 days, 7 days, and 28 days post-surgery. Mean knee temperature was also measured at 6-days besides the other follow-up periods. Results revealed that inflammatory markers, including levels of Hb, lymphocytes, ALP, and platelets, were not statistically significantly different between the 2 groups at any of the timepoints (p>0.05 for all). Yet, levels of neutrophils, ESR, LDH, cortisol, and CRP were statistically significantly reduced at 7-days post-surgery (p=0.002) in the robotic-TKA group compared to the conventional group. Also, TNF-alpha levels were statistically significantly reduced at all timepoints in the robotic TKA group (p<0.05 for all). IL-6 levels were statistically significantly lower in the robotic TKA group at 6 hours, 2 days, 7 days and 28 days post-surgery. CK levels were statistically significantly improved in the robotic TKA group at 6 hours and 7 days post-surgery. Furthermore, mean skin temperature, mean incision length, and surgical time were not statistically significantly different between the robotic TKA and conventional TKA groups (p>0.05 for all). The robotic-TKA group reported statistically significantly lower femoral and tibial trauma, as well as greater accuracy of femoral and tibial limb positioning (p<0.05). Finally, an overall decrease in soft tissue injury was observed in the robotic TKA group vs conventional TKA group (p<0.05).
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