ロボット支援下全人工膝関節置換術における中等度から重度の冠状面変形を有する患者：システマティックレビュー

Patients with moderate-to-severe varus or valgus deformities present with unique considerations. Therefore, this systematic review aims to evaluate the effectiveness of robotic-assisted total knee arthroplasty (RA-TKA) in addressing moderate-to-severe coronal plane deformities.

MEDLINE, Embase, and Web of Science were searched from inception to January 4, 2025, for single-arm or comparative studies assessing the efficacy of robotic-assisted total knee arthroplasty (RA-TKA) in patients with moderate-to-severe coronal plane deformities undergoing primary surgery. Primary outcome included patient-reported outcomes (PROs), radiographic outcomes, operative times, and complication rates.

Eight studies (1274 knees) were included in this study. Of 1244 knees (97.6%) replaced with RA-TKA, 599 presented with pre-operative varus deformity group (47.0%), 82 with valgus deformity group (6.4%), and 563 with minimal to no preoperative deformity (44.2%) used as a control. The remaining 30 patients were in a conventional technique (C-TKA) control group (2.4%). PROs at 1-year postoperatively and beyond were comparable across both varus and valgus knees, and their respective comparator groups. Only one study reported a significant difference in radiographic outlier between RA-TKA and C-TKA, in favor of the former. Operative times were conflicting when comparing RA-TKA versus C-TKA. Limited studies demonstrated no difference in complication rates.

RA-TKA reliably attains target radiographic alignment with favorable patient reported outcomes. Several methodological concerns have been highlighted to aid in the development of future studies including the standardization of moderate-to-severe deformity, reporting on associated soft-tissue releases as well as minimization of heterogenous implant use within studies.

IV.