Total Knee Arthroplasty Using an Active Robotic System
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 300
- 试验地点
- 2
- 主要终点
- Implant position assessment
研究概览
简要总结
For the first time in Russia, it is planned to introduce and study primary knee arthroplasty using an active robotic system. The aim is to increase the efficiency of primary total knee arthroplasty using an active robotic surgical system. Traditional endoprosthetics of the knee joint (TKA) has now reached its maximum manufacturability and efficiency, but the accuracy of the performance depends on the skill and experience of the surgeon, as well as the efficiency of the cutting instrument (oscillator saw) when performing bone resection, the condition of the instrument and on the density of bone tissue fabric, which is highly variable. Modern RSS used in orthopedics include a robotic arm, robotic cutting devices with a computer navigation system, which are in active, semi-automatic or passive control mode. The main advantage of robotic systems is accurate preliminary planning using 3D modeling, use individual implant selection and virtual positioning.The active robotic surgical system TSolution-One allows participants to level the error in the positioning of the implant. The active robotic surgical system (ARSS) allows to correctly install the implant, which affects its service life, reduces the risks of postoperative complications, quickly returns to the usual way of life and forgets about the technical negative sensations and limitations that existed before the operation.It is planned to conduct an open-label retrospective and prospective clinical study in parallel observations.The study is planned to include 300 patients with osteoarthritis of the knee joint stage 3-4 (according to Kellgren-Lawrence). Investigators took three groups of patients, 100 patients each, and offered different options for total knee arthroplasty techniques.According to the research:-A clinical active robotic system for primary total knee arthroplasty will be introduced in Russia-There will be recommended indications and contraindications for this system in patients with gonarthrosis-The methodology of preoperative planning will be improved-The results of primary knee arthroplasty with an active robotic system will be evaluated in comparison with standard techniques and computer navigation-The methodology developed and improved in the dissertation will be introduced into the work of the clinical departments of traumatology, orthopedics and disaster surgery, studying the learning curve.
详细描述
Relevance: Robotic technologies were first introduced into medicine in the 1950s. The use of robotic systems in surgery begins with the use in neurosurgery. In 1985, the Programmable Universal Manipulation Arm (PUMA) 560 was introduced to perform CT-guided brain biopsy. In 1992, the Robodoc system (IBM) became the first orthopedic robotic system used in orthopedics for hip replacement, which subsequently improved the ability to automatically perform the stages of prosthetics. (Caspar system, Acrobot). Around the same time, the development of a robot for performing total knee arthroplasty began.
A distinctive feature of total knee arthroplasty (TKA) is the manufacturability of the stages and the high accuracy of surgical manipulations, which attracts the attention of many robotic surgical systems (RSS).
Traditional total knee arthroplasty (TKA) has now reached its maximum manufacturability and efficiency, but the accuracy of the performance depends on the skill and experience of the surgeon, as well as the accuracy of the cutting instrument (oscillator saw) when performing bone resection, the condition of the instrument and the density of the bone fabric, which is highly variable. The use of intramedullary guides during conventional surgery increases the risk of thromboembolic and cardiorespiratory complications. Computer navigation partially solves the problem of resection accuracy, infrared cameras read information from sensors and display a model with anatomical and kinematic features of the knee joint, which helps the surgeon to more accurately determine the level and direction of resection, but cannot ensure the accuracy of this manipulation and compliance with the preoperative plan.
Modern RSS used in orthopedics include a robotic arm, robotic cutting devices with a computer navigation system that operate in an active, semi-automatic, or passive control mode. The main advantage of robotic systems is accurate preoperative planning using 3D modeling, the possibility of individual selection of the implant and virtual positioning. Another advantage is the ability to accurately reproduce the preoperative plan during orthopedic surgery.
Today, active robotic surgical systems (ARSS) are used in clinical practice. ROBODOC / TSolution One. Robotic Surgical System (Curexo Technology, Fremont, Calif.), And Navio PFS (Blue Belt Technologies, Plymouth, Minnesota) Semi-Active Surgical Systems, OMNI Robotic System (OMNIlife Science, East Taunton, MA), RIO Robotic Arm Interactive Orthopedic System (Mako Surgical Corporation, Fort Lauderdale, Florida), ROSA Knee (Zimmer Zimmer Biomet, Montreal (Quebec), Canada).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 45 Years 至 90 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Availability of written informed consent of the patient to participate in the study;
- •Patients with stage 3-4 osteoarthritis of the knee joint (according to Kellgren-Lawrence.).
- •Men and women from 45 to 90 years old.
- •Pain in the knee joint above 3 points according to VAS
- •Opportunity for observations during the entire study period (12 months);
- •Mental adequacy, ability, willingness to cooperate and to fulfill the doctor's recommendations.
排除标准
- •Refusal of the patient from surgical treatment;
- •Presence of contraindications to surgical treatment;
- •Severe forms of diabetes mellitus (glycosylated hemoglobin> 9%);
- •Diseases of the blood (thrombopenia, thrombocytopenia, anemia with Hb <90 g / l);
- •The patient's unwillingness to conscious cooperation.
- •Refusal of the patient to participate in the study;
- •Non-compliance with the hospital regimen, according to the order of the Ministry of Health and Social Development of Russia dated 01.08.07, No. 514;
- •The impossibility of observing the patient within the control period after the operation.
结局指标
主要结局
Implant position assessment
时间窗: 12 months after surgery
CT scanning
次要结局
未报告次要终点