Clinical Cohort Study of Knee Arthroplasty Assisted by Digital Technology

Study Overview
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Brief Summary
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Through this cohort study, previous clinical data can be systematically reviewed and supplemented through clinical follow-up. Prospective enrollment and follow-up observation of subsequent patients can also be carried out to build a retrospective-prospective two-way cohort study. The intraoperative, perioperative, clinical follow-up and health economics of surgical robot, computer navigation, personalized osteotomy guide and other digital technologies and traditional TKA were comprehensively and objectively compared, the results and conclusions of the center were summarized and reported, and the effectiveness and safety of digital assistive technology applied to TKA were explored, providing references for clinical diagnosis and follow-up research.

Detailed Description
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Through this cohort study, previous clinical data can be systematically reviewed and supplemented by follow-up visits. Prospective enrollment and follow-up of subsequent patients can also be carried out to build a retrospective-prospective two-way cohort study. The preoperative situation (general statistical information, educational level, preoperative clinical function score, etc.), intraoperative situation (operative time, intraoperative blood loss, intraoperative complications, etc.), perioperative situation (total postoperative blood loss, blood transfusion rate, postoperative complications, etc.) and clinical follow-up situation were comprehensively and objectively compared with surgical robot, computer navigation, personalized osteotomy guide and other digital technologies and traditional TKA We summarized and reported the results and conclusions of the center (postoperative force line, implant location, pain, mobility, clinical function score, patient satisfaction and postoperative complications, etc.) and health economics (average length of stay, hospitalization cost, etc.) to provide reference for clinical diagnosis and follow-up research.

Official Title
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Clinical Cohort Study of Knee Arthroplasty Assisted by Digital Technology

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Procedure: conventional intrumentation assisted knee arthroplasty
* Procedure: computer navigation assisted knee arthroplasty
* Procedure: robotic system assisted knee arthroplasty
* Procedure: patient-spercific assisted knee arthroplasty


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: a. primary knee osteoarthritis; b. Unilateral primary knee replacement; c. Surgical methods were traditional surgery, surgical robot, computer navigation or personalized osteotomy guide Exclusion Criteria: a. A history of renal insufficiency (Cr > 2.5), liver insufficiency, severe heart disease (or coronary stenting within the last 12 months), severe respiratory disease, history of VTE or high risk of thrombosis (hereditary/acquired thrombotic disease), cotting disorder, stroke, and malignancy; b. Those who do not accept this test for any reason and refuse to sign the informed consent.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| conventional group<br>Conventional instrument-assisted knee arthroplasty | Procedure: conventional intrumentation assisted knee arthroplasty<br>* conventional intrumentation assisted knee arthroplasty<br>|
| CAS group<br>computer navigation assisted knee arthroplasty | Procedure: computer navigation assisted knee arthroplasty<br>* computer navigation assisted knee arthroplasty<br>|
| RAS group<br>robotic system assisted knee arthroplasty | Procedure: robotic system assisted knee arthroplasty<br>* robotic system assisted knee arthroplasty<br>|
| PSI group<br>patient-spercific instrumentation assisted knee arthroplasty | Procedure: patient-spercific assisted knee arthroplasty<br>* patient-spercific assisted knee arthroplasty<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mechanical axis | The postoperative HKA Angle was measured, that is, the Angle between the center of the hip joint and the center of the knee joint and the center of the knee joint and the center of the ankle joint on the full-length X-ray film of the lower limb. The target Angle was defined as 0°, the Angle was positive when the knee was varus, the Angle was negative when the knee was varus, and the acceptable range was ±3°, beyond which the line deviation was defined. | Postoperative day 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| operation time | The surgical time is defined as the time from incision to the completion of the skin suture, accurate to minutes | immediately after the surgery | 
| Intraoperative blood loss | Intraoperative blood loss = total amount of fluid drawn during the operation - intraoperative irrigation volume + intraoperative gauze infiltration blood loss, accurate to ml | immediately after the surgery | 
| Intraoperative complications | Various complications occurred during the operation were recorded | immediately after the surgery | 
| Total postoperative blood loss | Gross linear equation was used to calculate total blood loss and latent blood loss 3 days after surgery. Total blood loss = preoperative blood volume (PBV) × (preoperative hematocrit - postoperative hematocrit). PBV was calculated using Nadler method: PBV=K1× height (m) 3+K2× weight (kg) +K3, where male K1=0.3669, K2=0.03219, K3=0.6041; Female K1=0.3561, K2=0.03308, K3=0.1833. Postoperative total blood loss = total blood loss - intraoperative blood loss; | Postoperative day 3 | 
| Blood transfusion rate | The postoperative blood transfusion situation and the amount of blood transfusion were recorded. The blood was transfused mainly with suspended red blood cells, and the amount of a single transfusion was 400ml. The Hb situation was evaluated again by blood routine review on the morning of the second day after transfusion. Indications for postoperative blood transfusion: No blood transfusion for Hb up to 8g/L or above; Hb up to 7g/L (including) must be transfused; Hb is between 7-8g/L, and blood transfusion should be given when anemia symptoms such as dizziness, weakness, palpitation, etc. | At discharge | 
| Postoperative complication | The postoperative complications such as wound nonunion, wound infection, hematomas and anemia were recorded. | 3 years postoperatively | 
| Rotation Angle of femur prosthesis | On the horizontal plane of CT scan of the affected knee, the Angle between the line of the posterior condyle of the femoral prosthesis and the line of the transcondyle of the femur was shown. The target Angle was defined as 0° external rotation of the femoral prosthesis, positive Angle during external rotation, negative Angle during internal rotation, acceptable range of ±2°, beyond which was defined as angular deviation | Postoperative day 3 | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | Postoperative day 3 | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 2 weeks postoperatively | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 6 weeks postoperatively | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 3 months postoperatively | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 6 months postoperatively | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 12 months postoperatively | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 24 months postoperatively | 
| Visual analogue scale | The pain of the affected limb was assessed by Visual analogue scale. The highest score is ten and the lowest score is zero. A higher score indicates a higher level of pain. | 36 months postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 3 days postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 2 weeks postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 6 weeks postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 3 months postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 6 months postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 12 months postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 24 months postoperatively | 
| Range of motion | The Range of motion of the knee on the operative side of the patient was measured | 36 months postoperatively | 
| knee society score | This method is to evaluate the patient's knee joint and its function in two aspects according to the particularity of joint replacement surgery through the evaluator interview and physical examination, that is, to obtain the information of joint anatomy, biomechanics and other aspects, and to understand the patient's functional recovery. Knee joint evaluation is to evaluate the impact of surgery on the joint and the recovery of the joint after surgery, such as: joint pain, joint range of motion, ligament stability, muscle strength, bone alignment, contracture deformity; Functional assessments include activities of daily living, walking ability, going up and down stairs, and the need for AIDS. The evaluation was numerically quantified (see table), and the knee joint score and the functional score were obtained respectively. The higher the value, the better the function. | 6 weeks postoperatively | 
| knee society score | This method is to evaluate the patient's knee joint and its function in two aspects according to the particularity of joint replacement surgery through the evaluator interview and physical examination, that is, to obtain the information of joint anatomy, biomechanics and other aspects, and to understand the patient's functional recovery. Knee joint evaluation is to evaluate the impact of surgery on the joint and the recovery of the joint after surgery, such as: joint pain, joint range of motion, ligament stability, muscle strength, bone alignment, contracture deformity; Functional assessments include activities of daily living, walking ability, going up and down stairs, and the need for AIDS. The evaluation was numerically quantified (see table), and the knee joint score and the functional score were obtained respectively. The higher the value, the better the function. | 3 months postoperatively | 
| knee society score | This method is to evaluate the patient's knee joint and its function in two aspects according to the particularity of joint replacement surgery through the evaluator interview and physical examination, that is, to obtain the information of joint anatomy, biomechanics and other aspects, and to understand the patient's functional recovery. Knee joint evaluation is to evaluate the impact of surgery on the joint and the recovery of the joint after surgery, such as: joint pain, joint range of motion, ligament stability, muscle strength, bone alignment, contracture deformity; Functional assessments include activities of daily living, walking ability, going up and down stairs, and the need for AIDS. The evaluation was numerically quantified (see table), and the knee joint score and the functional score were obtained respectively. The higher the value, the better the function. | 6 months postoperatively | 
| knee society score | This method is to evaluate the patient's knee joint and its function in two aspects according to the particularity of joint replacement surgery through the evaluator interview and physical examination, that is, to obtain the information of joint anatomy, biomechanics and other aspects, and to understand the patient's functional recovery. Knee joint evaluation is to evaluate the impact of surgery on the joint and the recovery of the joint after surgery, such as: joint pain, joint range of motion, ligament stability, muscle strength, bone alignment, contracture deformity; Functional assessments include activities of daily living, walking ability, going up and down stairs, and the need for AIDS. The evaluation was numerically quantified (see table), and the knee joint score and the functional score were obtained respectively. The higher the value, the better the function. | 12 months postoperatively | 
| knee society score | This method is to evaluate the patient's knee joint and its function in two aspects according to the particularity of joint replacement surgery through the evaluator interview and physical examination, that is, to obtain the information of joint anatomy, biomechanics and other aspects, and to understand the patient's functional recovery. Knee joint evaluation is to evaluate the impact of surgery on the joint and the recovery of the joint after surgery, such as: joint pain, joint range of motion, ligament stability, muscle strength, bone alignment, contracture deformity; Functional assessments include activities of daily living, walking ability, going up and down stairs, and the need for AIDS. The evaluation was numerically quantified (see table), and the knee joint score and the functional score were obtained respectively. The higher the value, the better the function. | 24 months postoperatively | 
| knee society score | This method is to evaluate the patient's knee joint and its function in two aspects according to the particularity of joint replacement surgery through the evaluator interview and physical examination, that is, to obtain the information of joint anatomy, biomechanics and other aspects, and to understand the patient's functional recovery. Knee joint evaluation is to evaluate the impact of surgery on the joint and the recovery of the joint after surgery, such as: joint pain, joint range of motion, ligament stability, muscle strength, bone alignment, contracture deformity; Functional assessments include activities of daily living, walking ability, going up and down stairs, and the need for AIDS. The evaluation was numerically quantified (see table), and the knee joint score and the functional score were obtained respectively. The higher the value, the better the function. | 36 months postoperatively | 
| Western Ontario and McMaster Universities Osteoarthritis Index | This score is used to assess the severity of arthritis and its therapeutic effect based on the patient's relevant signs and symptoms. The structure and function of the knee joint were evaluated by pain, stiffness and joint function. A higher score indicates better functionality. | 6 weeks postoperatively | 
| Western Ontario and McMaster Universities Osteoarthritis Index | This score is used to assess the severity of arthritis and its therapeutic effect based on the patient's relevant signs and symptoms. The structure and function of the knee joint were evaluated by pain, stiffness and joint function. A higher score indicates better functionality. | 3 months postoperatively | 
| Western Ontario and McMaster Universities Osteoarthritis Index | This score is used to assess the severity of arthritis and its therapeutic effect based on the patient's relevant signs and symptoms. The structure and function of the knee joint were evaluated by pain, stiffness and joint function. A higher score indicates better functionality. | 6 months postoperatively | 
| Western Ontario and McMaster Universities Osteoarthritis Index | This score is used to assess the severity of arthritis and its therapeutic effect based on the patient's relevant signs and symptoms. The structure and function of the knee joint were evaluated by pain, stiffness and joint function. A higher score indicates better functionality. | 12 months postoperatively | 
| Western Ontario and McMaster Universities Osteoarthritis Index | This score is used to assess the severity of arthritis and its therapeutic effect based on the patient's relevant signs and symptoms. The structure and function of the knee joint were evaluated by pain, stiffness and joint function. A higher score indicates better functionality. | 24 months postoperatively | 
| Western Ontario and McMaster Universities Osteoarthritis Index | This score is used to assess the severity of arthritis and its therapeutic effect based on the patient's relevant signs and symptoms. The structure and function of the knee joint were evaluated by pain, stiffness and joint function. A higher score indicates better functionality. | 36 months postoperatively | 
| Patient satisfaction | At follow-up, patients' satisfaction scores were recorded (using 5-Likert scale). The higher the score, the higher the satisfaction | 6 months postoperatively | 
| Patient satisfaction | At follow-up, patients' satisfaction scores were recorded (using 5-Likert scale). The higher the score, the higher the satisfaction | 12 months postoperatively | 
| Patient satisfaction | At follow-up, patients' satisfaction scores were recorded (using 5-Likert scale). The higher the score, the higher the satisfaction | 24 months postoperatively | 
| Patient satisfaction | At follow-up, patients' satisfaction scores were recorded (using 5-Likert scale). The higher the score, the higher the satisfaction | 36 months postoperatively | 
| Length of stay | The number of days a patient stays in hospital from admission to discharge | an average of 3 days postoperatively | 
| Medical expenses | The total cost of a patient from admission to discharge | an average of 3 days postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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total knee arthroplasty, knee osteoarthritis, computer navigation, robotic system, patient-spercific instrumentation