PDF(Pubmed)
Abstract：
Background: In recent years, there has been considerable interest in prosthetic alignment techniques for total knee arthroplasty (TKA), particularly in the so-called kinematic alignment, which aims to restore the knee\'s native alignment. However, implementing this technique requires specialized instruments and procedural steps that can be laborious. This study introduces the bisector of the trochlear groove as a reliable landmark for performing the distal femoral cut while maintaining parallelism with the native femoral joint line. Methods: Three orthopedic specialists assessed 110 X-ray images of full-leg, weight-bearing lower limbs obtained from healthy individuals between January 2021 and December 2022. The bisector of the trochlear groove was identified on the X-ray images, and the angle between this bisector and the femoral joint line was measured. The consistency of these measurements across repeated assessments and different examiners was evaluated. Results: The bisector of the trochlear groove was found to be perpendicular to the femoral joint line, with a mean angle of 89.4°. The inter-rater reliability was 68% within ±1.3° from the mean, while the intra-rater reliability was 82% within ±1.5° from the mean. Conclusions: These results suggest that by performing a femoral cut perpendicular to the bisector of the trochlear groove, surgeons can inherently restore the femoral joint line of the native knee in patients where the native joint line is no longer identifiable due to the effect of osteoarthritis. This method may offer a viable and straightforward alternative to the standard surgical technique currently practiced for kinematic alignment in TKA.
摘要：
背景：近年来，全膝关节置换术（TKA）的假体对准技术引起了人们的极大兴趣，特别是在所谓的运动学对准中，其目的是恢复膝盖的自然对齐。然而,实施这项技术需要专门的工具和可能费力的程序步骤。这项研究介绍了滑车沟的平分线作为执行股骨远端切割的可靠标志，同时保持与天然股骨关节线的平行性。方法：三名骨科专家评估了110张全腿X线图像，2021年1月至2022年12月从健康个体获得的负重下肢。在X射线图像上识别出滑车沟的平分线，并测量了该平分线与股骨关节线之间的角度。评估了重复评估和不同检查者之间这些测量的一致性。结果:发现滑车沟的平分线与股骨关节线垂直,平均角度为89.4°。评估者间可靠性在平均值±1.3°内为68%，而评分者内部可靠性在平均值±1.5°范围内为82%。结论：这些结果表明，通过垂直于滑车沟的平分线进行股骨切割，在由于骨关节炎的影响而无法识别天然关节线的患者中，外科医生可以固有地恢复天然膝关节的股骨关节线。该方法可以为目前在TKA中用于运动学对准的标准手术技术提供可行且直接的替代方案。
