目的:本研究的目的是比较运动对准(KA)和机械对准(MA)与后稳定(PS)全膝关节置换术(TKA)之间的临床和放射学结果,至少随访3年。作者假设使用PSTKA进行KA时无菌性松动的风险较高。
方法:进行了一项回顾性单中心单外科医生病例对照研究,比较了2016年1月至2017年10月期间100例使用MA哲学进行TKA的匹配患者与50例使用KA技术进行TKA的患者。所有患者均使用相同的膝关节假体(GMK原发后稳定型,Medacta®,瑞士)。两组均使用患者特异性切割块,KA组针对限制性KA(rKA)。进行了混合胶结技术。术前和最后随访时收集新的膝关节协会评分(KSS)和放射学评估。组间比较采用T检验或Fisher精确检验。用Kaplan-Meier模型估计全局生存曲线。显著性设定为p<0.05。
结果:rKA和MA组的平均随访时间为42.9个月±3.6(范围37.6-46.7)和53.3个月±4.1(范围45.5-59.8)。术后,两组间临床评分无显著差异.放射学评估发现rKA组和MA组术后髋-膝-踝角相似(分别为178°和179°,NS).在最后的随访中,以无菌性松动修正为终点,与rKA组相比,MA组的生存率显著较高(97%对84%;p<0.001).
结论:在短期随访中,使用后稳定型TKA与MA相比,发现rKA的胫骨植入物松动风险增加。在进行rKA时选择TKA设计时应谨慎。
方法:回顾性病例对照研究,四级。
OBJECTIVE: The purpose of the study was to compare clinical and radiological results between kinematic alignment (KA) and mechanical alignment (MA) with a posterior-stabilized (PS) total knee arthroplasty (TKA) with a post-cam mechanism at a minimum follow-up of 3 years. The authors hypothesized a higher risk of aseptic loosening when performing KA using PS TKA.
METHODS: A retrospective monocentric single surgeon
case control study was performed comparing 100 matched patients who had TKA performed using a MA philosophy to 50 patients receiving TKA with a KA technique between January 2016 and October 2017. All patients had the same knee prosthesis (GMK primary posterior-stabilized, Medacta®, Switzerland). Patient specific cutting blocks were used in both groups and a restricted KA (rKA) was aimed in the KA group. A hybrid cementation technique was performed. The new Knee Society Score (KSS) and radiological assessment were collected preoperatively and at the final follow-up. Comparisons between groups were done with the T test or Fisher exact test. Global survival curves were estimated with Kaplan-Meier model. Significance was set at p < 0.05.
RESULTS: Mean follow-up was 42.9 months ± 3.6 (range 37.6-46.7) and 53.3 months ± 4.1 (range 45.5-59.8) for rKA and MA groups. Postoperatively, no significant differences were found for clinical scores between both groups. Radiological assessment found similar postoperative Hip-Knee-Ankle angle for rKA and MA groups (178° versus 179° respectively, NS). At last follow-up, a significant higher survivorship was found for the MA group compared to the rKA group (97 versus 84%; p < 0.001) for aseptic loosening revision as the endpoint.
CONCLUSIONS: An increased risk of tibial implant loosening was found with rKA compared to MA using a posterior-stabilized TKA with a post-cam system at short-term follow-up. Caution should be taken when choosing the TKA design while performing rKA.
METHODS: Retrospective
case-control study, Level IV.