背景:在全膝关节置换术(TKA)中,关节线倾角(JLO)和关节线高度(JLH)的次优恢复可能导致植入物寿命缩短,增加并发症的风险,和减少患者报告的结果。这项研究的主要目的是确定与TKA中的机械对准(MA)相比,受限的运动学对准(rKA)是否可以改善JLO和JLH的恢复。
方法:这项回顾性研究评估了接受单种植体设计TKA治疗原发性骨关节炎的患者,无论是MA手动仪器或rKA辅助无图像导航机械臂TKA。术前和术后长期APX射线成像用于测量胫骨近端关节线和地板之间形成的JLO。JLH测量为从股骨关节表面到内收肌结节的距离。
结果:总体而言,200名患者(每组100名患者)。两组人口统计学包括年龄,性别,ASA,偏侧性,和BMI没有显著差异。KL骨关节炎分类的分布在组间相似。对于MA组,术前到术后JLO显著改变(2.94°vs.2.31°,p=0.004)。术前和术后JLH之间没有发现显著变化(40.6mmvs.40.6mm,p=0.89)。对于rKA组,术前和术后JLO之间没有发现显著变化(2.43°vs.2.30°,p=0.57)。此外,术前和术后无明显变化(41.2mmvs.42.4mm,p=0.17)。与rKA组相比,MA组的术前至术后JLO改变高五倍,尽管组间比较未达到统计学意义(p=0.09).
结论:rKA-TKA导致JLO和JLH的高恢复精度,与MA-TKA相比,手术前后JLO改变较少。随着对运动学对准的联合线恢复精度的兴趣增加,这些发现提示了与MA相比的潜在优势.未来的调查需要将rKA实现的关节线恢复精度与增强的植入物寿命相关联。降低术后并发症的风险,提高了患者的满意度。
BACKGROUND: In total knee arthroplasty (TKA), suboptimal
restoration of joint line obliquity (JLO) and joint line height (JLH) may lead to diminished implant longevity, increased risk of complications, and reduced patient reported outcomes. The primary objective of this study is to determine whether restricted kinematic alignment (rKA) leads to improved
restoration of JLO and JLH compared to mechanical alignment (MA) in TKA.
METHODS: This retrospective study assessed patients who underwent single implant design TKA for primary osteoarthritis, either MA with manual instrumentation or rKA assisted with imageless navigation robotic arm TKA. Pre- and post-operative long standing AP X-ray imaging were used to measure JLO formed between the proximal tibial joint line and the floor. JLH was measured as the distance from the femoral articular surface to the adductor tubercle.
RESULTS: Overall, 200 patients (100 patients in each group) were included. Demographics between the two groups including age, sex, ASA, laterality, and BMI did not significantly differ. Distribution of KL osteoarthritis classification was similar between the groups. For the MA group, pre- to post-operative JLO significantly changed (2.94° vs. 2.31°, p = 0.004). No significant changes were found between pre- and post-operative JLH (40.6 mm vs. 40.6 mm, p = 0.89). For the rKA group, no significant changes were found between pre- and post-operative JLO (2.43° vs. 2.30°, p = 0.57). Additionally, no significant changes were found between pre- and post-operative JLH (41.2 mm vs. 42.4 mm, p = 0.17). Pre- to post-operative JLO alteration was five times higher in the MA group compared to the rKA group, although this comparison between groups did not reach statistical significance (p = 0.09).
CONCLUSIONS: rKA-TKA results in high
restoration accuracy of JLO and JLH, and demonstrates less pre- and post-operative JLO alteration compared to MA-TKA. With risen interest in joint line
restoration accuracy with kinematic alignment, these findings suggest potential advantages compared to MA. Future investigation is needed to correlate between joint line
restoration accuracy achieved by rKA and enhanced implant longevity, reduced risk of post-operative complications, and heightened patient satisfaction.