目的:内翻膝骨关节炎患者通常在踝关节处进行代偿,通常以后足外翻对齐行走。由于全膝关节置换术(TKA)恢复了下肢的中性负重轴,脚踝和后足生物力学也发生了急剧变化。这项研究旨在调查在至少6个月的随访中,双侧骨关节炎患者的双侧机械TKA是否会导致踝关节临床影像学变化。
方法:前瞻性观察性研究包括61例同时接受双侧TKA(机械对位)的患者(122膝)。胫骨距骨角度(TTA),胫骨前表面角度(TAS),胫骨远端外侧角(LDTA),距骨倾斜角(TT),解剖学截骨角度(ATC),地面和胫骨远端平台角(GP),在长片X光片上测量地面和距骨角(GT),胫骨平台和胫骨平台角(PP)的上表面,以寻找踝关节的变化,而功能评估是使用美国足踝协会(AOFAS)进行的,足踝残疾指数(FADI)和被遗忘的联合(FJS-12)得分。根据髋关节-膝关节-踝关节(HKA)轴对患者进行分组,并分析膝关节内翻严重程度对TKA术后踝关节的影响。最短随访时间为6个月。
结果:胫骨平台-胫骨平台(PP)显着减少,胫骨平台(GP),TKA后注意到地面-距骨圆顶(GT)角(p值<0.05)。术后功能参数与术前状态相当,FADI除外,显着改善(p值-0.03)。根据膝关节内翻严重程度(HKA)进行的亚组分析显示,GT降低最显著(p值为0.036),而距骨倾斜(TT)增加(p值-0.044)。TKA术后纠正严重膝内翻,临床上脚踝的功能结果得到改善。在TKA术后13.2个月的平均随访中,61例患者中有7例(11.4%)主诉TKA术后同侧踝关节疼痛。
结论:在严重的膝关节内翻畸形中,机械对齐的双侧TKA显着降低了GT角,但增加了距骨外侧不一致和覆盖不足的距骨的内翻倾斜。尽管严重的膝内翻畸形的急性矫正使胫骨更加中性,导致踝关节功能的整体临床明显改善,内翻向距骨倾斜的增加仍然是一个令人深为关切的问题。
方法:前瞻性,观察,二级比较研究。
OBJECTIVE: Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months.
METHODS: The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months.
RESULTS: A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain.
CONCLUSIONS: Mechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern.
METHODS: Prospective, observational, comparative study Level II.