Hofmann S, Romero J, Roth-Schiffl E, Albrecht T
Allgemeines und Orthopädisches LKH, Stolzalpe, Austria.
Orthopade. 2003 Jun;32(6):469-76. doi: 10.1007/s00132-003-0503-5.
Rotational alignment of the tibial and femoral component plays an important role in modern total knee replacement surgery. After correct frontal alignment and proper soft tissue balancing, the rotational placement of the components represents the "third dimension" in knee endoprosthetic surgery. Improved surgical techniques with modified instruments and better rotational component positioning will lead to better functional outcomes. Patients with painful total knee arthroplasties (TKA) or early failure without evident classic implantation failures or signs of infection should be evaluated for malrotation of the components. In a prospective study in 26 patients with painful TKA and malrotation of the tibia and/or femur component, revision surgery with exchange of the components was performed. Twenty-five cases showed clinically relevant internal malrotation of the tibial component (ø 8.4 degrees ) and/or femoral component (ø 5.6 degrees ). Only one patient had 10 degrees of external malrotation of the femoral component. Combined malrotations of the tibia and femur were found in ten knees (38%). After revision surgery and correction of malrotations, 20 patients (78%) were scored with excellent and good results. Patients with painful TKA resistant to conservative therapy and evident malrotations of the component should be considered for revision surgery with change of the malrotated components.
在现代全膝关节置换手术中，胫骨和股骨假体组件的旋转对线起着重要作用。在实现正确的额状面对线和适当的软组织平衡后，组件的旋转放置代表了膝关节置换手术中的“第三维度”。采用改良器械的改进手术技术以及更好的组件旋转定位将带来更好的功能结果。对于患有疼痛性全膝关节置换术（TKA）或早期失败且无明显典型植入失败或感染迹象的患者，应评估组件是否存在旋转不良。在一项针对26例患有疼痛性TKA且胫骨和/或股骨组件旋转不良的患者的前瞻性研究中，进行了更换组件的翻修手术。25例病例显示胫骨组件存在临床相关的内旋（平均8.4度）和/或股骨组件存在内旋（平均5.6度）。仅有1例患者股骨组件存在10度的外旋。在10个膝关节（38%）中发现了胫骨和股骨的联合旋转不良。翻修手术并纠正旋转不良后，20例患者（78%）的评分结果为优或良。对于保守治疗无效且组件存在明显旋转不良的疼痛性TKA患者，应考虑进行更换旋转不良组件的翻修手术。
