Dalury David F, Mulliken Brian D, Adams Mary Jo, Lewis Christina, Sauder Rebecca R, Bushey Jennifer A
Department of Orthopaedic Surgery, St. Joseph Medical Center, Towson, Maryland, USA.
J Bone Joint Surg Am. 2009 Jun;91(6):1339-43. doi: 10.2106/JBJS.H.00435.
Proponents of minimally invasive total knee arthroplasty claim that patellar eversion and anterior tibial translation during total knee arthroplasty have a deleterious effect on early patient rehabilitation and the early clinical outcome. Our purpose was to identify differences in knee preference and clinical outcome measures in a series of patients who had undergone bilateral total knee arthroplasty with each knee randomized to one of two different surgical approaches: patellar eversion and anterior tibial translation, or patellar subluxation and no tibial translation.
The knees of forty patients were prospectively randomized to one of two treatment groups, patellar eversion or patellar subluxation, with each patient having one knee treated with each type of approach. Three patients were withdrawn, leaving a final study group of thirty-seven patients. The patients and physical therapists were blinded to the type of treatment. Clinical outcomes, including the Knee Society scores, range of motion, quadriceps strength as tested with a dynamometer, and the patient's preferred knee on the basis of pain, motion, and strength, were collected preoperatively and at six weeks, twelve weeks, and six months postoperatively and were analyzed.
At six weeks after the surgery, there were no significant differences between the two groups with regard to the range of motion, quadriceps strength, or Knee Society scores. With regard to the patient's knee preference at six weeks, the two knees were rated as being the same in terms of pain, whereas a higher percentage preferred the knee treated with eversion in terms of motion (43% compared with 35% who preferred the knee treated with subluxation) and strength (43% compared with 22%). The mean arc of motion in both groups was approximately 113 degrees. At twelve weeks and six months after the surgery, we found no significant differences between the treatment groups in terms of the range of motion, quadriceps strength, or Knee Society scores, and there was no difference with regard to the patient's knee preference.
We found no significant differences between the two treatment groups (patellar eversion and anterior tibial translation compared with patellar subluxation and no tibial translation) at six weeks, twelve weeks, or six months after the surgery. We concluded that patellar eversion and anterior tibial translation appear to have no adverse effects on the range of motion, quadriceps strength, or patient's knee preference during the early postoperative recovery period after total knee arthroplasty.
微创全膝关节置换术的支持者称，全膝关节置换术中髌骨外翻和胫骨前移对患者早期康复及早期临床疗效有不良影响。我们的目的是确定一系列接受双侧全膝关节置换术患者的膝关节偏好及临床疗效指标的差异，每个膝关节随机分配至两种不同手术方式之一：髌骨外翻和胫骨前移，或髌骨半脱位且无胫骨前移。
40例患者的膝关节被前瞻性随机分为两个治疗组之一，即髌骨外翻组或髌骨半脱位组，每位患者的一个膝关节接受每种手术方式治疗。3例患者退出研究，最终研究组为37例患者。患者和物理治疗师对治疗类型不知情。收集术前及术后6周、12周和6个月时的临床疗效指标，包括膝关节协会评分、活动范围、用测力计测试的股四头肌力量，以及基于疼痛、活动和力量的患者偏好膝关节，然后进行分析。
术后6周时，两组在活动范围、股四头肌力量或膝关节协会评分方面无显著差异。关于患者术后6周时的膝关节偏好，在疼痛方面，两个膝关节的评分相同；而在活动（43% 偏好外翻治疗的膝关节，相比之下35% 偏好半脱位治疗的膝关节）和力量（43% 偏好外翻治疗的膝关节，相比之下22% 偏好半脱位治疗的膝关节）方面，偏好外翻治疗膝关节的患者比例更高。两组的平均活动弧度约为113度。术后12周和6个月时，我们发现治疗组在活动范围、股四头肌力量或膝关节协会评分方面无显著差异，在患者膝关节偏好方面也无差异。
我们发现术后6周、12周或6个月时，两个治疗组（髌骨外翻和胫骨前移组与髌骨半脱位且无胫骨前移组）之间无显著差异。我们得出结论，在全膝关节置换术后的早期恢复阶段，髌骨外翻和胫骨前移似乎对活动范围、股四头肌力量或患者膝关节偏好没有不良影响。
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