Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chaoyang District, Beijing, 100020, China.
Knee Surg Sports Traumatol Arthrosc. 2012 Oct;20(10):2032-8. doi: 10.1007/s00167-011-1829-x. Epub 2011 Dec 20.
Implantation of prosthetic tibio-femoral components in hyperextension is a well-established and effective procedure, but whether prosthetic orientation in the sagittal plane has any effects on the postoperative kinematics remains unclear. The purpose of this study is to explore how the aforementioned hyperextension affects knee kinematics.
Validated computational dynamic TKA models were established. Based on representative literatures and actual operation specifications, femoral and tibial components were assembled with 0° or 5° of hyperextension. Dynamic data, including the timing of cam-post engagement, anterioposterior femoral translation and tibial axial rotation coupling with knee flexion, were recorded for analysis.
5° of femoral component hyperextension delayed cam-post engagement by an angle of 2°. Nevertheless, a 5° posterior slope of the tibial component resulted in a 38° delay in engagement. Comparing this with the femoral component at the same angle of hyperextension, the tibial component could more evidently assist in the prevention of paradoxical femoral anterior translation and the promotion of tibial internal rotation through early flexion.
Tibio-femoral components in hyperextension did significantly alter postoperative kinematics, especially for the tibial component. These results suggest that the degree of tibial posterior slope cutting should be more highly scrutinized intraoperatively.
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在过伸位植入人工全膝关节假体是一种成熟且有效的方法，但假体在矢状面的方向是否会影响术后的运动学尚不清楚。本研究旨在探讨上述过伸位对膝关节运动学的影响。
建立了经过验证的计算动态 TKA 模型。基于代表性文献和实际手术规范，将股骨和胫骨组件装配成 0°或 5°过伸位。记录了动态数据，包括凸轮销接合的时间、股骨前后平移以及与膝关节屈曲相关的胫骨轴向旋转的耦合。
5°的股骨组件过伸使凸轮销接合延迟了 2°。然而，胫骨组件的 5°后倾导致接合延迟了 38°。与同一角度的股骨组件相比，胫骨组件通过早期屈曲更明显地有助于预防反常的股骨前向平移和促进胫骨内旋。
过伸位的胫股组件确实显著改变了术后的运动学，尤其是胫骨组件。这些结果表明，术中应更仔细地检查胫骨后倾截骨的程度。
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