Ee Gerard, Pang Hee Nee, Chong Hwei Chi, Tan Mann Hong, Lo Ngai Nung, Yeo Seng Jin
Singapore General Hospital Outram Road, Singapore 169608, Singapore.
Knee. 2013 Aug;20(4):256-62. doi: 10.1016/j.knee.2012.10.026. Epub 2012 Dec 7.
Restoration of the native joint line in total knee arthroplasty is important in restoring ligamentous balance and normal knee kinematics. Failure to achieve this could lead suboptimal outcomes. The purpose of this study was to analyze the clinical and functional outcome of patients who demonstrated joint line changes after computer-assisted (CAS) total knee arthroplasty (TKA).
One hundred sixty-eight patients (168 knees) underwent CAS TKA by two surgeons at a single institution with 2 years follow-up. The final change in joint line was calculated from the verified tibial resection and distal femoral cuts. Group A patients had joint line changes of less than 4mm and Group B patients had joint line changes of more than 4mm. Post-operative Oxford scores, Knee scores, Function scores and SF-36 scores were obtained at 6 months and 2 years post TKA.
There was significant linear correlation between joint line changes and Oxford scores (P=0.0001), Function scores (P=0.0001) and Knee scores (P=0.0001) at 6 months and Oxford scores (P=0.0001) alone at 2 years with increasing joint line changes having poorer outcome scores. Group A compared to Group B patients demonstrated better Oxford scores (P=0.0001), Function scores (P=0.0001), Knee scores (P=0.0001) and total SF-36 scores (P=0.003) at 6 months as well as better Oxford scores (P=0.0001) and Knee scores (P=0.014) at 2 years.
CAS is a useful intra-operative tool for assessing the final joint line in TKA. Outliers in joint line changes of ≥4 mm are associated with poorer clinical outcome scores.
Prognostic Study, Level II-1.
全膝关节置换术中恢复天然关节线对于恢复韧带平衡和正常膝关节运动学至关重要。未能实现这一点可能导致不理想的结果。本研究的目的是分析在计算机辅助（CAS）全膝关节置换术（TKA）后出现关节线改变的患者的临床和功能结果。
168例患者（168膝）在单一机构由两名外科医生进行了CAS TKA，并进行了2年的随访。根据经核实的胫骨截骨和股骨远端截骨计算关节线的最终变化。A组患者的关节线变化小于4mm，B组患者的关节线变化大于4mm。在TKA术后6个月和2年时获得术后牛津评分、膝关节评分、功能评分和SF-36评分。
在6个月时，关节线变化与牛津评分（P = 0.0001）、功能评分（P = 0.0001）和膝关节评分（P = 0.0001）之间存在显著的线性相关性，在2年时仅与牛津评分（P = 0.0001）存在显著线性相关性，关节线变化越大，结果评分越差。与B组患者相比，A组患者在6个月时的牛津评分（P = 0.0001）、功能评分（P = 0.0001）、膝关节评分（P = 0.0001）和总SF-36评分（P = 0.003）更好，在2年时的牛津评分（P = 0.0001）和膝关节评分（P = 0.014）也更好。
CAS是TKA术中评估最终关节线的有用工具。关节线变化≥4mm的异常情况与较差的临床结果评分相关。
预后研究，II-1级。
