Hakki Sam, Saleh Khaled J, Potty Anish G, Bilotta Victor, Oliveira Daniel
Department of Orthopedic Surgery, Department of Veterans Affairs, Bay Pines VA Healthcare System, Bay Pines, FL 33744, USA.
Orthopedics. 2013 Mar;36(3):e308-18. doi: 10.3928/01477447-20130222-19.
The major factors that determine a favorable long-term clinical and functional outcome after conventional total knee arthroplasty (TKA) include correct implant positioning and restoration of the mechanical axis with soft tissue balancing to reduce aseptic failure; hence, the need for further developmental strategies that improve the accuracy and reproducibility of the surgical technique remains paramount for contemporary navigation research. Not all navigation systems are the same. The literature published thus far on mid-term results of navigated TKA relies on software that has no step-by-step soft tissue balancing with the tibia-first technique. The results are equivalent to those of conventional TKA.Therefore, the current authors conducted a minimum 5-year follow-up of a soft tissue-based navigated TKA system with the goal of soft tissue balancing. They analyzed intraoperative alignment and range of motion measurements, functional outcomes, radiographic assessment, and survival rates of high-flexion, high-conformity unresurfaced patella TKAs. The results at 5 years revealed a component revision rate of 0% compared with other nonnavigated TKAs (2.8% revision rate). The authors achieved a well-balanced TKA with a 0°±2° mechanical axis and an improved range of motion from 95° preoperatively to 110° postoperatively.
决定传统全膝关节置换术(TKA)后良好长期临床和功能结果的主要因素包括正确的植入物定位以及通过软组织平衡恢复机械轴以减少无菌性失败;因此,对于当代导航研究而言,开发进一步提高手术技术准确性和可重复性的策略仍然至关重要。并非所有导航系统都是一样的。迄今为止发表的关于导航TKA中期结果的文献所依赖的软件,在采用胫骨优先技术时没有逐步进行软组织平衡。其结果与传统TKA的结果相当。因此,本文作者对基于软组织的导航TKA系统进行了至少5年的随访,目的是实现软组织平衡。他们分析了术中对线和活动度测量、功能结果、影像学评估以及高屈曲、高顺应性非表面置换髌骨TKA的生存率。5年的结果显示,与其他非导航TKA(翻修率为2.8%)相比,组件翻修率为0%。作者实现了平衡良好的TKA,机械轴为0°±2°,活动度从术前的95°提高到术后的110°。