Kim Chang Wan, Seo Seung Suk, Kim Jung Han, Lee Hyeong Joo, Lee Chang Rack
Department of Orthopedic Surgery, Busan Paik Hospital, College of Medicine, Inje University, 633-166 Gaegeum-dong, Busan Jin-gu, Busan, 614-735, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2015 Jun;23(6):1863-9. doi: 10.1007/s00167-014-3088-0. Epub 2014 Jun 11.
The purpose of the present study was to evaluate factors that affect the occurrence of osteolysis through clinical and radiological comparison between a patient group in which osteolysis occurred after total knee arthroplasty (TKA) and a patient group in which osteolysis did not occur after TKA.
The present study was conducted with 486 knees that had been followed up for at least 2 years after undergoing a posterior-stabilized TKA. The subjects were divided into a group in which osteolysis occurred and a group in which osteolysis did not occur and retrospectively compared and analyzed. Knee Society Knee Score and Function Score, preoperative and postoperative range of motion (ROM), femoral and tibial implant positions, preoperative and postoperative femerotibial angles, posterior femoral condylar offset (PCO), level of joint line (JL), and posterior tibial slopes were measured and clinically and radiologically compared.
Osteolysis occurred in 28 knee joints (5.7%). No significant difference was observed between the patient group without osteolysis, and the patient group with osteolysis was observed in preoperative and postoperative ROM, femoral and tibial implant positions, or preoperative and postoperative femerotibial angles. The means of preoperative and postoperative differences in PCO and level of JL were significantly larger in the patient group with osteolysis than in the patient group without osteolysis (p = 0.01, p = 0.007), and regression analyses showed that the means of preoperative and postoperative differences in these two variables were related with the occurrence of osteolysis (p = 0.021, p = 0.018).
The present study shows that biomechanical changes occurring after TKA are related with the occurrence of osteolysis. For clinical relevance, surgeons should pay great attention to restore normal anatomical structure as much as possible with careful preoperative plans, accurate surgical techniques, and selection of appropriate implants.
Retrospective comparative study, Level III.
本研究的目的是通过对全膝关节置换术（TKA）后发生骨溶解的患者组和TKA后未发生骨溶解的患者组进行临床和影像学比较，评估影响骨溶解发生的因素。
本研究对486例接受后稳定型TKA并随访至少2年的膝关节进行。将受试者分为发生骨溶解的组和未发生骨溶解的组，并进行回顾性比较和分析。测量膝关节协会膝关节评分和功能评分、术前和术后活动范围（ROM）、股骨和胫骨植入物位置、术前和术后股胫角、股骨后髁偏移（PCO）、关节线水平（JL）和胫骨后倾角，并进行临床和影像学比较。
28个膝关节（5.7%）发生骨溶解。在术前和术后ROM、股骨和胫骨植入物位置或术前和术后股胫角方面，未发生骨溶解的患者组与发生骨溶解的患者组之间未观察到显著差异。发生骨溶解的患者组术前和术后PCO及JL水平差异的均值显著大于未发生骨溶解的患者组（p = 0.01，p = 0.007），回归分析表明这两个变量术前和术后差异的均值与骨溶解的发生有关（p = 0.021，p = 0.018）。
本研究表明TKA后发生的生物力学变化与骨溶解的发生有关。为具有临床相关性，外科医生应通过仔细的术前规划、准确的手术技术和选择合适的植入物，尽可能重视恢复正常解剖结构。
回顾性比较研究，III级。
