Lee Ju Hong, Wang Seong-Il
Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.
Clin Orthop Surg. 2015 Jun;7(2):217-24. doi: 10.4055/cios.2015.7.2.217. Epub 2015 May 18.
We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system.
We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups.
The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups.
Surgeons should be aware of the risks associated with anterior femoral notching when using a navigation system for TKA. A modification of the femoral cut should be considered when remarkable femoral bowing is observed.
我们回顾性研究了使用无图像导航系统进行全膝关节置换术（TKA）后股骨前部切迹的发生率及危险因素。
我们回顾性分析了2005年7月开始的130例患者的148例连续TKA。70例膝关节（62例患者）接受传统TKA，78例膝关节（68例患者）接受导航TKA。我们调查了股骨前部切迹的发生率，并通过传统TKA和导航TKA测量切迹深度。此外，导航TKA组根据是否发生股骨前部切迹分为两个亚组。通过术前和术后X线片确定术前内翻畸形程度、股骨弓以及股骨假体大小的内外侧适配性。在切除股骨远端时检查矢状面的切除角度和导航系统设定的外旋角度。使用两组之间的活动范围（ROM）、特种外科医院（HSS）评分和西安大略和麦克马斯特大学骨关节炎指数（WOMAX）评分比较临床结果。
传统TKA股骨前部切迹的发生率为5.7%，导航TKA为16.7%（p = ）。传统TKA的平均切迹深度为2.92±1.18mm（范围1.8至4.5mm），导航TKA为3.32±1.54mm（范围1.55至6.93mm）。导航TKA时，切迹组61.5%观察到术前股骨前部弓形（p = 0.047），5例同时观察到股骨前部和外侧弓形（p = 0.021）。53.8%的病例插入了过大的股骨假体（p = 0.035）。两组之间在ROM或HSS和WOMAX评分的临床结果上未观察到差异。传统TKA组和导航TKA组各有1例发生假体周围骨折，这被认为是与切迹相关的副作用。
在使用导航系统进行TKA时，外科医生应意识到与股骨前部切迹相关的风险。当观察到明显的股骨弓形时，应考虑修改股骨截骨。
