Toliopoulos Panagiota, LeBlanc Marc-Andre, Hutt Jonathan, Lavigne Martin, Desmeules Francois, Vendittoli Pascal-Andre
Maisonneuve-Rosemont Hospital, Department of Surgery, University of Montreal, Montreal, Quebec, Canada; Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Maisonneuve-Rosemont Hospital, Department of Surgery, University of Montreal, Montreal, Quebec, Canada.
Open Orthop J. 2016 Jul 28;10:357-63. doi: 10.2174/1874325001610010357. eCollection 2016.
The purpose of this study was to compare the intra-operative benefits and the clinical outcomes from kinematic or mechanical alignment for total knee arthroplasty (TKA) in patients undergoing revision of failed unicompartmental kneel arthroplasty (UKA) to TKA.
Ten revisions were performed with a kinematic alignment technique and 11 with a mechanical alignment. Measurements of the hip-knee-ankle angle (HKA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) were performed using long-leg radiographs. The need for augments, stems, and constrained inserts was compared between groups. Clinical outcomes were compared using the WOMAC score along with maximum distance walked as well as knee range of motion obtained prior to discharge. All data was obtained by a retrospective review of patient files.
The kinematic group required less augments, stems, and constrained inserts than the mechanical group and thinner polyethylene bearings. There were significant differences in the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) between the two groups (p<0.05). The mean WOMAC score obtained at discharge was better in the kinematic group as was mean knee flexion. At last follow up of 34 months for the kinematic group and 58 months for the mechanical group, no orthopedic complications or reoperations were recorded.
Although this study has a small patient cohort, our results suggest that kinematic alignment for TKA after UKA revision is an attractive method. Further studies are warranted.
本研究旨在比较在接受单髁膝关节置换术（UKA）失败后翻修为全膝关节置换术（TKA）的患者中，运动学对线与机械对线在全膝关节置换术中的术中益处及临床结果。
采用运动学对线技术进行了10例翻修手术，采用机械对线进行了11例。使用长腿X线片测量髋-膝-踝角（HKA）、股骨远端外侧角（LDFA）和胫骨近端内侧角（MPTA）。比较两组之间对增加物、柄和限制性衬垫的需求。使用WOMAC评分以及出院前行走的最大距离和膝关节活动范围比较临床结果。所有数据均通过回顾患者档案获得。
运动学组比机械组需要更少的增加物、柄和限制性衬垫以及更薄的聚乙烯轴承。两组之间的股骨远端外侧角（LDFA）和胫骨近端内侧角（MPTA）存在显著差异（p<0.05）。运动学组出院时获得的平均WOMAC评分以及平均膝关节屈曲度更好。在运动学组随访34个月、机械组随访58个月时，未记录到骨科并发症或再次手术情况。
尽管本研究的患者队列较小，但我们的结果表明，UKA翻修术后TKA的运动学对线是一种有吸引力的方法。有必要进行进一步研究。
