De Valk Eduard J, Noorduyn Julia C A, Mutsaerts Eduard L A R
Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2016 Nov;24(11):3517-3528. doi: 10.1007/s00167-016-4325-5. Epub 2016 Sep 21.
One of the most important factors leading to revision of total knee arthroplasties (TKA) is malrotation of femoral and/or tibial component. Rotation measurements performed on radiographs are limited and less reliable compared to 2D computed tomography (CT). Nowadays, 2D-CT and 3D-CT can be distinguished in measuring rotation of the TKA components. The aim of this systematic review is to determine the most reliable CT techniques in measuring rotation of the TKA components and to investigate possible cut-off points that can be used in the clinician's decision for a possible revision of the TKA.
A search of PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science was performed up to April 2015. Final selections of 12 articles were used in this systematic review.
3D-CT, compared to 2D-CT, is more reliable and shows a high level of intra- and interobserver reliability. Femoral component rotation is measured using the component's posterior condylar line or inner pegs in relation to the epicondylar axis. Five different techniques were used to measure tibial component rotation. The posterior border of the tibial component in relationship to the geometric centre and tibial tubercle was most frequently used.
This systematic review shows a strong preference for 3D-CT to determine the component's rotation following a TKA. The literature shows consensus on the reference points of the femoral component. In measurements of the tibial component, various techniques are used with similar results. No clear cut-off point for revision of malrotated TKA components can be stated because of limited evidence.
III.
导致全膝关节置换术（TKA）翻修的最重要因素之一是股骨和/或胫骨假体的旋转不良。与二维计算机断层扫描（CT）相比，在X线片上进行的旋转测量有限且可靠性较低。如今，二维CT和三维CT在测量TKA假体旋转方面有所不同。本系统评价的目的是确定测量TKA假体旋转最可靠的CT技术，并研究可用于临床医生决定是否可能对TKA进行翻修的可能截断点。
截至2015年4月，对PubMed、Embase、Cochrane对照试验中央注册库和科学网进行了检索。本系统评价使用了最终筛选出的12篇文章。
与二维CT相比，三维CT更可靠，并且在观察者内和观察者间显示出高度的可靠性。股骨假体旋转通过假体的后髁线或内固定钉相对于上髁轴进行测量。使用了五种不同的技术来测量胫骨假体旋转。最常使用的是胫骨假体后缘相对于几何中心和胫骨结节的关系。
本系统评价显示，在确定TKA术后假体旋转方面，强烈倾向于使用三维CT。文献表明在股骨假体的参考点上存在共识。在测量胫骨假体时，使用了各种技术，结果相似。由于证据有限，无法明确陈述旋转不良的TKA假体翻修的截断点。
III级。
