Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3892-3900. doi: 10.1007/s00167-016-4400-y. Epub 2016 Dec 22.
The aim of this study was to evaluate femoral and tibial as well as whole leg coronal TKA alignment using 3D-reconstructed CTs and to assess the relationship of coronal TKA alignment and clinical outcome in a large prospective series of patients. It was hypothesized that a coronal deviation of TKA position and leg alignment from the mechanical axis is correlated with poorer patients' outcome after TKA.
A total of 81 consecutive patients who underwent primary TKA were prospectively included. The patient's demographics such as age, gender and time from primary TKA were noted. All patients underwent clinical and radiological examination including standardized radiographs (anteroposterior and lateral weight-bearing, patellar skyline view) and CT as part of their postoperative follow-up. For assessment of TKA component position and orientation 3D-reconstructed CT was used. For clinical outcome scoring the Knee Society Score (KSS) was used at 1 and 2 years postoperatively. Linear and quadratic regression models were used to test for correlations between alignment variables and KSS (p < .05).
The mean Knee Society Score was 181 ± 28 (range 52-200) 2 years postoperatively, while 78% of the patients were completely pain free and 22% had some persisting pain interfering with their daily activities. The mean mechanical whole limb alignment (HKA angle), femoral component alignment and tibial component alignment were 0°, 0.1° and -0.7°, respectively. The component position parameters, as well as the whole limb alignment measurements, did not show any statistically significant correlation with the KSS, after 1 and 2 years postoperatively.
In this prospective study, using 3D-CT to measure the component position, the postoperative outcome was not influenced by coronal TKA component position as well as the whole leg alignment. The findings challenge the current target of neutral coronal alignment and point towards a more individualized mechanical alignment target.
Prognostic study, Level I.
本研究旨在通过三维重建 CT 评估全膝关节置换术（TKA）的股骨和胫骨以及整个腿部冠状面的对线，并评估在大型前瞻性患者系列中 TKA 对线与临床结果的关系。假设 TKA 位置和腿部对线相对于机械轴的冠状偏差与 TKA 后患者的结果较差相关。
共前瞻性纳入 81 例连续接受初次 TKA 的患者。记录患者的人口统计学特征，如年龄、性别和初次 TKA 后时间。所有患者均接受临床和影像学检查，包括标准的影像学（前后位和负重位，髌骨切线位）和作为术后随访的一部分进行 CT 检查。使用 3D 重建 CT 评估 TKA 组件位置和方向。使用膝关节协会评分（KSS）评估术后 1 年和 2 年的临床结果评分。使用线性和二次回归模型测试对线变量与 KSS 之间的相关性（p<.05）。
术后 2 年平均 KSS 为 181±28（范围 52-200），78%的患者完全无痛，22%的患者仍有一些持续疼痛干扰其日常活动。平均机械全下肢对线（HKA 角）、股骨组件对线和胫骨组件对线分别为 0°、0.1°和-0.7°。术后 1 年和 2 年，组件位置参数以及全下肢对线测量值与 KSS 均无统计学显著相关性。
在这项前瞻性研究中，使用 3D-CT 测量组件位置，术后结果不受冠状 TKA 组件位置和全腿对线的影响。这些发现挑战了当前的中立冠状对线目标，并指向更个体化的机械对线目标。
预后研究，I 级。
