Gustke Kenneth A, Golladay Gregory J, Roche Martin W, Elson Leah C, Anderson Christopher R
Florida Orthopaedic Institute, Tampa, Florida.
Department of Orthopaedics, Virginia Commonwealth Medical Center, Richmond, Virginia.
J Arthroplasty. 2017 Jul;32(7):2127-2132. doi: 10.1016/j.arth.2017.02.021. Epub 2017 Feb 16.
Currently, soft-tissue imbalance contributes to several of the foremost reasons for revision following primary TKA, including instability, stiffness, and aseptic loosening. In order to decrease the incidence of soft-tissue imbalance, intraoperative sensors were developed to provide real-time, quantitative load data within the knee. This study examines the intraoperative data of a group of multicenter patients to determine how targeted ligament releases affect intra-articular loading, and to understand which types of releases are necessary to achieve quantified ligament balance.
A group of 129 patients received sensor-assisted TKA, as part of a multicenter study. Medial and lateral loading data were collected pre-release, during any sequential releases, and post-release. All data were collected at 10°, 45°, and 90° during range of motion testing. Ligament release type, release technique type, and resultant loading were collected.
Loading across the joint decreased, overall, and became more symmetrical after releases were performed. On average, between 2 and 3 corrections were made (up to 8) in order to achieve ligament balance. The ligament release type and subsequent quantified change in loading were in agreement with historical, qualified sources.
Objective data from sensor output may assist surgeons in decreasing loading variability and, thereby, decreasing ligament imbalance and its associated complications.
目前,软组织失衡是初次全膝关节置换术(TKA)后翻修的几个主要原因之一,包括不稳定、僵硬和无菌性松动。为了降低软组织失衡的发生率,开发了术中传感器以提供膝关节内实时、定量的负荷数据。本研究检查了一组多中心患者的术中数据,以确定有针对性的韧带松解如何影响关节内负荷,并了解哪些类型的松解对于实现量化的韧带平衡是必要的。
作为一项多中心研究的一部分,一组129例患者接受了传感器辅助的TKA。在松解前、任何连续松解过程中以及松解后收集内侧和外侧负荷数据。所有数据均在运动范围测试的10°、45°和90°时收集。收集韧带松解类型、松解技术类型和由此产生的负荷。
总体而言,进行松解后关节两侧的负荷降低且变得更加对称。为了实现韧带平衡,平均进行了2至3次(最多8次)调整。韧带松解类型和随后负荷的量化变化与既往的经验来源一致。
传感器输出的客观数据可能有助于外科医生降低负荷变异性,从而减少韧带失衡及其相关并发症。