Murakami Koji, Hamai Satoshi, Okazaki Ken, Ikebe Satoru, Nakahara Hiroyuki, Higaki Hidehiko, Shimoto Takeshi, Mizu-Uchi Hideki, Kuwashima Umito, Iwamoto Yukihide
Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Katai Orthopaedic Hospital, 132-1 Okuma Kasuya-machi, Kasuya-gun, Fukuoka, 811-2302, Japan.
Arch Orthop Trauma Surg. 2017 May;137(5):701-711. doi: 10.1007/s00402-017-2662-6. Epub 2017 Mar 13.
The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing.
The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types.
There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively).
Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes.
IV.
我们研究的目的是比较和对比两种类型的活动平台全膝关节置换术（TKA），即保留交叉韧带（CR）型和后稳定（PS）型TKA，对爬楼梯时临床结果和体内运动学的影响。
CR型和PS型TKA均使用Press-Fit Condylar Sigma旋转平台。使用2011年膝关节协会评分评估患者报告的结果。通过等速测力法评估股四头肌力量。使用在爬楼梯过程中获得的周期性矢状面X线影像评估体内运动学，采用图像匹配技术量化前后（AP）胫股平移、植入物屈曲和轴向旋转角度。对20例临床成功的TKA进行结果评估，包括10例CR型膝关节和10例PS型膝关节。
CR组和PS组在等长伸肌扭矩（分别为1.0±0.2和1.1±0.6 N m/kg）或患者报告的爬楼梯功能评分（分别为4.0±0.5和3.8±0.9）方面无显著差异（p>0.05）。两种类型的TKA在爬楼梯过程中均显示在膝关节屈曲中间范围有稳定的AP平移，在屈曲低范围有反常平移，旋转有限。CR组和PS组在膝关节屈曲80°至40°的前向平移（分别为4.2±1.2和3.5±1.6 mm）、膝关节屈曲40°至10°的后向平移（分别为2.3±1.9和2.0±1.5 mm）以及总外旋（分别为2.8°±4.9°和0.5°±5.0°）方面无显著差异（P>0.05）。
CR型和PS型旋转平台活动轴承TKA在爬楼梯过程中均提供了可重复的膝关节运动学和相当的临床结果。
IV级
