Webb Bradley T, Ulrich Slif D, MacKinlay Kenneth G W, Smith Langan S, Malkani Arthur L
University of Louisville Adult Reconstruction Program, Louisville, Kentucky.
Kentucky One Health, Jewish Physician Group, Louisville, Kentucky.
J Knee Surg. 2018 Apr;31(4):348-351. doi: 10.1055/s-0037-1603796. Epub 2017 Jun 22.
Alignment after total knee arthroplasty (TKA) plays an important role with respect to patient satisfaction and implant survivorship. In patients undergoing ipsilateral TKA with prior total hip arthroplasty (THA), the femoral intramedullary (IM) guide cannot be fully inserted into the femoral canal because of the prior THA. The purpose of this study was to determine the effect of femoral component alignment using a shorter IM guide during TKA in patients with an ipsilateral THA. We identified 42 patients undergoing ipsilateral TKA with the use of a short IM guide in the setting of a prior THA. A matched cohort group was identified from our total joint registry that included 42 patients who underwent primary TKA. The surgical goal was to achieve 5 degrees of valgus on the femoral side and 0 degree on the tibial side with an overall postoperative tibial-femoral angle of 5 degrees of valgus. Patients were evaluated clinically using Knee Society pain scores (KSSs), function scores, and with radiography. Both the tibial-femoral limb alignment and the femoral component alignment were compared using Student's -test. There were no significant differences between the two groups with respect to sex, age, body mass index (BMI), pre- and postoperative KSSs. There was a statistically significant difference between the two groups with respect to radiographic tibial-femoral limb alignment, 4.33 degrees of valgus in the short stem THA-TKA group versus 5.4 degrees of valgus in the TKA group ( < 0.04); however, this difference did not correlate to a difference in postoperative outcomes. An adequate tibial-femoral component alignment was achieved in patients undergoing ipsilateral TKA with prior THA using a shortened IM femoral guide.
全膝关节置换术（TKA）后的力线对于患者满意度和植入物存活率起着重要作用。在先前接受过全髋关节置换术（THA）的同侧TKA患者中，由于先前的THA，股骨髓内（IM）导向器无法完全插入股骨髓腔。本研究的目的是确定在同侧THA患者的TKA手术中使用较短的IM导向器对股骨组件力线的影响。我们确定了42例在先前THA情况下使用短IM导向器进行同侧TKA的患者。从我们的全关节登记处确定了一个匹配的队列组，其中包括42例行初次TKA的患者。手术目标是股骨侧达到5°外翻，胫骨侧达到0°，术后胫股角总体为5°外翻。使用膝关节协会疼痛评分（KSS）、功能评分对患者进行临床评估，并进行影像学检查。使用Student's -检验比较胫股肢体力线和股骨组件力线。两组在性别、年龄、体重指数（BMI）、术前和术后KSS方面无显著差异。两组在影像学胫股肢体力线方面存在统计学显著差异，短柄THA-TKA组为4.33°外翻，TKA组为5.4°外翻（<0.04）；然而，这种差异与术后结果的差异无关。使用缩短的股骨髓内导向器，在先前接受过THA的同侧TKA患者中实现了足够的胫股组件力线。
