Rivière C, Iranpour F, Harris S, Auvinet E, Aframian A, Chabrand P, Cobb J
Department of joint replacement, the MSK Lab, Charing Cross Campus, Laboratory Block, Fulham Palace Rd, W6 8RP London, UK.
Department of joint replacement, the MSK Lab, Charing Cross Campus, Laboratory Block, Fulham Palace Rd, W6 8RP London, UK.
Orthop Traumatol Surg Res. 2017 Nov;103(7):1069-1073. doi: 10.1016/j.otsr.2017.06.016. Epub 2017 Sep 1.
Kinematic alignment (KA) technique is an alternative technique for positioning a TKA, which aims a patient-specific implant positioning in order to reproduce the pre-arthritic knee anatomy. Because reliability in implant positioning is of interest to obtain reproducible good functional results, our study tests the hypothesis that the medial and lateral distal and posterior positions of the planned and surgically implanted kinematically aligned femoral component are similar.
Preoperative knee magnetic resonance imaging (MRI) and postoperative knee computed tomography (CT) of 13 patients implanted with a KA Persona TKA (Zimmer, Warsaw, USA) using manual instrumentation (kinematically-aligned TKA procedure pack, Zimmer Biomet, Warsaw, USA) were segmented to create 3D femoral models. The kinematic alignment position of the femoral component was planned on the 3D model created from the preoperative MRI. Differences in the positions of the planned and surgically implanted kinematically-aligned femoral component were determined with in-house analysis software.
The average differences between the medial and lateral distal and posterior positions of the planned and surgically implanted kinematically-aligned femoral component were inferior to 1mm and no statistically significant. In terms of variability, 62% (8/13) of performed implants matched all four positions within 1.5mm, and the maximum difference was 3mm.
In this small series, intraoperative kinematic positioning of the femoral component with the specific manual instrumentation closely matched the planned position, which suggests that this technique reliably aligned the flexion-extension axis of the femoral component to the cylindrical axis.
Level 3.
运动学对线（KA）技术是全膝关节置换术（TKA）定位的一种替代技术，其目的是进行针对患者的植入物定位，以重现关节炎前的膝关节解剖结构。由于植入物定位的可靠性对于获得可重复的良好功能结果至关重要，我们的研究检验了以下假设：计划中以及手术植入的运动学对线股骨组件的内侧和外侧远端及后方位置相似。
对13例使用手动器械（运动学对线TKA手术包，美国华沙捷迈公司）植入KA Persona TKA（美国华沙捷迈公司）的患者进行术前膝关节磁共振成像（MRI）和术后膝关节计算机断层扫描（CT），对其进行分割以创建三维股骨模型。在由术前MRI创建的三维模型上规划股骨组件的运动学对线位置。使用内部分析软件确定计划中以及手术植入的运动学对线股骨组件位置的差异。
计划中以及手术植入的运动学对线股骨组件的内侧和外侧远端及后方位置的平均差异小于1毫米，且无统计学意义。在变异性方面，62%（8/13）的植入手术中，所有四个位置的匹配度在1.5毫米以内，最大差异为3毫米。
在这个小样本系列中，使用特定手动器械对股骨组件进行术中运动学定位与计划位置紧密匹配，这表明该技术能可靠地将股骨组件的屈伸轴与圆柱轴对齐。
3级。
