Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea.
Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea.
J Arthroplasty. 2018 Feb;33(2):391-397. doi: 10.1016/j.arth.2017.09.056. Epub 2017 Oct 6.
We compared clinical and radiographic results after total knee arthroplasty (TKA) using Attune and Press Fit Condylar Sigma, and investigated whether use of the current prosthesis increased injury risk to the tibial cortex in Asian patients. We also assessed whether a preoperative posterior tibial slope angle (PSA) is associated with the injury when using the current prosthesis.
The 300 TKAs with Attune (group A) were compared to the 300 TKAs with Press Fit Condylar Sigma (group B). Demographics were not different, except follow-up periods (24.8 vs 33.3 months, P < .001). The Western Ontario and McMaster Universities Index and range of motion were compared. A minimum distance between tibial component stem and posterior tibial cortex (mDSC) was compared. The correlation between preoperative PSA and mDSC was analyzed in group A.
The postoperative Western Ontario and McMaster Universities Index and range of motion of group A were better than those of group B (17.7 vs 18.8, P = .004; 131.4° vs 129.0°, P = .008). The mDSC was shorter in group A (6.3 vs 7.0 mm, P < .001), which made up a higher proportion of the high-risk group for posterior tibial cortical injury with an mDSC of <4 mm (20.0% vs 10.7%, P = .002). A negative correlation was found between the preoperative PSA and mDSC in group A (r = -0.205, P < .001).
The TKA using the current prosthesis provided more satisfactory results than the TKA using the previous prosthesis. However, the injury risk to the posterior tibial cortex increased in the knees with a large PSA when using the current prosthesis for Asian patients.
我们比较了使用 Attune 和 Press Fit Condylar Sigma 的全膝关节置换术（TKA）的临床和影像学结果，并探讨了当前假体的使用是否会增加亚洲患者胫骨皮质损伤的风险。我们还评估了当前假体使用时，术前胫骨后倾角（PSA）是否与损伤相关。
将 300 例使用 Attune 的 TKA（A 组）与 300 例使用 Press Fit Condylar Sigma 的 TKA（B 组）进行比较。两组的人口统计学数据无差异，除了随访时间（24.8 与 33.3 个月，P<0.001）。比较了 Western Ontario 和 McMaster 大学指数以及活动范围。比较了胫骨组件柄和胫骨后皮质之间的最小距离（mDSC）。分析了 A 组中术前 PSA 与 mDSC 的相关性。
A 组术后 Western Ontario 和 McMaster 大学指数以及活动范围优于 B 组（17.7 与 18.8，P=0.004；131.4°与 129.0°，P=0.008）。A 组的 mDSC 更短（6.3 与 7.0mm，P<0.001），mDSC<4mm 的胫骨皮质损伤高危比例更高（20.0%与 10.7%，P=0.002）。A 组中发现术前 PSA 与 mDSC 呈负相关（r=-0.205，P<0.001）。
与使用旧假体的 TKA 相比，使用当前假体的 TKA 提供了更满意的结果。然而，对于亚洲患者，当前假体使用时，如果膝关节 PSA 较大，则增加了胫骨后皮质损伤的风险。
