全膝关节置换术中股骨内侧假体旋转不良会显著改变胫股关节运动学。

Internal femoral component malrotation in TKA significantly alters tibiofemoral kinematics.

机构信息

Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.

Smith & Nephew, Zaventem, Belgium.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2018 Jun;26(6):1767-1775. doi: 10.1007/s00167-017-4778-1. Epub 2017 Nov 11.

DOI:10.1007/s00167-017-4778-1

PMID:29128876

Abstract

PURPOSE

Femoral component malrotation in total knee arthroplasty (TKA) is clinically proven to cause dissatisfaction and impaired function. This study is an attempt to characterize the tibiofemoral kinematics following femoral malrotation in posterior stabilized (PS) TKA. It was hypothesized that internal malrotation would introduce the most pronounced changes.

METHODS

Six fresh-frozen cadaver specimens were mounted in a kinematic rig. Three motion patterns were applied with the native knee and following PS TKA (passive motion, open chain extension, and squatting) while infrared cameras recorded the trajectories of markers attached to femur and tibia. Three different femoral implants were tested: a conventional posterior stabilized component, and adapted components of the same implant with 5° of intrinsic external and internal rotation, respectively.

RESULTS

The implantation of the PS TKA resulted in less tibial internal rotation (squat 33-70°, p < 0.05) and the medial femoral condyle shifted posteriorly especially in deep flexion (squat 84-111°, p < 0.05). Internal component malrotation caused internal rotation and abduction of the tibia in flexion (squat 33-111°, p < 0.05), an elevated (squat 43-111°, p < 0.05) and more anterior (passive 61-126°, p < 0.05) located medial femoral condyle and a lateral femoral condyle located more posterior and inferior (squat 73-111°, p < 0.05) than in the neutrally aligned TKA. External component malrotation caused only little changes under passive motion. Under a squat there was less internal rotation and more adduction to the tibia (33-111°, p < 0.05). The medial femoral condyle was moved more posterior (squat 59-97°, p < 0.05), the lateral femoral condyle more superior (squat 54-105°, p < 0.05) than in the neutrally aligned TKA.

CONCLUSION

The greatest differences to the native tibiofemoral kinematics were introduced by internal rotation of the femoral component. Also neutrally and externally rotated femoral components introduce kinematic changes, but to a lesser extent. With respect to the alterations introduced to kinematics internal malrotation should be avoided when performing PS TKA.

摘要

目的

全膝关节置换术（TKA）中股骨部件的旋转不良已被临床证明会导致患者不满和功能受损。本研究试图描述后稳定型（PS）TKA 中股骨旋转不良后的胫股关节运动学特征。假设内旋会引起最明显的变化。

方法

将 6 个新鲜冷冻的尸体标本安装在运动学夹具中。在应用三种运动模式的同时，用正常膝关节和 PS TKA 进行测试（被动运动、开链伸展和深蹲），同时红外摄像机记录附着在股骨和胫骨上的标记的轨迹。测试了三种不同的股骨植入物：一种传统的后稳定组件，以及相同植入物的具有 5°内旋和外旋的改良组件。

结果

PS TKA 的植入导致胫骨内旋减少（深蹲 33-70°，p<0.05），内侧股骨髁在深度弯曲时向后移位（深蹲 84-111°，p<0.05）。内侧组件内旋导致在弯曲时胫骨内旋和外展（深蹲 33-111°，p<0.05），抬高（深蹲 43-111°，p<0.05）和更靠前（被动 61-126°，p<0.05）的内侧股骨髁以及更靠后和更下方的外侧股骨髁（深蹲 73-111°，p<0.05），而在中立对齐的 TKA 中则没有这些变化。外侧组件内旋仅在被动运动时引起很小的变化。在深蹲时，胫骨的内旋和内收减少（33-111°，p<0.05）。内侧股骨髁向后移动（深蹲 59-97°，p<0.05），外侧股骨髁向上移动（深蹲 54-105°，p<0.05），而在中立对齐的 TKA 中则没有这些变化。