Kaneko Takao, Kono Norihiko, Mochizuki Yuta, Ikegami Hiroyasu, Musha Yoshiro
Department of Orthopedic Surgery, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
Arch Orthop Trauma Surg. 2018 Apr;138(4):543-552. doi: 10.1007/s00402-018-2872-6. Epub 2018 Jan 10.
This study asked whether differences in coronal alignment after total knee arthroplasty (TKA) affect the load distribution on the tibial plateau. The aim of this study was to investigate the correlation between coronal alignment and the load distribution on the tibial plateau after TKA, using three-dimensional multi-detector-row-computed tomography (3D-MDCT).
In this study, we performed 84 cementless TKA with porous tantalum modular tibial component (PTMT) and divided into three groups based on post-operative hip-knee-ankle (HKA) angle: varus alignment group (n = 22), (176° ≧) neutral alignment group (n = 45), (180° ± 3°), and valgus alignment group (n = 17) (184° ≦).The changes in bone quality parameters of trabecular patterns under peg of PTMT were interpreted as load distribution due to changes in alignment. The relationship between HKA angle and load distribution on the tibial plateau was analyzed every 6 months for 4.5 years by measuring Bone marrow contents/tissue volumes (mg/cm) and bone volumes/tissue volumes (%) under peg of porous tantalum modular tibial component by visualizing three dimensionally with 3D-osteo-morphometry software.
There were no correlations between HKA angle and the load distribution on the tibial plateau after TKA at all periods. There was a significantly higher increase in the medial region than the lateral about the BMC/TV and BV/TV values, regardless of the post-operative alignment after TKA for all periods. The relative BMC/TV and BV/TV changes at medial region in varus alignment group were significantly lower than the neutral and the valgus alignment groups of pre-operative medial osteoarthritis of the knee.
As far, it can be concluded by the study and the methods used therein that there were no relationships between the load distribution on the tibial plateau and HKA angle after TKA.
Therapeutic study, Level III.
本研究旨在探讨全膝关节置换术（TKA）后冠状面排列差异是否会影响胫骨平台的负荷分布。本研究的目的是使用三维多排螺旋计算机断层扫描（3D-MDCT）研究TKA后冠状面排列与胫骨平台负荷分布之间的相关性。
在本研究中，我们对84例采用多孔钽模块化胫骨组件（PTMT）的非骨水泥型TKA进行了研究，并根据术后髋-膝-踝（HKA）角分为三组：内翻排列组（n = 22），（176°≧）中立排列组（n = 45），（180°±3°），以及外翻排列组（n = 17）（184°≦）。PTMT钉下小梁模式的骨质量参数变化被解释为由于排列变化导致的负荷分布。通过使用3D骨形态计量软件进行三维可视化，每6个月测量多孔钽模块化胫骨组件钉下的骨髓含量/组织体积（mg/cm）和骨体积/组织体积（%），分析4.5年期间HKA角与胫骨平台负荷分布之间的关系。
在所有时间段，TKA后HKA角与胫骨平台负荷分布之间均无相关性。在所有时间段，无论TKA术后排列如何，内侧区域的骨矿物质含量/组织体积（BMC/TV）和骨体积/组织体积（BV/TV）值的增加均显著高于外侧。内翻排列组内侧区域的相对BMC/TV和BV/TV变化显著低于术前膝关节内侧骨关节炎的中立和外翻排列组。
就目前而言，通过本研究及其所使用的方法可以得出结论，TKA后胫骨平台的负荷分布与HKA角之间没有关系。
治疗性研究，III级。
