Ishii Yoshinori, Noguchi Hideo, Sato Junko, Ishii Hana, Todoroki Koji, Toyabe Shin-Ichi
Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
Kouseiren Takaoka Hospital, 5-10 Eirakutyo Takaoka, Toyama, 933-8555, Japan.
Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1143-1149. doi: 10.1007/s00590-018-2155-5. Epub 2018 Feb 10.
Tibial component coverage (TCC) and tibial rotational angle (TRA) have been studied simultaneously in simulations, but not in clinical studies after total knee arthroplasty (TKA). The purposes of this study were (1) to evaluate TCC and rotational setting postoperatively in mobile-bearing TKA patients and (2) to compare the results with previously published simulation data.
We prospectively examined 100 patients who underwent primary TKA using the LCS Total Knee System (LCS) posterior cruciate ligament-substituting prosthesis. Clinical outcomes, TCC (coverage area of the tibial component over the tibia), and TRA (relative to the femoral transepicondylar axis (TEA)) were assessed. Quantitative three-dimensional computed tomography was used to assess TCC and TRA. All values are expressed as median (25th percentile, 75th percentile) using minus (-) for internal and plus (+) for external rotation.
Hospital for Special Surgery scores improved from 46 (36, 50) preoperatively to 92 (90, 92) postoperatively. TRA showed a median divergence of - 2.0° (- 4.75°, + 2.74°). All knees were located within 10° of the TEA (range - 10.0° to + 9.7°). The median TCC of the knees was 82.7% (80.6, 84.7%), and there were no knees that hung over the tibial component in any direction.
The LCS prosthesis had good clinical outcomes, comparable TCC, and improved TRA as compared to previous reports, as all knees were located within 10° of the TEA. Simultaneous optimization of both TCC and TRA may contribute to the excellent long-term outcomes that have been observed with this system.
Level II, Prognostic study.
在模拟研究中曾同时对胫骨部件覆盖率（TCC）和胫骨旋转角度（TRA）进行过研究，但在全膝关节置换术（TKA）后的临床研究中尚未开展此类研究。本研究的目的是：（1）评估活动平台TKA患者术后的TCC和旋转定位情况；（2）将结果与先前发表的模拟数据进行比较。
我们前瞻性地检查了100例行初次TKA并使用LCS全膝关节系统（LCS）后交叉韧带替代假体的患者。评估临床结果、TCC（胫骨部件在胫骨上的覆盖面积）和TRA（相对于股骨髁间轴（TEA））。采用定量三维计算机断层扫描评估TCC和TRA。所有数值均以中位数（第25百分位数，第75百分位数）表示，内旋用减号（-），外旋用加号（+）。
特种外科医院评分从术前的46分（36分，50分）提高到术后的92分（90分，92分）。TRA的中位数偏差为-2.0°（-4.75°，+2.74°）。所有膝关节均位于TEA的10°范围内（范围为-10.0°至+9.7°）。膝关节的TCC中位数为82.7%（80.6%，84.7%），且没有膝关节在任何方向上超出胫骨部件。
与先前报告相比，LCS假体具有良好的临床效果、相当的TCC且TRA有所改善，因为所有膝关节均位于TEA的10°范围内。同时优化TCC和TRA可能有助于实现该系统所观察到的出色长期效果。
二级，预后研究。
