Rassir Rachid, van de Bunt Fabian, Sierevelt Inger N, Nolte Peter A
Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, 2134AT Hoofddorp, the Netherlands.
Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, 2134AT Hoofddorp, the Netherlands.
Knee. 2019 Jan;26(1):213-221. doi: 10.1016/j.knee.2018.09.014. Epub 2018 Nov 20.
The purpose of this retrospective cohort study was to investigate the influence of parameters of malalignment on knee function 5 years post TKA and, additionally, to explore alterations in patellar height after TKA.
All 661 patients undergoing TKA between 2010 and 2011 were considered for inclusion. Preoperative and 1-year postoperative short-leg radiographs were assessed for malalignment parameters: coronal tibial angle (cTA), sagittal tibial angle (sTA), femoral flexion angle (FFA) and mediolateral tibial mismatch. Patellar height was measured using the modified Insall-Salvati ratio. We determined improvements in knee function utilizing the Knee Society Score (Function score, KSS-F), Oxford Knee Score (OKS) and Algofunctional index (AI). Influences of malalignment parameters were analyzed univariate and selected (p < 0.10) for multivariate linear regression analysis. Inter-observer reproducibility was assessed by test-retest analysis of 30 randomly selected radiographs and calculation of an intra-class correlation coefficient (ICC) for all radiographic parameters.
Three-hundred and four patients were included. Multivariate regression showed degrees of cTA malalignment to be significantly associated with only the KSS-F (β = -3.52). Correction of coronal deformity was stronger associated with knee function (KSS-F β = 2.81; AI β = -0.36). Patellar height was significantly reduced after TKA (1.51 vs 1.44). Decrease of patellar height was weakly associated with the OKS (β = 10.69). ICC scores were: cTA 0.81, sTA 0.57, IS 0.72, FFA 0.75.
Postoperative coronal tibial plate alignment and correction of preoperative coronal deformity are associated with improved knee function 5 years post TKA. Decrease in patellar height was weakly associated with knee function. Short-leg radiography can be a sufficient screening tool for prosthesis alignment.
这项回顾性队列研究的目的是调查膝关节置换术后5年时对线不良参数对膝关节功能的影响，此外，还要探究膝关节置换术后髌腱长度的变化。
纳入2010年至2011年间接受膝关节置换术的所有661例患者。对术前和术后1年的短腿X线片进行评估，以获取对线不良参数：冠状位胫骨角（cTA）、矢状位胫骨角（sTA）、股骨屈曲角（FFA）和胫骨干内外侧失配情况。使用改良的Insall-Salvati比率测量髌腱长度。我们利用膝关节协会评分（功能评分，KSS-F）、牛津膝关节评分（OKS）和功能指数（AI）来确定膝关节功能的改善情况。对各对线不良参数的影响进行单因素分析，并选择P<0.10的参数进行多因素线性回归分析。通过对30张随机选择的X线片进行重测分析，并计算所有X线参数的组内相关系数（ICC），来评估观察者间的可重复性。
共纳入304例患者。多因素回归分析显示，cTA对线不良程度仅与KSS-F显著相关（β=-3.52）。冠状位畸形的矫正与膝关节功能的相关性更强（KSS-F β=2.81；AI β=-0.36）。膝关节置换术后髌腱长度显著缩短（1.51对1.44）。髌腱长度的缩短与OKS轻度相关（β=10.69）。ICC评分分别为：cTA 0.81，sTA 0.57，IS 0.72，FFA 0.75。
术后冠状位胫骨假体对线及术前冠状位畸形的矫正与膝关节置换术后5年膝关节功能的改善相关。髌腱长度的缩短与膝关节功能轻度相关。短腿X线摄影可作为评估假体对线的充分筛查工具。
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