Edelstein Adam I, Bhatt Surabhi, Wright-Chisem Josh, Sullivan Ryan, Beal Matt, Manning David W
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
J Knee Surg. 2020 May;33(5):452-458. doi: 10.1055/s-0039-1678524. Epub 2019 Feb 8.
Up to 20% of total knee arthroplasty (TKA) patients report dissatisfaction with their outcome, especially with weight-bearing in flexion (WBiF) activities. Sagittal plane instability may contribute to dissatisfaction following TKA. We assessed the impact of implant design on TKA sagittal plane stability and clinical satisfaction. We randomized patients to receive one of two TKA implant designs: medial-stabilized (MS) or posterior-stabilized (PS). Sagittal stability was assessed using a KT-1000 arthrometer. Patient-reported outcome measures, including a custom bank of questions targeting patient satisfaction (0-100%) with WBiF activities, were administered to patients 2 years following surgery. The final analysis included 50 patients (25 MS, 25 PS). The MS group had greater sagittal plane stability than the PS group at 30-degree flexion (5.6 ± 1.9 vs. 10.2 ± 2.7 mm; < 0.0001) but not at 90-degree flexion (4.1 ± 2 vs. 5.3 ± 3 mm; = 0.14). Range of motion was not different (111.3 ± 10.4 vs. 114.7 ± 10.7 degrees; = 0.31). There were no differences in the PROMIS (Patient-Reported Outcomes Measurement Information System) score, Oxford Knee Score, Knee Society Score, Forgotten Joint Score, or Veterans Rand. The MS group had no difference in satisfaction for WBiF activities versus non-WBiF activities (80.5 ± 18 vs. 88.3% ± 16.4%; = 0.13), whereas the PS group had significantly worse satisfaction for WBiF versus non-WBiF activities (71.6 ± 24.6 vs. 87.8% ± 16.6%; = 0.019). An MS prosthetic design was more stable in the sagittal plane in midflexion compared with a PS design. There was no difference in patient-reported outcomes, although custom survey data suggest improved satisfaction with MS design during WBiF activities.
高达20%的全膝关节置换术（TKA）患者对手术结果不满意，尤其是在屈膝负重（WBiF）活动方面。矢状面不稳定可能导致TKA术后患者不满意。我们评估了植入物设计对TKA矢状面稳定性和临床满意度的影响。我们将患者随机分为接受两种TKA植入物设计之一：内侧稳定型（MS）或后稳定型（PS）。使用KT-1000关节测量仪评估矢状面稳定性。术后2年对患者进行患者报告的结局测量，包括一组针对患者对WBiF活动满意度（0-100%）的定制问题。最终分析纳入了50例患者（25例MS，25例PS）。MS组在30度屈膝时矢状面稳定性高于PS组（5.6±1.9对10.2± 2.7毫米；<0.0001），但在90度屈膝时无差异（4.1±2对5.3±3毫米；=0.14）。活动范围无差异（111.3±10.4对114.7±10.7度；=0.31）。患者报告结局测量信息系统（PROMIS）评分、牛津膝关节评分、膝关节协会评分、遗忘关节评分或退伍军人兰德评分均无差异。MS组在WBiF活动与非WBiF活动的满意度方面无差异（80.5± 18对88.3%±16.4%；=0.13），而PS组在WBiF活动与非WBiF活动的满意度方面明显更差（71.6±24.6对87.8%±16.6%；=0.019）。与PS设计相比，MS假体设计在屈膝中期矢状面更稳定。患者报告的结局无差异，尽管定制调查数据表明在WBiF活动期间对MS设计的满意度有所提高。
