Amaro Joicemar Tarouco, Novaretti João Victor, Astur Diego Costa, Cavalcante Elton Luiz Batista, Rodrigues Junior Adilson Góes, Debieux Pedro, Kaleka Camila Cohen, Cohen Moisés
Cohen Institute, São Paulo, Brazil.
Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center (CETE), Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil.
J Knee Surg. 2020 May;33(5):474-480. doi: 10.1055/s-0039-1678675. Epub 2019 Feb 12.
The objective of this study was to determine in vivo knee kinematics and clinical outcomes of patients who underwent fixed- and mobile-bearing total knee arthroplasty (TKA) at 1- and 2-year follow-up. This prospective double-blinded randomized controlled trial was performed from November 2011 to December 2012. A total of 64 patients were randomized to fixed- and mobile-bearing TKA groups (32 patients in each group). All patients were evaluated with the following: three-dimensional in vivo knee kinematics analysis during gait, stepping up and stepping down stair steps, and getting up from and sitting on a chair; and knee range of motion and patient-reported outcome measures (Knee Outcome Survey Activities of Daily Living Scale [KOS-ADLS] and pain visual analog scale [VAS]) at 1- and 2-year follow-up. Descriptive statistics (means, standard deviations, and percentages) were calculated for all variables. The Kolmogorov-Smirnov test was used to test if variables were normally distributed. A Student's -test was used to compare continuous variables between patients in the two groups. The chi-square test was used to compare the groups with respect to categorical variables. The level for statistical significance was set at < 0.05. The mean axial tibiofemoral rotation in patients who underwent mobile-bearing TKA was significantly higher during gait (13.3 vs. 10.7), stepping up (12.8 vs. 10) stair steps, and getting up (16.1 vs. 12.1) from a chair compared with fixed-bearing TKA patients at 1-year follow-up ( < 0.05). KOS-ADLS function score was significantly higher in the mobile-bearing compared with the fixed-bearing TKA group (32 vs. 27.7) at 1-year follow-up ( < 0.05). No significant difference in kinematics and clinical outcomes between fixed- and mobile-bearing TKA groups was observed at 2-year follow-up ( > 0.05). Based on the results of this study, mobile-bearing TKA allowed a higher degree of rotation when walking, stepping up stair steps, and standing up from a chair, and had higher functional outcomes compared with fixed-bearing TKA at 1-year follow-up. However, no difference in in vivo kinematics or in clinical outcomes was observed between fixed- and mobile-bearing prostheses at 2-year follow-up.
本研究的目的是确定接受固定平台和活动平台全膝关节置换术（TKA）的患者在1年和2年随访时的体内膝关节运动学及临床结果。这项前瞻性双盲随机对照试验于2011年11月至2012年12月进行。共有64例患者被随机分为固定平台和活动平台TKA组（每组32例患者）。所有患者均接受以下评估：步态、上楼梯和下楼梯以及从椅子上起身和坐在椅子上时的三维体内膝关节运动学分析；以及1年和2年随访时的膝关节活动范围和患者报告的结局指标（膝关节日常生活活动量表[KOS-ADLS]和疼痛视觉模拟量表[VAS]）。计算所有变量的描述性统计量（均值、标准差和百分比）。采用Kolmogorov-Smirnov检验来检验变量是否呈正态分布。采用Student's t检验比较两组患者之间的连续变量。采用卡方检验比较两组在分类变量方面的情况。设定统计学显著性水平为P<0.05。在1年随访时，与固定平台TKA患者相比，接受活动平台TKA的患者在步态（13.3°对10.7°）、上楼梯（12.8°对10°）和从椅子上起身（16.1°对12.1°）时的平均胫股轴向旋转显著更高（P<0.05）。在1年随访时，活动平台TKA组的KOS-ADLS功能评分显著高于固定平台TKA组（32分对27.7分）（P<0.05）。在2年随访时，固定平台和活动平台TKA组之间在运动学和临床结果方面未观察到显著差异（P>0.05）。基于本研究结果，在1年随访时，活动平台TKA在行走、上楼梯和从椅子上起身时允许更高程度的旋转，并且与固定平台TKA相比具有更高的功能结局。然而，在2年随访时，固定平台和活动平台假体之间在体内运动学或临床结果方面未观察到差异。
