Tsukeoka Tadashi, Tsuneizumi Yoshikazu, Yoshino Kensuke
Department of Orthopaedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho, Midori-ku, Chiba, 266-0005, Japan.
Department of Orthopaedic Surgery, Chiba University, Chiba, Japan.
Arch Orthop Trauma Surg. 2019 Apr;139(4):561-567. doi: 10.1007/s00402-019-03147-1. Epub 2019 Feb 13.
Although the most commonly used method of femoral component alignment in total knee arthroplasty (TKA) is intramedullary (IM) guides, this method demonstrated a limited degree of accuracy. Because of the femoral anterior bowing, the tip of the guide rod will impinge on the anterior cortex if a long rod is inserted. We hypothesized that the pre-operative planned insertion depth of the rod could increase the accuracy of the femoral component positioning in conventional TKA (modified conventional technique). Accelerometer-based, portable navigation device has been postulated to have better accuracy than conventional TKA in component positioning. The purpose of this study was to compare the post-operative femoral component alignment of TKA using the modified conventional technique with the accelerometer-based navigation.
Fifty-five knees underwent TKA using the modified conventional technique and femoral component positioning was compared with 55 knees performed using the accelerometer-based navigation device. The femoral component alignment was evaluated with a CT-based three-dimensional software.
The mean absolute deviation from targeted alignment in the sagittal plane was significantly less in the modified conventional cohort than in the accelerometer-based navigation cohort (1.1° vs 2.6°, P < 0.001). In the modified conventional cohort, 96.4% had an alignment within 3° of a targeted angle in the coronal plane (vs 89.1% with the accelerometer-based navigation, P = 0.14), and 96.4% in the sagittal plane (vs 74.5% with the accelerometer-based navigation, P < 0.001).
The modified conventional technique is a simple and equal to or more accurate method than the accelerometer-based navigation in positioning the femoral component in TKA at a mid-volume hospital.
尽管全膝关节置换术（TKA）中股骨组件对线最常用的方法是髓内（IM）导向，但该方法的准确性有限。由于股骨存在前弓，若插入长杆，导向杆尖端会撞击前皮质。我们推测，术前计划的杆插入深度可提高传统TKA（改良传统技术）中股骨组件定位的准确性。基于加速度计的便携式导航设备在组件定位方面被认为比传统TKA具有更高的准确性。本研究的目的是比较使用改良传统技术的TKA术后股骨组件对线与基于加速度计的导航技术。
55例膝关节采用改良传统技术进行TKA，并将股骨组件定位与55例使用基于加速度计的导航设备进行的手术进行比较。使用基于CT的三维软件评估股骨组件对线情况。
改良传统组矢状面与目标对线的平均绝对偏差显著小于基于加速度计的导航组（1.1°对2.6°，P < 0.001）。在改良传统组中，96.4%的冠状面对线在目标角度的3°范围内（基于加速度计的导航组为89.1%，P = 0.14），矢状面为96.4%（基于加速度计的导航组为74.5%，P < 0.001）。
在中等规模医院的TKA中，改良传统技术在股骨组件定位方面是一种简单且准确性等同于或高于基于加速度计的导航的方法。
