Larose Gabriel, Fuentes Alexandre, Lavoie Frederic, Aissaoui Rachid, de Guise Jacques, Hagemeister Nicola
Université de Montréal, Montréal, Québec, Canada; Laboratoire de recherche en imagerie et orthopédie (LIO), École de technologie supérieure, Centre de recherche du CHUM, Tour Viger, Montréal, Québec, Canada.
Laboratoire de recherche en imagerie et orthopédie (LIO), École de technologie supérieure, Centre de recherche du CHUM, Tour Viger, Montréal, Québec, Canada.
Knee. 2019 Jun;26(3):586-594. doi: 10.1016/j.knee.2019.02.012. Epub 2019 Apr 29.
Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Postoperative static knee alignment has been recognized as a key component of successful surgery. A correction toward the kinematics of a native knee is expected after TKA, with an aim for neutral mechanical alignment. The evolution of frontal plane knee kinematics is not well understood.
Nineteen patients awaiting TKA were recruited. Three-dimensional knee kinematics during treadmill gait were assessed pre-operatively, 12 months after surgery, and compared to a control group of 17 asymptomatic participants.
Mean radiographic mechanical alignment was corrected from 5.4° ± 5.0 (Standard Deviation) varus pre-operatively to 0.1° ± 2.0 (Standard Deviation) valgus postoperatively (P = 0.002). Mean stance coronal plane alignment decreased from 6.7° ± 4.0 (Standard Deviation) varus per-operatively to 2.1° ± 3.8 (Standard Deviation) postoperatively (P = 0.001). Correlation between radiographic mechanical axis angle and dynamic frontal plane alignment during gait, before and after surgery, was weak (pre-operative R = 0.41; postoperative R = 0.13) compared to control (R = 0.88). In the sagittal plane, TKA patients maintained their pre-operative stiff knee gait adaptation. Postoperative transverse plane kinematics suggested restoration of external tibial rotation during swing after TKA compared to control (Pre-operative 3.1°, postoperative 6.8°, control 7.1°, P = 0.05).
The lack of correlation between static and dynamic alignment suggests that static radiographic coronal alignment of the knee does not accurately predict dynamic behavior. In the sagittal plane, pre-operative gait adaptations were still present 12 months after surgery, supporting the need for a functional assessment to guide postoperative rehabilitation following TKA.
全膝关节置换术（TKA）是终末期膝关节骨关节炎的首选治疗方法。术后静态膝关节对线已被认为是手术成功的关键因素。TKA术后期望向天然膝关节的运动学方向矫正，目标是达到中立机械对线。额状面膝关节运动学的演变尚不清楚。
招募了19名等待TKA的患者。在术前、术后12个月评估跑步机步态期间的三维膝关节运动学，并与17名无症状参与者的对照组进行比较。
平均放射学机械对线从术前内翻5.4°±5.0（标准差）矫正为术后外翻0.1°±2.0（标准差）（P = 0.002）。平均站立位冠状面对线从术前内翻6.7°±4.0（标准差）降至术后2.1°±3.8（标准差）（P = 0.001）。与对照组（R = 0.88）相比，术前和术后步态期间放射学机械轴角与动态额状面对线之间的相关性较弱（术前R = 0.41；术后R = 0.13）。在矢状面，TKA患者保持术前僵硬膝关节步态适应性。与对照组相比，术后横断面运动学提示TKA术后摆动期胫骨外旋恢复（术前3.1°，术后6.8°，对照组7.1°，P = 0.05）。
静态和动态对线之间缺乏相关性表明膝关节的静态放射学冠状面对线不能准确预测动态行为。在矢状面，术后12个月仍存在术前步态适应性，支持在TKA术后需要进行功能评估以指导康复治疗。
