Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain.
Department of Surgery, Faculty of Medicine, Universitat Autònoma Barcelona, Badalona, Spain.
Knee Surg Sports Traumatol Arthrosc. 2020 Jun;28(6):1805-1813. doi: 10.1007/s00167-019-05591-3. Epub 2019 Jul 3.
Femoral rotation in total knee arthroplasty (TKA) is hypothesized to vary in the same knee depending on the method used to establish it.
Thirty-eight patients who underwent TKA surgery using a measured resection technique (RT) were compared with 40 patients who underwent a flexion-gap balancing technique with computer-assisted (for navigation) surgery (FB-CAS) to assess clinical and radiographic alignment differences at two years postoperatively. In 36 of the 40 patients in the FB-CAS group, both methods were used. Intraoperatively, the transepicondylar femoral rotation (TEFR) in reference to the transepicondylar axis was established as the rotation that balanced the flexion gap. Once the TEFR was obtained, an analogous rotation as measured by a posterior reference femoral rotation (PRFR) cutting guide was determined.
Femoral component rotation determined by the TEFR and PRFR methods differed in each of the knees. The median TEFR was 0.08°±0.6° (range - 1.5°, 1.5°), and the median PRFR was 0.06°±2.8° (range - 6°, 5°). The mean difference in the rotational alignment between the TEFR and PRFR techniques was 0.01° ± 3.1°. The 95% limits of agreement between the mean differences in measurements were between 6.2° external rotation and - 6.1° internal rotation. At 2 years postoperatively, we found no differences in the radiographic or clinical American Knee Society score between the two groups.
Rotation of the femoral component in TKA can vary in the same knee depending on the surgical method used to establish it. This variation in femoral rotation is sufficiently small enough to have no apparent effect on the 2-year clinical outcome score.
II.
全膝关节置换术（TKA）中股骨的旋转角度可能会因所采用的测量方法不同而在同一膝关节中发生变化。
本研究比较了 38 例采用测量截骨技术（RT）行 TKA 手术的患者与 40 例采用计算机辅助（导航）下屈伸间隙平衡技术（FB-CAS）行 TKA 手术的患者，以评估术后 2 年的临床和影像学对线差异。在 FB-CAS 组的 40 例患者中，有 36 例同时使用了这两种方法。术中，以髁间轴为参照，将平衡屈伸间隙的股骨转距（TEFR）确定为旋转角度。获得 TEFR 后，确定与后参考股骨旋转（PRFR）切割导向器类似的旋转角度。
每只膝关节的 TEFR 和 PRFR 方法确定的股骨组件旋转角度均不同。TEFR 的中位数为 0.08°±0.6°（范围-1.5°，1.5°），PRFR 的中位数为 0.06°±2.8°（范围-6°，5°）。TEFR 和 PRFR 技术之间旋转对线的平均差异为 0.01°±3.1°。测量差异的 95%一致性界限在 6.2°外旋和-6.1°内旋之间。术后 2 年，我们发现两组之间在影像学或临床美国膝关节协会评分方面无差异。
在 TKA 中，股骨组件的旋转可以根据用于确定其旋转的手术方法在同一膝关节中发生变化。这种股骨旋转的变化足够小，对 2 年的临床结果评分没有明显影响。
II 级。
