Kim Jung-Taek, Han Jun, Lim Sumin, Shen Quan Hu, Won Ye Yeon
Department of Orthopedic Surgery, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, South Korea.
Department of Orthopaedics, Yanbian No. 2 People's Hospital, Jilin, China.
J Knee Surg. 2019 Oct;32(10):1033-1038. doi: 10.1055/s-0039-1694796. Epub 2019 Aug 21.
Mechanically aligned total knee arthroplasty (MATKA) aims to make alignment of the hip, knee, and ankle straight unexceptionally. However, emerging evidence suggests that unexceptional straightening the mechanical axis of the lower limb may lead to clinical and radiological problems of the ankle joint. By contrast, kinematically aligned total knee arthroplasty (KATKA) strives to restore the articular surface of the prearthritic knee. In this study, we examined results from KATKA and MATKA to determine which surgery restores the ankle joint orientation closer to the native ankle joint in bipedal stance and hypothesized that KATKA, rather than MATKA, would be more effective. Data from long-leg standing radiographs of 60 healthy adults (control group, = 120 knees), patients who underwent MATKA ( = 90 knees), and patients who underwent KATKA ( = 90 knees) were retrospectively reviewed. The hip-knee-ankle angle, orientation of the tibial plafond and the talar dome relative to the ground (G-plafond and G-talus, respectively), and orientation of the plafond relative to the mechanical axis of the limb (M-plafond and M-talus, respectively) were measured and analyzed for comparison. Results show that bipedal stance alignment in patients who underwent KATKA (G-plafond: -0.65 ± 3.03 and G-talus: -1.72 ± 4.02) were not significantly different to native ankle joint alignment indicated by the control group. Compared with the native ankle joint measured in the control group (G-plafond: -0.76 ± 2.69 and G-talus: -1.30 ± 3.25), the tibial plafond and talar dome significantly tilted laterally relative to the ground in ankle joints after MATKA (G-plafond: -2.32 ± 3.30 and G-talus: -2.97 ± 3.98, = 0.001 and = 0.004, respectively). Thus, postoperative ankle joint line orientation after KATKA was horizontal to the floor and closer to that of native ankle joints than those after MATKA. The level of evidence is Level III.
机械对线全膝关节置换术（MATKA）旨在使髋、膝和踝关节的对线毫无例外地保持笔直。然而，新出现的证据表明，使下肢机械轴毫无例外地伸直可能会导致踝关节的临床和影像学问题。相比之下，运动学对线全膝关节置换术（KATKA）致力于恢复关节炎前膝关节的关节面。在本研究中，我们检查了KATKA和MATKA的结果，以确定哪种手术在双足站立时能使踝关节的方向恢复得更接近天然踝关节，并假设KATKA比MATKA更有效。对60名健康成年人（对照组，n = 120膝）、接受MATKA的患者（n = 90膝）和接受KATKA的患者（n = 90膝）的长腿站立位X线片数据进行回顾性分析。测量并分析髋-膝-踝角、胫骨平台和距骨穹顶相对于地面的方向（分别为G-平台和G-距骨）以及平台相对于肢体机械轴的方向（分别为M-平台和M-距骨），以进行比较。结果显示，接受KATKA的患者的双足站立对线（G-平台：-0.65±3.03，G-距骨：-1.72±4.02）与对照组所示的天然踝关节对线无显著差异。与对照组测量的天然踝关节（G-平台：-0.76±2.69，G-距骨：-1.30±3.25）相比，MATKA术后踝关节的胫骨平台和距骨穹顶相对于地面明显向外倾斜（G-平台：-2.32±3.30，G-距骨：-2.97±3.98，P分别为0.001和0.004）。因此，KATKA术后踝关节线的方向与地面水平，且比MATKA术后更接近天然踝关节。证据等级为III级。
