Sandberg Rory, Deckard Evan R, Ziemba-Davis Mary, Banks Scott A, Meneghini R Michael
Pinnacle Surgical Orthopedics, 5651 Frist Blvd #400, Hermitage, TN 37076, USA.
Indiana University School of Medicine, Department of Orthopaedic Surgery, 1120 West Michigan Street, Suite 600, Indianapolis, IN 46202, USA.
Knee. 2019 Dec;26(6):1243-1249. doi: 10.1016/j.knee.2019.08.006. Epub 2019 Aug 30.
Modern understanding of native knee kinematics reveals more complex pattern of lateral-pivot in early flexion activities, and medial-pivot in deeper flexion (i.e. dual-pivot). The purpose of this study was to compare patient outcomes with a contemporary dual-pivot TKA, designed to replicate anterior-cruciate substitution and stability, with a traditional TKA.
One hundred and eighty-three dual-pivot TKAs were matched with 183 traditional non-conforming TKAs. All TKAs were cemented and performed with identical perioperative protocols. Patients were matched on age, sex, BMI, and ASA score. Patient-reported outcome measures were prospectively obtained and compared at minimum one-year follow-up.
Study cohorts were identical with 72% female, average age of 68 years, and BMI of 33 kg/m. There were no differences in prevalence of fibromyalgia, depression, preoperative narcotic use, or femoral component alignment (p ≥ 0.105). Dual-pivot TKA patients had a greater prevalence of lumbar spine disease (p = 0.012) and more reported their knee never feels normal preoperatively (p = 0.012). Dual-pivot TKA patients reported less walking pain at latest follow-up (p = 0.022). Trends for greater level of participation in very active activities or impact sports (p = 0.067) and more reporting their knee feels normal (p = 0.091) were observed in dual-pivot TKAs.
Patients with dual-pivot knees reported less walking pain despite greater lumbar spine disease, supporting the potential benefit of lateral-pivot motion in early flexion activities. However, the groups were similar in overall satisfaction suggesting the nuances and potential ceiling-effect of patient satisfaction warrants further study.
现代对自然膝关节运动学的理解揭示了在早期屈曲活动中更复杂的外侧旋转模式，以及在深度屈曲时的内侧旋转模式（即双旋转）。本研究的目的是比较采用当代双旋转全膝关节置换术（TKA）与传统TKA的患者结局，前者旨在复制前交叉韧带替代和稳定性。
183例双旋转TKA与183例传统非顺应性TKA相匹配。所有TKA均采用骨水泥固定，并按照相同的围手术期方案进行。患者在年龄、性别、体重指数（BMI）和美国麻醉医师协会（ASA）评分方面进行匹配。前瞻性获取患者报告的结局指标，并在至少一年的随访中进行比较。
研究队列相同，女性占72%，平均年龄68岁，BMI为33kg/m²。纤维肌痛、抑郁症、术前使用麻醉剂或股骨组件对线的患病率无差异（p≥0.105）。双旋转TKA患者腰椎疾病的患病率更高（p = 0.012），更多患者报告术前膝盖从未感觉正常（p = 0.012）。双旋转TKA患者在最新随访时报告的行走疼痛较少（p = 0.022）。在双旋转TKA中观察到参与非常活跃的活动或冲击性运动的水平更高（p = 0.067）以及更多患者报告膝盖感觉正常（p = 0.091）的趋势。
双旋转膝关节患者尽管腰椎疾病较多，但报告的行走疼痛较少，这支持了早期屈曲活动中外侧旋转运动的潜在益处。然而，两组在总体满意度方面相似，这表明患者满意度的细微差别和潜在的天花板效应值得进一步研究。
