Ishii Yoshinori, Noguchi Hideo, Sato Junko, Ishii Hana, Ishii Ryo, Toyabe Shin-Ichi
Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
Kanazawa Medical University, School of Plastic Surgery, 1-1 Daigaku Uchinada, Ishikawa, 920-0253, Japan.
J Orthop. 2020 Jan 25;20:181-185. doi: 10.1016/j.jor.2020.01.026. eCollection 2020 Jul-Aug.
Prolonged operative time has frequently been implicated as a risk factor for various complications after total knee arthroplasty (TKA). We aimed to determine whether preoperative factors such as sex, age, body mass index (BMI), prosthetic design, tibiofemoral angle (TFA), range of motion, coronal laxity, Hospital for Special Surgery score and periarticular bone mineral density (BMD) affect operative time.
We evaluated 164 patients (187 knees) with medial osteoarthritis who underwent primary TKA performed by a single surgeon. The medical records of 27 males and 137 females (median age of 77 and 72 years, respectively) were retrospectively reviewed. TFA was measured on non-weightbearing, standard radiographs. We used dual-energy X-ray absorptiometry to measure BMD, and an arthrometer to evaluate total coronal laxity in each patient.
According to univariate analyses, there was a weak positive correlation between BMI and operative time (r = 0.265, p < 0.001), between TFA and operative time (r = 0.235, p = 0.001) and between BMD of the femur and tibia and operative time (r = 0.280, p < 0.001, r = 0.286, p < 0.001, respectively). No significant correlations were found between the other factors and operative time. Based on multivariate analyses, only BMD of the tibia and TFA were significantly correlated with operative time (β = 0.418, p < 0.001 and β = 0.182, p = 0.007, respectively).
TFA and BMD of the tibia were the variables more strongly correlated with operative time. Surgeons should recognize preoperatively that patients who have increased TFA, higher periarticular BMD, and higher BMI may have longer operative times.
Level IV retrospective study.
手术时间延长常被认为是全膝关节置换术（TKA）后发生各种并发症的危险因素。我们旨在确定术前因素，如性别、年龄、体重指数（BMI）、假体设计、胫股角（TFA）、活动范围、冠状面松弛度、特殊外科医院评分和关节周围骨密度（BMD）是否会影响手术时间。
我们评估了164例（187膝）患有内侧骨关节炎且由同一位外科医生进行初次TKA的患者。回顾性分析了27例男性和137例女性（中位年龄分别为77岁和72岁）的病历。在非负重标准X线片上测量TFA。我们使用双能X线吸收法测量BMD，并使用关节测量仪评估每位患者的总冠状面松弛度。
单因素分析显示，BMI与手术时间之间存在弱正相关（r = 0.265，p < 0.001），TFA与手术时间之间存在弱正相关（r = 0.235，p = 0.001），股骨和胫骨的BMD与手术时间之间也存在弱正相关（分别为r = 0.280，p < 0.001；r = 0.286，p < 0.001）。未发现其他因素与手术时间之间存在显著相关性。多因素分析显示，仅胫骨BMD和TFA与手术时间显著相关（β = 0.418，p < 0.001；β = 0.182，p = 0.007）。
胫骨TFA和BMD是与手术时间相关性更强的变量。外科医生应在术前认识到，TFA增加、关节周围BMD较高和BMI较高的患者可能手术时间更长。
IV级回顾性研究。
