Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2021 Oct;29(10):3178-3185. doi: 10.1007/s00167-020-06103-4. Epub 2020 Jun 15.
The Attune® Knee System provides new instrumentation to achieve symmetric flexion/extension gaps in total knee arthroplasty (TKA). However, there is limited information on the optimal TKA technique using this system. The aim of this randomised controlled trial was to determine which surgical technique results in better postoperative clinical outcomes after TKA using the contemporary Attune Knee System: the measured resection or gap balancing technique.
A prospective randomized controlled trial was conducted with 100 patients undergoing TKA using measured resection (n = 50) or gap balancing (n = 50) technique. The measured femoral sizer was used in the measured resection group, while the balanced femoral sizer was used in the gap balancing group. Functional outcomes and quality of life were assessed preoperatively and at 6 months and 2 years post-surgery, using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 (SF-36). Using weight-bearing coronal radiographs, the hip-knee-ankle angle (HKA), coronal femoral component angle (CFA), coronal tibial component angle (CTA) and joint line height were also evaluated for each patient.
There were no significant differences in the functional scores or the proportion of patients from each group who were satisfied or had their expectations fulfilled at 6 months or 2 years post-surgery. There was also no significant difference in the number of patients who attained minimum clinically important difference (MCID) postoperatively between the groups. Postoperatively, there was no significant difference in the number of HKA outliers between the groups (p = 0.202). The postoperative CFA (p = 0.265) and CTA (p = 0.479) were similar between the groups. There was also no significant difference in the absolute change (p = 0.447) or proportion of outliers (p = 0.611) for joint line height between the groups.
Both measured resection and gap balancing techniques resulted in comparable functional and quality of life outcomes up to 2 years post-surgery. Both techniques appear to be equally effective in achieving excellent outcomes with the Attune Knee System.
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Attune®膝关节系统提供了新的仪器设备，可在全膝关节置换术（TKA）中实现对称的屈伸间隙。然而，关于使用该系统的 TKA 最佳技术的信息有限。本随机对照试验的目的是确定在使用当代 Attune 膝关节系统时，哪种手术技术可获得更好的术后临床结果：测量切除或间隙平衡技术。
对 100 例行 TKA 的患者进行前瞻性随机对照试验，采用测量切除（n=50）或间隙平衡（n=50）技术。在测量切除组中使用测量股骨定标器，而在间隙平衡组中使用平衡股骨定标器。使用膝关节学会功能评分（KSFS）、膝关节学会膝关节评分（KSKS）、牛津膝关节评分（OKS）、SF-36 短式量表的物理成分评分（PCS）和心理成分评分（MCS）在术前以及术后 6 个月和 2 年评估功能结果和生活质量。使用负重冠状位 X 线片评估每位患者的髋膝踝角（HKA）、冠状股骨组件角度（CFA）、冠状胫骨组件角度（CTA）和关节线高度。
在术后 6 个月或 2 年时，两组的功能评分或每个组中满意或达到预期的患者比例均无显着差异。两组术后达到最小临床重要差异（MCID）的患者数量也无显着差异。术后两组 HKA 异常值的数量无显着差异（p=0.202）。两组术后 CFA（p=0.265）和 CTA（p=0.479）相似。两组关节线高度的绝对变化（p=0.447）或异常值比例（p=0.611）也无显着差异。
在术后 2 年内，测量切除和间隙平衡技术均导致功能和生活质量结果相当。这两种技术似乎在使用 Attune 膝关节系统时同样有效，都能获得出色的结果。
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