Thompson Kristen, Griffiths-Jones Will, Frendin Lisa, Wood Jil, Harris Ian A, Chen Darren B, MacDessi Samuel J
Sydney Knee Specialists, Kogarah, NSW, Australia.
North Devon District Hospital, Raleigh Park, Barnstaple, United Kingdom.
Knee. 2020 Jun;27(3):717-722. doi: 10.1016/j.knee.2020.02.023. Epub 2020 May 12.
Sensor-guided compartmental pressure measurements are becoming increasingly utilized in total knee arthroplasty (TKA) to objectively confirm intraoperative knee balance. We aimed to determine agreement of pressure measurements between two observers when performing sensor-guided TKA with the use of computer-assisted surgery (CAS).
One-hundred and eighteen consecutive patients undergoing 130 TKAs were analysed. Femoral and tibial trial implants were inserted prior to performing knee balancing. We compared the reliability of sensor pressure compartmental measurements between two observers at 10, 45 and 90° of flexion using intraclass correlation coefficient (ICC) estimates and the 95% limits of agreement (Bland-Altman plots).
The interobserver agreement between sensor pressure measurements was excellent at 10° of knee flexion, with ICCs of 0.93 and 0.91 in the medial and lateral compartments, respectively (P < 0.001). At 45°, medial and lateral compartment ICCs were 0.91 and 0.76, respectively (P < 0.001). At 90°, the ICC was 0.88 medially and 0.76 laterally (P < 0.001). Although the agreement decreased at higher knee flexion, it remained good to excellent. The 95% limits of agreement at each angle were all within 20 psi and 11 psi for the medial and lateral compartments, respectively.
There was excellent interobserver agreement of sensor pressure measurements at 10° of knee flexion with computer-assisted TKA. Interobserver agreement decreased slightly as knee flexion angles increased, particularly in the lateral compartment. It is likely that interobserver agreement and hence reliability of sensor pressure measurements in TKA has some dependence on accurate angular positioning of the knee.
在全膝关节置换术（TKA）中，传感器引导下的关节腔压力测量越来越多地用于客观确认术中膝关节平衡。我们旨在确定在使用计算机辅助手术（CAS）进行传感器引导下的TKA时，两名观察者之间压力测量的一致性。
分析了连续118例接受130次TKA的患者。在进行膝关节平衡之前插入股骨和胫骨试验植入物。我们使用组内相关系数（ICC）估计值和95%一致性界限（Bland-Altman图）比较了两名观察者在膝关节屈曲10°、45°和90°时传感器压力关节腔测量的可靠性。
在膝关节屈曲10°时，传感器压力测量的观察者间一致性极佳，内侧和外侧关节腔的ICC分别为0.93和0.91（P<0.001）。在45°时，内侧和外侧关节腔的ICC分别为0.91和0.76（P<0.001）。在90°时，内侧ICC为0.88，外侧为0.76（P<0.001）。尽管在更高的膝关节屈曲角度时一致性有所下降，但仍保持良好至极佳。每个角度的95%一致性界限在内侧和外侧关节腔分别均在20 psi和11 psi以内。
在计算机辅助TKA中，膝关节屈曲10°时传感器压力测量的观察者间一致性极佳。随着膝关节屈曲角度增加，观察者间一致性略有下降，特别是在外侧关节腔。在TKA中，观察者间一致性以及因此传感器压力测量的可靠性可能在一定程度上依赖于膝关节的准确角度定位。
