Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101, Basel, Switzerland.
Amsler Consulting, CH-4059, Basel, Switzerland.
Int Orthop. 2021 May;45(5):1205-1213. doi: 10.1007/s00264-020-04717-4. Epub 2020 Jul 17.
To investigate if the latest-generation cruciate-retaining total knee arthroplasty (CR-TKA) systems through more patella-friendly femoral trochlea reduce the patellar bone loading.
Twenty patients who underwent Attune CR-TKA were matched with twenty-one patients who underwent Press-Fit Condylar® (PFC) CR-TKA. The patella was always preserved. The in vivo patellar loading was measured twice by two blinded observers and localised on an 8-quadrant grid on 1-year post-operatively SPECT/CT images. The position of the TKA components, patella height, thickness, tilt, and tibial tuberosity-trochlear groove index were measured in 3D CT. Knee function was assessed pre-operatively, at 12 and 24 months post-operatively with the knee society score (KSS). All data were compared between groups with the Mann-Whitney U test and within groups with Spearman's correlation.
A significantly higher bone tracer uptake (BTU) was seen in the Attune group in the lateral non-articular patellar quadrants. No other significant differences of the BTU were seen. The post-operative KSS did not differ significantly. Spearman's correlation showed no correlations between the significantly higher BTU of the lateral non-articular patellar quadrants and the position of the TKA and patellar measurements. All patellar measurements did not correlate with bone stress in SPECT/CT.
No significant improvement in terms of in vivo patellar bone stress was seen with the latest-generation CR-TKA system. The increased bone stress at the non-articular lateral patellar quadrants of the Attune could be due to higher stabilising quadriceps forces.
研究最新一代的保留后交叉韧带的全膝关节置换（CR-TKA）系统是否通过更友好的髌骨股骨滑车来减少髌骨骨负荷。
将 20 例接受 Attune CR-TKA 的患者与 21 例接受 Press-Fit Condylar®（PFC）CR-TKA 的患者相匹配。始终保留髌骨。在术后 1 年的 SPECT/CT 图像上，通过两位盲法观察者两次测量髌骨的体内髌骨负荷，并在 8 象限网格上定位。在 3D CT 上测量 TKA 组件的位置、髌骨高度、厚度、倾斜度和胫骨结节滑车沟指数。在术前、术后 12 个月和 24 个月使用膝关节协会评分（KSS）评估膝关节功能。使用 Mann-Whitney U 检验对组间数据进行比较，使用 Spearman 相关系数对组内数据进行比较。
Attune 组髌骨外侧非关节象限的骨示踪剂摄取（BTU）明显较高。未发现其他 BTU 的显著差异。术后 KSS 无显著差异。Spearman 相关分析显示，髌骨外侧非关节象限的 BTU 与 TKA 和髌骨测量的位置之间无显著相关性。所有髌骨测量值与 SPECT/CT 中的骨应力均无相关性。
最新一代的 CR-TKA 系统在体内髌骨骨负荷方面没有明显改善。Attune 髌骨外侧非关节象限骨应力增加可能是由于股四头肌稳定力增加所致。
