Shin Kyun-Ho, Jang Ki-Mo, Han Seung-Beom
Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul, 02841, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):507-516. doi: 10.1007/s00167-020-06201-3. Epub 2020 Aug 3.
The objectives were to compare the coronal joint configuration of the knee joints, coronal gap imbalances requiring substantial medial release, and patient-reported outcomes, including the forgotten joint score, between knees in which residual varus alignment was intentionally allowed according to an individualised lower limb analysis and those with mechanical alignment in total knee arthroplasty for varus osteoarthritis.
Consecutive primary navigated total knee arthroplasty procedures for varus osteoarthritis were retrospectively reviewed. The study cohort was stratified based on whether residual varus alignment was intentionally allowed. Propensity-score matching was performed based on the baseline characteristics, including demographic characteristics, preoperative radiological measurements, and the Western Ontario and McMaster University Osteoarthritis Index (mechanical alignment group vs residual varus group). The patient-reported outcomes and coronal joint line orientation of the knee (relative to the ground) and ankle were evaluated. Coronal gap differences and coronal gap imbalances were analysed using intraoperative gap measurements.
Relative to the ground and ankle, the postoperative knee joint line orientation slanted down laterally in the mechanical alignment group (- 3.05˚ ± 1.62, relative to the ground; - 2.65˚ ± 1.56, relative to the ankle joint), but was parallel in the residual varus group (- 0.75˚ ± 1.59, relative to the ground; - 0.95˚ ± 1.71, relative to the ankle joint). Coronal gap differences at extension and the proportion of coronal gap imbalances requiring substantial medial release were 1.27 ± 1.53 and 6% in the residual varus group and 2.32 ± 1.24 and 15% in the mechanical alignment group. Postoperatively, the residual varus group showed higher Western Ontario and McMaster University Osteoarthritis Index scores and total forgotten joint scores than the mechanical alignment group (6.97 ± 4.75 vs. 10.31 ± 5.74 and 56.42 ± 12.85 vs. 45.69 ± 14.49, respectively).
Intentionally allowed residual varus alignment with individualised analysis of lower limb alignment restored the parallel joint line of the knees, preserved the soft tissue envelope, and reduced joint awareness after total knee arthroplasty for varus osteoarthritis.
Therapeutic, Level III retrospective case-control study.
本研究旨在比较膝关节的冠状位关节结构、需要大量内侧松解的冠状位间隙不平衡以及患者报告的结果，包括遗忘关节评分，比较在膝关节置换术中根据个体化下肢分析有意允许残留内翻对线的膝关节与机械对线的膝关节在治疗内翻性骨关节炎方面的差异。
回顾性分析连续进行的导航下初次全膝关节置换治疗内翻性骨关节炎的病例。根据是否有意允许残留内翻对线对研究队列进行分层。基于基线特征进行倾向得分匹配，包括人口统计学特征、术前影像学测量以及西安大略和麦克马斯特大学骨关节炎指数（机械对线组与残留内翻组）。评估患者报告的结果以及膝关节（相对于地面）和踝关节的冠状位关节线方向。使用术中间隙测量分析冠状位间隙差异和冠状位间隙不平衡。
相对于地面和踝关节，机械对线组术后膝关节关节线方向向外下倾斜（相对于地面为-3.05˚±1.62；相对于踝关节为-2.65˚±1.56），而残留内翻组则平行（相对于地面为-0.75˚±1.59；相对于踝关节为-0.95˚±1.71）。残留内翻组伸直位冠状位间隙差异以及需要大量内侧松解的冠状位间隙不平衡比例分别为1.27±1.53和6%，机械对线组分别为2.32±1.24和15%。术后，残留内翻组的西安大略和麦克马斯特大学骨关节炎指数评分以及总遗忘关节评分均高于机械对线组（分别为6.97±4.75对10.31±5.74以及56.42±12.85对45.69±14.49）。
对于内翻性骨关节炎的全膝关节置换术，通过个体化下肢分析有意允许残留内翻对线可恢复膝关节的平行关节线，保留软组织包膜，并降低关节感知度。
治疗性，III级回顾性病例对照研究。
