Knee Surgery Department, Piero Pederzoli Private Hospital, Peschiera del Garda, Verona, Italy.
Orthopaedics and Trauma Department, Piero Pederzoli Private Hospital, Via Monte Baldo, 24 Peschiera del Garda, 37019, Verona, Italy.
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):500-506. doi: 10.1007/s00167-020-06196-x. Epub 2020 Aug 3.
This study aims to evaluate the clinical and radiological outcomes of a modified technique of Kinematically Aligned Total Knee Arthroplasty (KA TKA) using a cruciate sacrificing (CS) medially stabilised prosthesis at a minimum 24-months follow-up.
59 patients with a varus HKA angle who underwent a TKA from May, 2016 to April, 2017 were retrospectively enrolled. Radiological and clinical evaluations were assessed after 40 days, 6 months and at a minimum follow-up of 24 months. Long leg standing X-rays were performed pre-operatively and the Hip-Knee-Ankle (HKA) angle, the mechanical Lateral Distal Femoral Angle (mLDFA), the mechanical Medial Proximal Tibial Angle (mMPTA) and the Knee Joint Line Obliquity Angle (KJLOA) were analysed. At a minimum follow-up of 24 months, the patients were evaluated subjectively based on the Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) and the Oxford Knee Score (OKS). The post-operative range of motion (ROM) was measured. To reduce flexion instability, an original technique was used, with more posterior positioning of the femoral component, called the "virtuous mistake". Results were compared to the data reported in the literature in patients treated with standard kinematic alignment (KA) technique.
No difference was found between the mean pre-operative and post-operative angles regarding mLDFA (p value = 0.410) and mMTPA (p value = 0.242). A difference of 0.8° in HKA angle between males and females was found, with more varus results in males. At a minimum follow-up of 24 months, the WOMAC was 87 (SD 4.3), the OKS was 41 (SD 2.4), and the flexion was 124°, which was similar to the data reported in literature with standard KA. There were not any cases of aseptic failures.
The modified KA TKA surgical technique proposed in this study can achieve good clinical results at minimum 24 months of follow-up, reproducing accurately native mLDFA and mMPTA.
Level III, therapeutic study.
本研究旨在评估一种改良的运动学对线全膝关节置换术（KA TKA）技术的临床和影像学结果，该技术使用的是牺牲交叉韧带的内侧稳定型假体，随访时间至少为 24 个月。
回顾性纳入 2016 年 5 月至 2017 年 4 月期间因内翻型 HKA 角行 TKA 的 59 例患者。术后 40 天、6 个月和至少 24 个月进行影像学和临床评估。术前拍摄下肢全长站立位 X 线片，分析 Hip-Knee-Ankle（HKA）角、机械外侧远端股骨角（mLDFA）、机械内侧近段胫骨角（mMPTA）和膝关节线倾斜角（KJLOA）。至少 24 个月随访时，根据 Western Ontario 和 McMaster 大学骨关节炎指数评分（WOMAC）和牛津膝关节评分（OKS）对患者进行主观评估。测量术后活动范围（ROM）。为减少屈曲不稳定性，采用了一种原始技术，即股骨组件更向后放置，称为“良性错误”。结果与采用标准运动学对线（KA）技术治疗的患者的文献数据进行比较。
在 mLDFA（p 值=0.410）和 mMPTA（p 值=0.242）方面，术后平均角度与术前平均角度无差异。男性和女性的 HKA 角存在 0.8°的差异，男性结果为内翻。至少 24 个月随访时，WOMAC 为 87（SD 4.3），OKS 为 41（SD 2.4），屈曲度为 124°，与文献报道的标准 KA 数据相似。无无菌性失败病例。
本研究提出的改良 KA TKA 手术技术在至少 24 个月的随访中可获得良好的临床效果，可准确复制 native mLDFA 和 mMPTA。
III 级，治疗研究。
