前瞻性随机对照试验比较了中轴稳定型与后稳定型全膝关节置换术。

A Prospective Randomized Controlled Trial Comparing Medial-Pivot versus Posterior-Stabilized Total Knee Arthroplasty.

机构信息

Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, United Kingdom; Department of Trauma and Orthopaedic Surgery, The Princess Grace Hospital, London, United Kingdom.

Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, United Kingdom.

出版信息

J Arthroplasty. 2021 May;36(5):1584-1589.e1. doi: 10.1016/j.arth.2021.01.013. Epub 2021 Jan 12.

DOI:10.1016/j.arth.2021.01.013

PMID:33531176

Abstract

BACKGROUND

The medial-pivot (MP) design for total knee arthroplasty (TKA) aims to restore more natural "ball-and-socket" knee kinematics compared to the traditional posterior-stabilized (PS) implants for TKA. The objective of this study is to determine if there was any difference in functional outcomes between patients undergoing MP-TKA vs PS-TKA.

METHODS

This prospective randomized controlled trial consisted of 43 patients undergoing MP-TKA vs 45 patients receiving a single-radius PS-TKA design. The primary outcome was postoperative range of motion (ROM). Secondary outcomes included the Western Ontario and McMaster Universities Arthritis Index, Oxford Knee Score, Knee Society Score (KSS), and radiological outcomes. All study patients were followed-up for 2 years after surgery.

RESULTS

Patients undergoing MP-TKA had comparable ROM at 1 year (114.6° ± 16.3° vs 111.3° ± 17.8° respectively, P = .88) and 2 years after surgery (114.9° ± 15.5° vs 114.9° ± 16.4° respectively, P = .92) compared to PS-TKA. There were also no differences in Western Ontario and McMaster Universities Arthritis Index (26.8 ± 19.84 vs 22.0 ± 12.03 respectively, P = .14), Oxford Knee Score (42.7 ± 8.1 vs 42.3 ± 6.7 respectively, P = .18), KSS clinical scores (82.9 ± 16.96 vs 81.42 ± 10.45 respectively, P = .12) and KSS functional scores (76.2 ± 18.81 vs 73.93 ± 8.53 respectively, P = .62) at 2-year follow-up. There was no difference in postoperative limb alignment or complications.

CONCLUSION

This study demonstrated excellent results in both the single-radius PS-TKA design and MP-TKA design. No differences were identified at 2-year follow-up with respect to postoperative ROM and patient-reported outcome measures.

摘要

背景

与传统的后稳定型（PS）全膝关节置换术（TKA）植入物相比，内侧枢轴（MP）设计旨在恢复更自然的“球窝”膝关节运动学。本研究的目的是确定接受 MP-TKA 与 PS-TKA 的患者之间在功能结果方面是否存在差异。

方法

这项前瞻性随机对照试验包括 43 例接受 MP-TKA 的患者和 45 例接受单半径 PS-TKA 设计的患者。主要结果是术后活动范围（ROM）。次要结果包括西部安大略省和麦克马斯特大学关节炎指数、牛津膝关节评分、膝关节协会评分（KSS）和影像学结果。所有研究患者在手术后均随访 2 年。

结果

接受 MP-TKA 的患者在术后 1 年（分别为 114.6°±16.3°和 111.3°±17.8°，P=.88）和术后 2 年（分别为 114.9°±15.5°和 114.9°±16.4°，P=.92）的 ROM 相似，与 PS-TKA 相比，也没有差异。西部安大略省和麦克马斯特大学关节炎指数（分别为 26.8±19.84 和 22.0±12.03，P=.14）、牛津膝关节评分（分别为 42.7±8.1 和 42.3±6.7，P=.18）、KSS 临床评分（分别为 82.9±16.96 和 81.42±10.45，P=.12）和 KSS 功能评分（分别为 76.2±18.81 和 73.93±8.53，P=.62）在术后 2 年随访时也没有差异。术后肢体对线和并发症没有差异。