MSK Lab-Imperial College London, White City Campus, London, W12 0BZ, UK.
The Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK.
Knee Surg Sports Traumatol Arthrosc. 2022 Mar;30(3):1082-1094. doi: 10.1007/s00167-021-06462-6. Epub 2021 Mar 20.
Owing to the improved understanding of knee kinematics and the successful introduction of the kinematic alignment (KA) technique for implanting total knee arthroplasty (TKA), it was recently understood that the "Cartier angle technique" corresponds to a kinematic implantation of the uni-compartmental knee arthroplasty (UKA) components. When compared to the universally spread mechanical alignment (MA) technique for implanting UKA, the KA method generates a more anatomic prosthetic knee that may be clinically advantageous. The aims of this study are to determine if KA UKAs are associated with acceptable functional performance and patient satisfaction (question 1), rates of residual pain and tibia plateau fracture (question 2), and rates of reoperation and revision (question 3), and to define the component orientation and limb alignment as measured on radiograph (question 4), and the stress shielding related bone loss in the proximal tibia (question 5) with KA UKA, and where possible to compare with MA UKA.
KA UKA generates good clinical outcomes, similar or superior to the ones of MA UKA.
Systematic review of literature databases were primarily searched using Healthcare Databases Advanced Search (HDAS). Two primary searches were conducted using the electronic databases MEDLINE, EMBASE, and PubMed, and a secondary search was conducted using review articles and bibliography of obtained papers in order to ascertain more material.
Nine eligible non-comparative prospective (3) or retrospective (6) cohort studies, which cumulated 593 KA UKAs with follow-up between 3.2 and 12 years, fulfilled the inclusion criteria for this systematic review. The findings demonstrated high Knee Society Score (KSS) (from 87 to 95) and function scores (from 81 to above 91) in addition to patient satisfaction scores of 88%. There was no revision for tibia plateau fracture, 0.8% (5 cases) for unexplained pain tibia, 2.0% (12 cases) for component loosening, and 5.6% (33 cases) for any causes of aseptic failures reported for KA UKA. The prosthetic lower limb and tibia implant alignments were both found to be in slight varus (means between 3 and 5°), and the postoperative joint line and tibia component was shown to be parallel to the floor when standing. The KA UKA components migration, as measured on radiostereometry, was acceptable.
DISCUSSION/CONCLUSION: The KA technique is an alternative, personalised, more physiological method for implanting UKA, which could be clinically advantageous when compared to the MA technique. The literature supports the good mid- to long-term clinical safety and good efficacy of KA UKA; however, comparison between KA and MA techniques for UKA was not performed due to limited literature. Further investigations are needed to better define the clinical impact of KA UKA, and the acceptable limits for KA of the UKA tibial component.
Level 4; systematic review of level 4 studies.
由于对膝关节运动学的理解不断提高，以及成功引入了用于全膝关节置换术（TKA）的运动学对准（KA）技术，最近人们认识到“卡地亚角技术”对应于单髁膝关节置换术（UKA）组件的运动学植入。与普遍应用的机械对准（MA）技术相比，KA 方法产生了更符合解剖学的假体膝关节，这在临床上可能具有优势。本研究的目的是确定 KA UKA 是否与可接受的功能表现和患者满意度相关（问题 1）、残留疼痛和胫骨平台骨折的发生率（问题 2）、以及翻修和再手术的发生率（问题 3），并确定放射影像学上组件定向和肢体对线（问题 4）以及 KA UKA 相关的胫骨近端应力遮挡性骨丢失（问题 5），并在可能的情况下与 MA UKA 进行比较。
KA UKA 产生良好的临床结果，与 MA UKA 相似或优于 MA UKA。
主要使用医疗保健数据库高级搜索（HDAS）对文献数据库进行系统检索。使用电子数据库 MEDLINE、EMBASE 和 PubMed 进行了两次主要搜索，并进行了二次搜索，以查阅获得的论文的综述和参考文献，以确定更多的材料。
符合本系统评价纳入标准的是 9 项非对照前瞻性（3 项）或回顾性（6 项）队列研究，共纳入 593 例 KA UKA，随访时间为 3.2 至 12 年。研究结果表明，Knee Society Score（KSS）（87 至 95）和功能评分（81 至 91 以上）以及 88%的患者满意度评分均较高。KA UKA 没有胫骨平台骨折的翻修，胫骨不明原因疼痛的发生率为 0.8%（5 例），组件松动的发生率为 2.0%（12 例），无菌性失败的任何原因的发生率为 5.6%（33 例）。KA UKA 的假体下肢和胫骨植入物的对线均发现为轻度内翻（平均值在 3 至 5°之间），站立时关节线和胫骨组件与地面平行。通过放射立体测量术测量的 KA UKA 组件迁移是可接受的。
讨论/结论：KA 技术是一种替代的、个性化的、更符合生理的 UKA 植入方法，与 MA 技术相比，它可能具有临床优势。文献支持 KA UKA 的中期至长期临床安全性和良好疗效；然而，由于文献有限，未对 KA 和 MA 技术用于 UKA 进行比较。需要进一步研究以更好地确定 KA UKA 的临床影响，以及 KA UKA 胫骨组件的可接受 KA 范围。
4 级；4 级研究的系统评价。
