Ghirardelli Stefano, Asay Jessica L, Leonardi Erika A, Amoroso Tommaso, Andriacchi Thomas P, Indelli Pier Francesco
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, The Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA 94304, USA.
J Funct Morphol Kinesiol. 2021 Mar 15;6(1):27. doi: 10.3390/jfmk6010027.
: This study compares knee kinematics in two groups of patients who have undergone primary total knee arthroplasty (TKA) using two different modern designs: medially congruent (MC) and posterior-stabilized (PS). The aim of the study is to demonstrate only minimal differences between the groups. : Ten TKA patients (4 PS, 6 MC) with successful clinical outcomes were evaluated through 3D knee kinematics analysis performed using a multicamera optoelectronic system and a force platform. Extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA), and knee rotational angle at heel-strike. Data were compared with a group of healthy controls. There were no differences in preferred walking speed between MC and PS groups, but we found consistent differences in knee function. At heel-strike, the knee tended to be more flexed in the PS group compared to the MC group; the MSKFA tended to be higher in the PS group compared to the MC group. There was a significant fluctuation in KAA during the swing phase in the PS group compared to the MC group, PS patients showed a higher peak knee flexion moment compared to MC patients, and the PS group had significantly less peak internal rotation moments than the MC group. Modern, third-generation TKA designs failed to reproduce normal knee kinematics. MC knees tended to reproduce a more natural kinematic pattern at heel-strike and during axial rotation, while PS knees showed better kinematics during mid-flexion.
本研究比较了两组接受初次全膝关节置换术（TKA）的患者的膝关节运动学，这两组患者使用了两种不同的现代设计：内侧匹配型（MC）和后稳定型（PS）。本研究的目的是证明两组之间只有极小的差异。对10例临床结果成功的TKA患者（4例PS型，6例MC型）进行了评估，通过使用多摄像头光电系统和测力平台进行三维膝关节运动学分析。提取的运动学数据包括足跟触地时的膝关节屈曲角度（KFH）、步幅中点膝关节屈曲角度峰值（MSKFA）、膝关节内收角度的最大值和最小值（KAA）以及足跟触地时的膝关节旋转角度。将数据与一组健康对照进行比较。MC组和PS组在首选步行速度上没有差异，但我们发现膝关节功能存在一致的差异。在足跟触地时，与MC组相比，PS组的膝关节往往更屈曲；与MC组相比，PS组的MSKFA往往更高。与MC组相比，PS组在摆动期KAA有显著波动，PS患者的膝关节屈曲力矩峰值高于MC患者，且PS组的峰值内旋力矩明显低于MC组。现代第三代TKA设计未能重现正常的膝关节运动学。MC型膝关节在足跟触地和轴向旋转时倾向于重现更自然的运动学模式，而PS型膝关节在中度屈曲时表现出更好的运动学。
