Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan.
Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1292-1299. doi: 10.1007/s00167-021-06577-w. Epub 2021 Apr 16.
The hypothesis of this study was that the kinematics of patients with higher patient-reported outcome measures (PROMs) differ from those of patients with lower PROMs after bicruciate-stabilized total knee arthroplasty (BCS-TKA).
A total of 32 patients with severe knee osteoarthritis were examined 11.2 ± 3.2 months after BCS-TKA. The patients performed squats under single fluoroscopic surveillance in the sagittal plane. To estimate the spatial position and orientation of the femoral and tibial components, a 2D-to-3D registration technique was used. This technique uses a contour-based registration algorithm, single-view fluoroscopic images and 3D computer-aided design models. Knee range of motion, varus-valgus alignment, axial rotation of the femur relative to the tibial component, anteroposterior translation of the medial and lateral femorotibial contact points, kinematic paths, and anterior and posterior post-cam engagement were measured. The patients were divided into two groups using hierarchical cluster analysis based on the 1-year postoperative Knee Injury and Osteoarthritis Outcome Score and 2011 Knee Society Score.
The femoral component had significantly more external rotation in the low-score group than in the high-score group (5.1 ± 1.8° vs. 2.2 ± 2.7°, p = 0.02). The high-score group had a medial pivot pattern from 0 to 20° of flexion, without significant movement from 20 to 70°, and final bicondylar rollback beyond 70°. The low-score group had a medial pivot from 0 to 70° of flexion and bicondylar rollback beyond 70°. There were no significant between-group differences in the varus-valgus angle or post-cam engagement.
The higher PROM group had smaller external rotation of the femur after BCS-TKA.
Level III.
本研究的假设是，在双交叉韧带稳定型全膝关节置换术（BCS-TKA）后，患者报告的结果测量（PROM）较高的患者的运动学与 PROM 较低的患者不同。
共对 32 例患有严重膝关节骨关节炎的患者在 BCS-TKA 后 11.2±3.2 个月进行了检查。患者在矢状面单透视监测下进行深蹲。为了估计股骨和胫骨组件的空间位置和方向，使用了 2D 到 3D 的配准技术。该技术使用基于轮廓的配准算法、单视图透视图像和 3D 计算机辅助设计模型。测量膝关节活动范围、内翻-外翻对线、股骨相对于胫骨组件的轴向旋转、内侧和外侧股骨-胫骨接触点的前后平移、运动学路径以及前和后凸轮的啮合。根据术后 1 年的膝关节损伤和骨关节炎结果评分（Knee Injury and Osteoarthritis Outcome Score，KOOS）和 2011 年膝关节协会评分（Knee Society Score，KSS），使用层次聚类分析将患者分为两组。
低分组的股骨组件外旋角度明显大于高分组（5.1±1.8°比 2.2±2.7°，p=0.02）。高分组在 0°到 20°屈曲时有内侧旋转模式，在 20°到 70°之间没有明显运动，在 70°以后有双髁后滚。低分组在 0°到 70°屈曲时有内侧旋转和双髁后滚。两组间在内外翻角度或凸轮后啮合上无显著差异。
BCS-TKA 后 PROM 较高的患者股骨外旋角度较小。
III 级。
