Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA.
Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, Columbia, Missouri, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):59-66. doi: 10.1302/0301-620X.103B6.BJJ-2020-2357.R1.
Alternative alignment concepts, including kinematic and restricted kinematic, have been introduced to help improve clinical outcomes following total knee arthroplasty (TKA). The purpose of this study was to evaluate the clinical results, along with patient satisfaction, following TKA using the concept of restricted kinematic alignment.
A total of 121 consecutive TKAs performed between 11 February 2018 to 11 June 2019 with preoperative varus deformity were reviewed at minimum one-year follow-up. Three knees were excluded due to severe preoperative varus deformity greater than 15°, and a further three due to requiring revision surgery, leaving 109 patients and 115 knees to undergo primary TKA using the concept of restricted kinematic alignment with advanced technology. Patients were stratified into three groups based on the preoperative limb varus deformity: Group A with 1° to 5° varus (43 knees); Group B between 6° and 10° varus (56 knees); and Group C with varus greater than 10° (16 knees). This study group was compared with a matched cohort of 115 TKAs and 115 patients using a neutral mechanical alignment target with manual instruments performed from 24 October 2016 to 14 January 2019.
Mean overall patient satisfaction for the entire cohort was 4.7 (SE 0.1) on a 5-point Likert scale, with 93% being either very satisfied or satisfied compared with a Likert of 4.3 and patient satisfaction of 81% in the mechanical alignment group (p < 0.001 and p < 0.006 respectively). At mean follow-up of 17 months (11 to 27), the mean overall Likert, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and Knee Society Knee and Function Scores were significantly better in the kinematic group than in the neutral mechanical alignment group. The most common complication in both groups was contracture requiring manipulation under anaesthesia, involving seven knees (6.1%) in the kinematic group and nine knees (7.8%) in the mechanical alignment group.
With the advent of advanced technology, and the ability to obtain accurate bone cuts, the target limb alignment, and soft-tissue balance within millimetres, using a restricted kinematic alignment concept demonstrated excellent patient satisfaction following primary TKA. Longer-term analysis is required as to the durability of this method. Cite this article: 2021;103-B(6 Supple A):59-66.
为了帮助改善全膝关节置换术（TKA）后的临床结果，已经引入了包括运动学和限制性运动学在内的替代对准概念。本研究的目的是评估使用限制性运动学对准概念进行 TKA 后的临床结果以及患者满意度。
回顾了 2018 年 2 月 11 日至 2019 年 6 月 11 日期间进行的 121 例连续 TKA，这些 TKA 均存在术前内翻畸形，且随访时间至少为 1 年。由于术前内翻畸形大于 15°，有 3 例被排除在外，另外 3 例因需要翻修手术而被排除在外，因此，共有 109 例患者和 115 例膝关节接受了使用先进技术的限制性运动学对准概念的初次 TKA。根据术前肢体内翻畸形程度，患者分为三组：A 组 1°至 5°内翻（43 例）；B 组 6°至 10°内翻（56 例）；C 组内翻大于 10°（16 例）。该研究组与一组使用手动器械进行的中性机械对准目标的 115 例 TKA 和 115 例患者进行了比较，该目标于 2016 年 10 月 24 日至 2019 年 1 月 14 日进行。
整个队列的总体平均患者满意度为 5 分制的 4.7（SE 0.1），93%的患者非常满意或满意，而机械对准组的满意度为 4.3，患者满意度为 81%（p < 0.001 和 p < 0.006）。在平均 17 个月（11 至 27）的随访中，运动学组的整体平均 Likert、膝关节损伤和骨关节炎结果评分关节置换、西安大略和麦克马斯特大学骨关节炎指数、遗忘关节评分和膝关节协会膝关节和功能评分均明显优于中性机械对准组。在两组中最常见的并发症是需要在麻醉下进行手法复位的挛缩，运动学组有 7 例（6.1%），机械对准组有 9 例（7.8%）。
随着先进技术的出现，以及能够获得精确的骨切、目标肢体对准和毫米级软组织平衡的能力，使用限制性运动学对准概念在初次 TKA 后表现出了极好的患者满意度。需要进行更长期的分析以确定这种方法的耐用性。
2021；103-B（6 增刊 A）：59-66.
