Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2021 Jun;13(2):175-184. doi: 10.4055/cios20188. Epub 2021 Feb 2.
One recently developed total knee arthroplasty (TKA) prosthesis was designed to alter the patellofemoral geometry and optimize patellar tracking compared to its predecessor. Despite an expectation that the improved design would contribute to optimal patellofemoral compatibility, its effect has not been confirmed with patellofemoral-specific clinical scoring systems and radiographic parameters. Our purpose was to compare patellofemoral-specific clinical and radiographic results after TKA using a patellofemoral design-modified prosthesis and its predecessor.
The results of 200 TKAs with Attune (group A) were compared to those of 200 TKAs with PFC Sigma (group B). Clinically, the presence of anterior knee pain (AKP), patellar crepitation, and Kujala score were checked. Radiographically, anterior femoral offset (AFO), posterior femoral offset (PFO), position of patellar ridge, and patellar tilt and translation were compared.
In group A, AKP and patellar crepitation occurred less frequently (AKP: 3% vs. 8%, = 0.028; patellar crepitation: 2.5% vs. 9%, = 0.005) and Kujala score was higher (81.8 vs. 77.9, < 0.001), when compared to group B. The AFO decreased in group A postoperatively but increased in group B (-1.2 vs. 1.1 mm, < 0.001). The change in PFO was smaller in group A than group B (-1.2 vs. -3.6 mm, < 0.001). The change in patellar ridge after TKA was smaller in group A than group B (1.4% vs. 8.3%, < 0.001). The postoperative patella of group A was more laterally tilted (5.9° vs. 2.2°, < 0.001) and less laterally translated (0.9 vs. 2.6 mm, < 0.001). The proportion of incompatible patella tilt angle (≥ ± 10°) was greater in group A than group B (21.7% vs. 4.5%, < 0.001).
TKA using Attune provided better patellofemoral-specific clinical results and favorable radiographic parameters related with patellar ridge, AFO, and PFO than TKA using PFC Sigma did. However, the current prosthesis did not provide better radiographic patellar tracking, which might be due to the medial location of the patellar ridge.
与前代产品相比，最近开发的一种全膝关节置换（TKA）假体设计用于改变髌股关节几何形状并优化髌骨轨迹。尽管预计改进的设计将有助于实现最佳的髌股关节兼容性，但尚未通过特定于髌股关节的临床评分系统和影像学参数来证实其效果。我们的目的是比较使用髌股关节设计改良型假体和前代假体的 TKA 的髌股关节特定的临床和影像学结果。
比较了 200 例使用 Attune（A 组）和 200 例使用 PFC Sigma（B 组）的 TKA。临床方面，检查了前膝疼痛（AKP）、髌骨弹响和 Kujala 评分。影像学方面，比较了前股骨偏心距（AFO）、后股骨偏心距（PFO）、髌骨嵴位置以及髌骨倾斜和平移。
与 B 组相比，A 组 AKP 和髌骨弹响的发生率较低（AKP：3%比 8%， = 0.028；髌骨弹响：2.5%比 9%， = 0.005），Kujala 评分更高（81.8 比 77.9， < 0.001）。A 组术后 AFO 减少，但 B 组增加（-1.2 比 1.1mm， < 0.001）。A 组 PFO 的变化小于 B 组（-1.2 比-3.6mm， < 0.001）。A 组术后髌骨嵴的变化小于 B 组（1.4%比 8.3%， < 0.001）。A 组术后髌骨外侧倾斜更大（5.9°比 2.2°， < 0.001），外侧平移更小（0.9 比 2.6mm， < 0.001）。A 组髌股关节倾斜角（≥±10°）不匹配的比例大于 B 组（21.7%比 4.5%， < 0.001）。
与使用 PFC Sigma 的 TKA 相比，使用 Attune 的 TKA 提供了更好的髌股关节特定的临床结果和有利的影像学参数，与髌骨嵴、AFO 和 PFO 有关。然而，目前的假体并没有提供更好的影像学髌骨跟踪，这可能是由于髌骨嵴的内侧位置。
