Feng Zhiwei, Ma Ming, Wang Yaobin, Yang Chenfei, Liu Zhongcheng, Xia Yayi
Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China.
Department of Orthopaedics, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, China.
Front Surg. 2021 Aug 30;8:713055. doi: 10.3389/fsurg.2021.713055. eCollection 2021.
Arthritis with severe varus deformity remains a challenge in total knee arthroplasty (TKA). Until recently, surgeons aimed at a neutral lower limb alignment when performing a TKA. However, the impact of TKA on the ankle joint has been ignored. Therefore, we conducted a systematic review to assess the clinical and radiological changes in the ankle joint after TKA on knees with severe varus deformity. A systematic search was conducted in four English (PubMed, Embase, Cochrane Library, and Web of Science) and four Chinese (CBM, VIP, CNKI, and Wan Fang Database) databases. Screening of literature and extraction of data were independently performed by two researchers. The modified methodological index for non-randomized studies (MINORS) was used to assess the quality. A total of eight studies were eligible, namely, four prospective and four retrospective studies. TKA resulted in a negative clinical effect in the ankle joint in patients with ankle osteoarthritis. Seven studies reported changes in the mechanical tibiofemoral angle, and four studies reported radiological changes in the hindfoot. The mean score of the MINORS was 9.8 out of eight (9-11). As a result of the correction of the knee osteoarthritis with severe varus deformity following mechanically aligned TKA, the radiological malalignment of the ankle joint was improved. However, some patients experience increased ankle pain after undergoing TKA, especially, if there was a residual knee varus deformity, a stiff hindfoot with varus deformity, or ankle arthritis.
重度内翻畸形的关节炎在全膝关节置换术（TKA）中仍然是一个挑战。直到最近，外科医生在进行全膝关节置换术时都旨在实现下肢中立位对线。然而，全膝关节置换术对踝关节的影响一直被忽视。因此，我们进行了一项系统评价，以评估重度内翻畸形膝关节行全膝关节置换术后踝关节的临床和放射学变化。我们在四个英文数据库（PubMed、Embase、Cochrane图书馆和Web of Science）和四个中文数据库（中国生物医学文献数据库、维普资讯、中国知网和万方数据库）中进行了系统检索。由两名研究人员独立进行文献筛选和数据提取。使用非随机研究的改良方法学指标（MINORS）来评估质量。共有八项研究符合条件，即四项前瞻性研究和四项回顾性研究。全膝关节置换术对踝骨关节炎患者的踝关节产生了负面临床影响。七项研究报告了机械性胫股角的变化，四项研究报告了后足的放射学变化。MINORS的平均得分为8分中的9.8分（9 - 11分）。由于机械对线的全膝关节置换术矫正了重度内翻畸形的膝骨关节炎，踝关节的放射学对线不良得到改善。然而，一些患者在接受全膝关节置换术后踝关节疼痛加剧，特别是如果存在残留的膝关节内翻畸形、伴有内翻畸形的僵硬后足或踝关节炎。
