Ragunandhan Narayanasamy, Jeya Venkatesh Palanisamy
Present Address: Consultant Orthopaedics, Rathimed Speciality Hospital, Chennai, Tamilnadu India.
Consultant Orthopaedics, Janani Hospital, Thiruvallur, Chennai, Tamilnadu India.
Indian J Orthop. 2021 Sep 18;55(5):1118-1126. doi: 10.1007/s43465-021-00521-3. eCollection 2021 Oct.
Kinematic total knee arthroplasty (KA) is emerging as an alternative for conventional mechanically aligned (MA) total knee arthroplasty (TKA) for treating patients with osteoarthritis (OA) knee. Since its introduction, concerns remain about the reproducibility and outcomes in different ethnic groups. This study was undertaken to analyse patient-reported outcomes of kinematically aligned total knee arthroplasty using Oxford Knee Score (OKS) in Indian population.
A total of 104 consecutive patients (75 females and 29 males) who underwent total knee arthroplasty between February 2016 and February 2018 were included in this prospective study. Only patients with primary OA knee were included, those with rheumatoid arthritis, previous knee surgery were excluded. All surgeries were done by a single surgeon using the same type of cruciate-retaining prosthesis (Vanguard, Zimmer Biomet, Indiana, United States) with the conventional instruments. The principles of kinematic knee alignment were followed. Preoperative and postoperative OKS were recorded. Secondary outcome variables such as Haemoglobin (Hb) drop and blood transfusion rate were noted.
The mean age of this group of patients was 65.28 years (range 54-83 years). 96 patients (108 knees) were available for final review. The average preoperative OKS was 15.71 whereas the average OKS at 2 years follow-up improved to 42.07. The mean Hb drop was 1.18 g/dl and none of the patients required blood transfusion.
This study demonstrates that kinematic alignment TKA provides excellent to good patient satisfaction in Indian population. There were no catastrophic failures in three years of follow-up in this series. The results of KA TKA were not compared to MA TKA in this study and our sample size is not big enough to make recommendations on routine use of this technique. Larger randomised trials in Indian patients are needed to propose solid recommendations. Our pilot data can be useful in calculating sample size for such studies.
运动学全膝关节置换术（KA）正逐渐成为治疗膝关节骨关节炎（OA）患者的传统机械对线（MA）全膝关节置换术（TKA）的替代方法。自引入以来，对于其在不同种族群体中的可重复性和疗效仍存在担忧。本研究旨在分析印度人群中使用牛津膝关节评分（OKS）评估运动学对线全膝关节置换术患者报告的结局。
本前瞻性研究纳入了2016年2月至2018年2月期间连续接受全膝关节置换术的104例患者（75例女性和29例男性）。仅纳入原发性膝关节OA患者，排除类风湿关节炎、既往膝关节手术患者。所有手术均由同一外科医生使用相同类型的保留交叉韧带假体（先锋，捷迈邦美，印第安纳州，美国）及传统器械完成。遵循运动学膝关节对线原则。记录术前和术后的OKS。记录次要结局变量，如血红蛋白（Hb）下降和输血率。
该组患者的平均年龄为65.28岁（范围54 - 83岁）。96例患者（108膝）可供最终评估。术前平均OKS为15.71，而2年随访时平均OKS提高至42.07。平均Hb下降1.18 g/dl，无一例患者需要输血。
本研究表明，运动学对线TKA在印度人群中提供了良好至优秀的患者满意度。本系列随访三年无灾难性失败病例。本研究未将KA TKA的结果与MA TKA进行比较，且我们的样本量不足以就该技术的常规使用提出建议。需要在印度患者中进行更大规模的随机试验以提出可靠建议。我们的试点数据可用于计算此类研究的样本量。
