Shatrov Jobe, Sappey-Marinier Elliot, Kafelov Moussa, Gunst Stanislas, Batailler Cécile, Servien Elvire, Lustig Sébastien
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia.
J Exp Orthop. 2022 Feb 15;9(1):17. doi: 10.1186/s40634-022-00456-0.
Prosthesis design influences stability in total knee arthroplasty and may affect maximum knee flexion. Posterior-stabilised (PS) and condylar-stabilised (CS) designed prosthesis do not require a posterior-cruciate ligament to provide stability. The aim of the current study was to compare the range of motion (ROM) and clinical outcomes of patients undergoing cemented total knee arthroplasty (TKA) using either a PS or CS design prosthesis.
A total of 167 consecutive primary TKAs with a CS bearing (mobile deep-dish polyethylene) were retrospectively identified and compared to 332 primary TKA with a PS constraint, with similar design components from the same manufacturer. Passive ROM was assessed at last follow-up with use of a handheld goniometer. Clinical scores were assessed using Patient-Reported Outcome Measures (PROMs); International Knee Society (IKS) knee and function scores and satisfaction score. Radiographic assessment was performed pre and post operatively consisting of mechanical femorotibial angle (mFTA), femoral and tibial mechanical angles measured medially (FMA and TMA, respectively) on long leg radiographs, tibial slope and patella height as measured by the Blackburne-Peel index (BPI).
Both groups had a mean follow-up of 3 years (range 2-3.7 years). Mean post-operative maximum knee flexion was 117° ± 4.9° in the PS group and 119° ± 5.2° in the CS group (p = 0.29). Postoperative IKS scores were significantly improved in both groups compared to preoperative scores (p < 0.01). The mean IKS score in the PS group was 170.9 ± 24.1 compared to 170.3 ± 22.5 in the CS group (p = 0.3). Both groups had similar radiographic outcomes as determined by coronal and sagittal alignment, tibial slope and posterior condylar offset ratio measurements. When considering the size of tibial slope change and posterior-condylar offset ratio, there was no differences between groups (p = 0.4 and 0.59 respectively). The PS group had more interventions for post-operative stiffness (arthrolysis or manipulation under anaesthesia) 8 (2.7%) compared to 1 (0.6%) in the CS group (p = 0.17).
Condylar-stabilised TKA have similar patient outcomes and ROM at a mean follow-up of 3 years compared to PS TKA. Highly congruent inserts could be used without compromising results in TKA at short term.
Level IV, retrospective case control study.
假体设计会影响全膝关节置换术的稳定性，并可能影响膝关节最大屈曲度。后稳定型（PS）和髁稳定型（CS）设计的假体不需要后交叉韧带提供稳定性。本研究的目的是比较使用PS或CS设计假体进行骨水泥型全膝关节置换术（TKA）患者的活动范围（ROM）和临床结果。
回顾性确定了167例连续的采用CS轴承（活动深盘聚乙烯）的初次TKA，并与332例采用PS限制的初次TKA进行比较，两组假体来自同一制造商，设计组件相似。在最后一次随访时使用手持量角器评估被动ROM。使用患者报告结局量表（PROMs）评估临床评分；国际膝关节协会（IKS）膝关节和功能评分以及满意度评分。术前和术后进行影像学评估，包括机械股骨胫骨角（mFTA）、长腿X线片上内侧测量的股骨和胫骨机械角（分别为FMA和TMA）、胫骨坡度以及由布莱克本-皮尔指数（BPI）测量的髌骨高度。
两组的平均随访时间均为3年（范围2 - 3.7年）。PS组术后膝关节最大屈曲度平均为117°±4.9°，CS组为119°±5.2°（p = 0.29）。与术前评分相比，两组术后IKS评分均显著改善（p < 0.01）。PS组的平均IKS评分为170.9±24.1，CS组为170.3±22.5（p = 0.3）。通过冠状面和矢状面排列、胫骨坡度和后髁偏移率测量确定，两组的影像学结果相似。考虑胫骨坡度变化大小和后髁偏移率时，两组之间无差异（分别为p = 0.4和0.59）。PS组术后僵硬（关节松解术或麻醉下手法操作）的干预次数更多，为8次（2.7%），而CS组为1次（0.6%）（p = 0.17）。
与PS TKA相比，髁稳定型TKA在平均3年的随访中具有相似的患者结局和ROM。在短期内，可使用高度贴合的衬垫而不影响TKA的结果。
IV级，回顾性病例对照研究。
