Kazarian Gregory S, Haddad Fares S, Donaldson Matthew J, Wignadasan Warran, Nunley Ryan M, Barrack Robert L
Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO.
J Arthroplasty. 2022 Jun;37(6S):S129-S133. doi: 10.1016/j.arth.2022.02.087. Epub 2022 Mar 4.
Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA).
Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and function in 262 patients who underwent surgery at 4 centers in the U.S. and U.K (average age, 67.2) at a mean 5.5 years after primary TKA. Postoperative distal femoral angle (DFA), proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured, and outliers were recorded. PROMs were compared between patients with aligned versus malaligned knees using univariate analysis.
Patients with DFA, PTA, and PSA outliers were more likely to experience similar or decreased activity levels postoperatively than patients with no alignment outliers, as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA, PTA, and PSA outliers were significantly more likely to be dissatisfied with their ability to perform activities of daily living (ADLs), as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA and PSA outliers were more likely to be dissatisfied with their degree of pain relief, as were patients with 2 outliers of any kind (P < .05). Finally, patients with DFA and PSA outliers, as well as those with 1 outlier of any kind, were more likely to be dissatisfied with their overall knee function (P < .05).
DFA, PTA, and PSA outliers represent a significant risk factor for decreased satisfaction with activities of daily living(ADLs), pain relief, and knee function, as well as decreased activity levels.
Level III.
在全膝关节置换术（TKA）后，植入物排列不齐可能是导致患者报告的结局指标（PROMs）不佳的一个风险因素。
对在美国和英国4个中心接受手术的262例患者（平均年龄67.2岁）进行术后调查，以评估其在初次TKA术后平均5.5年时关于满意度、疼痛和功能的PROMs。通过X线测量术后股骨远端角（DFA）、胫骨近端角（PTA）和胫骨后倾角度（PSA），并记录异常值。使用单因素分析比较膝关节排列整齐与排列不齐的患者的PROMs。
与无排列异常值的患者相比，DFA、PTA和PSA存在异常值的患者术后活动水平更有可能相似或降低，任何一种有1个或2个异常值的患者也是如此（P < 0.05）。与无异常值的患者相比，DFA、PTA和PSA存在异常值的患者对其日常生活活动（ADL）能力不满意的可能性显著更高，任何一种有1个或2个异常值的患者也是如此（P < 0.05）。与无异常值的患者相比，DFA和PSA存在异常值的患者对其疼痛缓解程度不满意的可能性更高，任何一种有2个异常值的患者也是如此（P < 0.05）。最后，DFA和PSA存在异常值的患者以及任何一种有1个异常值的患者对其整体膝关节功能不满意的可能性更高（P < 0.05）。
DFA、PTA和PSA异常值是导致对日常生活活动（ADL）满意度降低、疼痛缓解和膝关节功能下降以及活动水平降低的一个重要风险因素。
三级。
