Siddiqi Ahmed, Anis Hiba, Borukhov Ilya, Piuzzi Nicolas S
Division of Adult Reconstruction, Orthopedic Institute Brielle Orthopaedics, Ortho NJ, Manasquan, New Jersey.
Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Seton Hall, New Jersey.
J Bone Joint Surg Am. 2022 May 4;104(9):805-812. doi: 10.2106/JBJS.21.00892. Epub 2022 Mar 17.
Improved understanding of the morphological characteristics of knees with osteoarthritis (OA) and various deformities can enable personalized implant positioning and balancing in total knee arthroplasty in an effort to continue improving clinical outcomes and optimizing procedural value. Therefore, the purpose of this study was to outline morphological differences in the medial and lateral distal femur and proximal tibia associated with varus and valgus deformities in knee OA.
A large computed tomography (CT) database was used to identify 1,158 knees, which were divided into normal and osteoarthritic groups; the latter was further divided on the basis of deformity into neutral, varus, and valgus subgroups. Morphological measurements included the non-weight-bearing hip-knee-ankle angle (nwHKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), rotation of the posterior condylar axis (PCA) relative to the surgical transepicondylar axis (sTEA), ratio of medial to lateral posterior condylar offset, ratio of medial to lateral condylar radius, medial posterior slope (MPS), lateral posterior slope (LPS), medial coronal slope (MCS), and lateral coronal slope (LCS).
Compared with the normal group, the OA group was in overall varus (nwHKA, -2.2° ± 5.0° compared with -0.2° ± 2.4°) and had a significantly smaller MPS (8.4° ± 4.0° compared with 9.2° ± 4.0°), larger LPS (9.2° ± 3.6° compared with 7.2° ± 3.3°), and smaller MCS (82.1° ± 4.3° compared with 83.9° ± 3.3°). Differences among the OA subgroups were also observed for the MCS and LCS. Compared with the normal group, the sTEA of the OA group was less externally rotated relative to the PCA (0.3° ± 1.5° compared with 1.2° ± 1.9°), and both the condylar offset ratio (1.01 ± 0.06 compared with 1.04 ± 0.07) and the condylar radius ratio (0.98 ± 0.07 compared with 1.03 ± 0.07) were smaller. Only the condylar radius ratio showed differences among the OA subgroups, with valgus deformity associated with a larger ratio.
An analysis of CT scans of 965 healthy and 193 osteoarthritic knees revealed significant differences in PCA, condylar offset, and condylar radius as well as tibial slope in both the sagittal and coronal planes.
There is a strong need to evolve toward a more personalized treatment for osteoarthritic knees that utilizes implants and technology to help tailor total knee arthroplasty on the basis of the patient's morphologic characteristics.
更好地了解骨关节炎（OA）膝关节及各种畸形的形态特征，有助于在全膝关节置换术中实现个性化的植入物定位和平衡，从而持续改善临床效果并优化手术价值。因此，本研究的目的是概述膝关节OA中与内翻和外翻畸形相关的股骨远端和胫骨近端内外侧的形态差异。
使用一个大型计算机断层扫描（CT）数据库识别出1158个膝关节，分为正常组和骨关节炎组；后者再根据畸形情况进一步分为中立、内翻和外翻亚组。形态学测量包括非负重髋-膝-踝角（nwHKA）、机械性股骨远端外侧角（mLDFA）、胫骨近端内侧角（MPTA）、后髁轴（PCA）相对于手术经髁轴（sTEA）的旋转、后髁内外侧偏移比率、髁内外侧半径比率、内侧后倾坡度（MPS）、外侧后倾坡度（LPS）、内侧冠状坡度（MCS）和外侧冠状坡度（LCS）。
与正常组相比，OA组总体呈内翻（nwHKA为-2.2°±5.0°，而正常组为-0.2°±2.4°），且MPS显著更小（分别为8.4°±4.0°和9.2°±4.0°），LPS更大（分别为9.2°±3.6°和7.2°±3.3°），MCS更小（分别为82.1°±4.3°和83.9°±3.3°）。在OA亚组之间，MCS和LCS也存在差异。与正常组相比，OA组的sTEA相对于PCA的外旋角度更小（分别为0.3°±1.5°和1.2°±1.9°），髁偏移比率（分别为1.01±0.06和1.04±0.07）和髁半径比率（分别为0.98±0.07和1.03±0.07）均更小。仅髁半径比率在OA亚组之间存在差异，外翻畸形时该比率更大。
对965个健康膝关节和193个骨关节炎膝关节的CT扫描分析显示，在矢状面和冠状面中PCA、髁偏移、髁半径以及胫骨坡度存在显著差异。
迫切需要朝着更个性化的骨关节炎膝关节治疗方向发展，利用植入物和技术，根据患者的形态特征来定制全膝关节置换术。
