Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641 043, India.
Musculoskelet Surg. 2023 Jun;107(2):187-196. doi: 10.1007/s12306-022-00741-2. Epub 2022 Mar 24.
The effect of osteoarthritis (OA) with tibiofemoral (TF) subluxation on patients undergoing total knee arthroplasty (TKA) has been less studied, and there have been no studies on sagittal knee subluxation which is a component of a three-dimensional problem. We aim to analyze the influence of preoperative coronal and sagittal knee subluxation with OA on other radiological parameters and the functional outcome in patients undergoing TKA.
We retrospectively reviewed the 179-consecutive primary TKA in 151 patients from January 2017 to June 2017. The radiological parameters analyzed were the mechanical tibiofemoral angle (HKA), joint line congruence angle (JLCA) and coronal tibiofemoral (CTF) subluxation in long leg films. In the lateral view, posterior tibial slope, the settlement area of the femur over the tibia and the sagittal tibiofemoral (STF) subluxation were calculated. Preoperative and postoperative knee society and knee society functional scores were documented. Multivariate regression analysis was done to determine the association of preoperative radiological parameters with coronal and sagittal TF subluxation.
The average follow-up was 31 months (2.6 years). 102 knees (57%) had CTF subluxation (< 5 mm) within normal range, and 77 knees (43%) had CTF subluxation. There was a direct correlation between the magnitude of CTF subluxation and poor preoperative functional scores compared with the non-subluxation group (p < 0.05). CTF subluxation was not associated with the magnitude of varus deformity as it is correlated more with mild deformity (odds ratio [OR] 10.07, 95% confidence interval [CI] 3.47-29.25) than with moderate and severe varus deformity. The degree of the joint line convergence angle was positively correlated with the amount of CTF subluxation (p = 0.003). STF subluxation had a significant correlation with the posterior slope (p < 0.001), but not with the magnitude of varus deformity (p = 0.26).
Coronal and sagittal tibiofemoral subluxation had a significant association with poor preoperative clinical scores. The degree of CTF subluxation reduces with the increasing magnitude of varus deformity and JLCA. STF subluxation was associated with the posterior tibial slope. Patients who underwent posterior stabilized TKA had excellent clinical outcomes irrespective of preoperative knee subluxation.
伴有胫股（TF）半脱位的骨关节炎（OA）对接受全膝关节置换术（TKA）的患者的影响研究较少，而对于矢状面膝关节半脱位（膝关节三维问题的一个组成部分）则没有研究。我们旨在分析术前冠状面和矢状面膝关节半脱位与 OA 对接受 TKA 患者其他影像学参数和功能结果的影响。
我们回顾性分析了 2017 年 1 月至 2017 年 6 月期间 151 例患者的 179 例连续初次 TKA。分析的影像学参数包括机械胫股角（HKA）、关节线吻合角（JLCA）和长腿片上的冠状 TF 半脱位（CTF）。在侧位片上，计算胫骨后倾角、股骨在胫骨上的沉降区和矢状 TF 半脱位（STF）。记录术前和术后膝关节学会和膝关节功能评分。进行多元回归分析以确定术前影像学参数与冠状面和矢状面 TF 半脱位的相关性。
平均随访 31 个月（2.6 年）。102 膝（57%）的 CTF 半脱位（<5mm）在正常范围内，77 膝（43%）有 CTF 半脱位。与非半脱位组相比，CTF 半脱位的程度与较差的术前功能评分呈直接相关（p<0.05）。CTF 半脱位与畸形程度无相关性，因为它与轻度畸形相关性更强（比值比 [OR] 10.07，95%置信区间 [CI] 3.47-29.25），而与中重度内翻畸形相关性较弱。关节线会聚角的程度与 CTF 半脱位的程度呈正相关（p=0.003）。STF 半脱位与后倾角显著相关（p<0.001），但与内翻畸形程度无关（p=0.26）。
冠状面和矢状面 TF 半脱位与术前临床评分差有显著相关性。随着内翻畸形程度和 JLCA 的增加，CTF 半脱位程度减小。STF 半脱位与胫骨后倾角相关。接受后稳定型 TKA 的患者无论术前膝关节半脱位如何，均有良好的临床效果。
