Gu Cheng, Mao Yurong, Dong Haiyan, Cui Yu, Fu Ming
Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Healthcare (Basel). 2022 Feb 23;10(3):418. doi: 10.3390/healthcare10030418.
Total knee arthroplasty (TKA) is the only effective treatment of end-stage knee osteoarthritis (OA). Lower limb neutral alignment has been a criterion to predict prosthesis life; however, there has been recent controversy over this. Some researchers believe that lower limb static alignment does not significantly affect prosthesis life and some researchers have found that dynamic mechanical alignment may affect prosthesis life, which needs to be further studied.
Eighty-seven patients with knee OA were evaluated by a three-dimensional (3D) gait analysis system before TKA and six months after TKA, dynamic mechanical alignment and basic gait parameters were then calculated. Based on the static alignment of the lower limb on the postoperative X-radiographs, they were divided into a neutral alignment group (58 cases), varus alignment group (20 cases), and valgus alignment group (9 cases). Simple linear regression was used to assess the correlation between static and dynamic alignment. One-way analysis of variance (ANOVA) was used to compare the differences in gait parameters between and within groups.
Eighty-seven patients were followed up for an average of six months after the operation. There was no significant difference in all gait parameters among the three groups after TKA. There was no correlation found between static alignment and dynamic alignment/knee adduction moment (KAM) after TKA, although patients showed a significant linear correlation before operation. There was a significant linear correlation between dynamic alignment and KAM before and after the operation.
Static alignment has no significant effect on postoperative gait function. Static alignment is no longer an effective predictor of the dynamic alignment or KAM six months after TKA, although they are correlated before TKA. The dynamic alignment allows for better prediction of KAM, which may be a risk factor for the life of the prosthesis.
全膝关节置换术（TKA）是终末期膝骨关节炎（OA）的唯一有效治疗方法。下肢中立位对线一直是预测假体使用寿命的一个标准；然而，最近对此存在争议。一些研究人员认为下肢静态对线对假体使用寿命没有显著影响，而一些研究人员发现动态力学对线可能会影响假体使用寿命，这需要进一步研究。
87例膝骨关节炎患者在TKA术前及术后6个月通过三维（3D）步态分析系统进行评估，然后计算动态力学对线和基本步态参数。根据术后X线片上的下肢静态对线情况，将他们分为中立对线组（58例）、内翻对线组（20例）和外翻对线组（9例）。采用简单线性回归评估静态对线与动态对线之间的相关性。采用单因素方差分析（ANOVA）比较组间和组内步态参数的差异。
87例患者术后平均随访6个月。TKA术后三组间所有步态参数均无显著差异。TKA术后静态对线与动态对线/膝关节内收力矩（KAM）之间未发现相关性，尽管患者术前显示出显著的线性相关性。术前和术后动态对线与KAM之间均存在显著的线性相关性。
静态对线对术后步态功能无显著影响。TKA术后6个月，静态对线不再是动态对线或KAM的有效预测指标，尽管它们在TKA术前相关。动态对线能更好地预测KAM，而KAM可能是假体使用寿命的一个风险因素。
