Department of Orthopaedic Surgery, University of California, San Francisco, California.
J Arthroplasty. 2022 Sep;37(9):1793-1798. doi: 10.1016/j.arth.2022.04.024. Epub 2022 Apr 22.
Despite numerous advances in the implant design and surgical technique, improvement in patient satisfaction following total knee arthroplasty (TKA) has plateaued. Various TKA alignment strategies have been introduced that impact the coronal positioning of the tibial component relative to the native joint line. This study aims to analyze if postoperative variance of the joint line from preoperative native alignment is correlated with changes in patient-reported outcomes following primary TKA.
A retrospective review of an academic center's patient population identified all primary TKAs between 2013 and 2021 with full-length, standing radiographs and patient-reported outcome measures (PROMs) data. These measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcome Measurement Information System, and Veterans RAND 12 scores. Preoperative and postoperative radiographic measurements for hip-knee angle, tibia-metaphyseal angle, tibial-axis orientation angle, and joint-line obliquity angle were recorded. Three-month, 1-year, and 2-year PROM scores were correlated with the change in degrees for each of the angles using a Spearman's correlation. A Mann-Whitney U-test was used to compare angular changes with a change in PROM scores.
One hundred and ninety nine patients (204 knees) with a mean age of 67 years were included. Average follow-up was 23 months. Three-month, 1-year, and 2-year follow-up rates were 93%, 64%, and 34%, respectively. Improvements were seen across all PROMs regardless of an angular change.
There were no clear correlations between PROMs and variation in joint line obliquity in the coronal plane. These data suggest that the magnitude of the variation in coronal tibial alignment from native alignment does not impact PROMs. Further study is indicated to correlate an angular change with functional measures.
尽管在植入物设计和手术技术方面取得了众多进展，但全膝关节置换术（TKA）后患者满意度的提高已趋于平稳。已经引入了各种 TKA 对准策略，这些策略会影响胫骨组件相对于原生关节线的冠状定位。本研究旨在分析术后关节线相对于原生对线的变化是否与初次 TKA 后患者报告的结果变化相关。
对一个学术中心的患者人群进行回顾性研究，确定了所有 2013 年至 2021 年期间的初次 TKA 患者，这些患者都有全长站立位 X 线片和患者报告的结果测量（PROM）数据。这些措施包括膝关节损伤和骨关节炎结果评分-关节置换、患者报告的结果测量信息系统和退伍军人 RAND 12 评分。记录术前和术后髋关节-膝关节角、胫骨骨干角、胫骨轴定向角和关节线倾斜角的放射学测量值。使用 Spearman 相关分析将三个月、一年和两年的 PROM 评分与每个角度的变化程度相关联。使用 Mann-Whitney U 检验比较角度变化与 PROM 评分变化的关系。
纳入了 199 例（204 膝）平均年龄为 67 岁的患者。平均随访时间为 23 个月。三个月、一年和两年的随访率分别为 93%、64%和 34%。无论角度是否发生变化，所有 PROM 都有改善。
PROM 与冠状面关节线倾斜度的变化之间没有明显的相关性。这些数据表明，冠状胫骨对线相对于原生对线的变化幅度不会影响 PROM。需要进一步的研究来将角度变化与功能测量相关联。
