Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan.
Sonoda Joint Replacement Hospital, Tokyo, Japan.
Technol Health Care. 2022;30(5):1147-1154. doi: 10.3233/THC-213535.
Total knee arthroplasty (TKA) is a widely performed procedure to alleviate pain and restore function of patients with end-stage knee osteoarthritis.
The study aim was to determine if tibia-first (TF) total knee arthroplasty (TKA) using a novel computer-assisted surgery (CAS) system can yield better anterior and posterior (AP) knee stability.
Patients with knee osteoarthritis with obvious varus knee who met the indication for and underwent TKA from May 2019 to November 2020 were included. Forty-one measured resection (MR)-TKAs and 32 TF-TKAs were compared. The varus-valgus ligament balance and joint tension at a joint center-gap setting equal to the tibial-baseplate thickness were measured, and appropriate polyethylene inserts with 0∘, 30∘, 45∘, 60∘, 90∘, and 120∘ of knee flexion were placed. A Kneelax 3 arthrometer was used to measure knee AP laxity in the postoperative anesthetized patients with 30∘ and 90∘ of knee flexion.
The horizontal gap balance was significantly closer in the TF-TKA group than the MR-TKA group for 0∘, 30∘, 45∘, and 60∘ of knee flexion. In contrast, no significant differences were observed for 90∘ and 120∘ of knee flexion. No significant differences in joint-gap tensions among all knee-flexion angles were observed. Translation was significantly smaller in the TF-TKA group than the MR-TKA group for AP laxity with 30∘ of knee flexion (8.8 ± 2.9 mm vs. 10.7 ± 3.1 mm, P= 0.0079). In contrast, no significant AP laxity was observed with 90∘ of knee flexion (7.2 ± 2.8 mm vs. 7.2 ± 3.5 mm).
TF-TKA using a novel CAS system provided better AP knee stability with close to horizontal gap balances.
全膝关节置换术（TKA）是一种广泛应用的手术方法，可减轻晚期膝关节骨关节炎患者的疼痛并恢复其膝关节功能。
本研究旨在确定使用新型计算机辅助手术（CAS）系统的胫骨优先（TF）全膝关节置换术（TKA）是否能获得更好的膝关节前后（AP）稳定性。
纳入 2019 年 5 月至 2020 年 11 月间符合 TKA 适应证并接受 TKA 的膝关节骨关节炎患者。比较了 41 例测量切除（MR）-TKA 和 32 例 TF-TKA。测量了在关节中心间隙设置等于胫骨基板厚度时的内翻-外翻韧带平衡和关节张力，并在 0°、30°、45°、60°、90°和 120°膝关节屈曲时放置合适的聚乙烯衬垫。在膝关节 30°和 90°屈曲的麻醉患者中，使用 Kneelax 3 关节测量仪测量膝关节 AP 松弛度。
在 0°、30°、45°和 60°的膝关节屈曲时，TF-TKA 组的水平间隙平衡明显比 MR-TKA 组更接近。相比之下，在 90°和 120°的膝关节屈曲时，没有观察到显著差异。在所有膝关节屈曲角度下，关节间隙张力均无显著差异。在膝关节 30°屈曲时，TF-TKA 组的 AP 松弛度的平移明显小于 MR-TKA 组（8.8±2.9mm 比 10.7±3.1mm，P=0.0079）。相反，在膝关节 90°屈曲时，AP 松弛度没有显著差异（7.2±2.8mm 比 7.2±3.5mm）。
使用新型 CAS 系统的 TF-TKA 提供了更好的膝关节 AP 稳定性，具有更接近的水平间隙平衡。
