Sydney Knee Specialists, Suite 201, Level 2, 131 Princes Hwy, Kogarah, NSW, 2217, Australia.
CPAK Research Group, Sydney, Australia.
Knee Surg Sports Traumatol Arthrosc. 2022 Sep;30(9):2980-2990. doi: 10.1007/s00167-022-07038-8. Epub 2022 Jul 11.
Kinematically aligned total knee arthroplasty (KA TKA) relies on precise determination of constitutional alignment to set resection targets. The arithmetic hip-knee-ankle angle (aHKA) is a radiographic method to estimate constitutional alignment following onset of arthritis. Intraoperatively, constitutional alignment may also be approximated using navigation-based angular measurements of deformity correction, termed the stressed HKA (sHKA). This study aimed to investigate the relationship between these methods of estimating constitutional alignment to better understand their utility in KA TKA.
A radiological and intraoperative computer-assisted navigation study was undertaken comparing measurements of the aHKA using radiographs and computed tomography (CT-aHKA) to the sHKA in 88 TKAs meeting the inclusion criteria. The primary outcome was the difference in the paired means between the three methods to determine constitutional alignment (aHKA, CT-aHKA, sHKA). Secondary outcomes included testing agreement across measurements using Bland-Altman plots and analysis of subgroup differences based on different patterns of compartmental arthritis.
There were no statistically significant differences between any paired comparison or across groups (aHKA vs. sHKA: 0.1°, p = 0.817; aHKA vs. CT-aHKA: 0.3°, p = 0.643; CT-aHKA vs. sHKA: 0.2°, p = 0.722; ANOVA, p = 0.845). Bland-Altman plots were consistent with good agreement for all comparisons, with approximately 95% of values within limits of agreement. There was no difference in the three paired comparisons (aHKA, CT-aHKA, and sHKA) for knees with medial compartment arthritis. However, these findings were not replicated in knees with lateral compartment arthritis.
There was no significant difference between the arithmetic HKA (whether obtained using CT or radiographs) and the stressed HKA in this analysis. These findings further validate the preoperative arithmetic method and support use of the intraoperative stressed HKA as techniques to restore constitutional lower limb alignment in KA TKA.
III.
运动学对线全膝关节置换术（KA TKA）依赖于精确确定固有对线来设定切除目标。关节成形术后的解剖髋膝踝角（aHKA）是一种用于估计固有对线的放射学方法。术中，也可以使用基于导航的畸形校正角度测量来近似固有对线，称为应力 HKA（sHKA）。本研究旨在探讨这些估计固有对线的方法之间的关系，以更好地理解它们在 KA TKA 中的应用。
对符合纳入标准的 88 例 TKA 进行了放射学和术中计算机辅助导航研究，比较了使用 X 线片和计算机断层扫描（CT-aHKA）测量的 aHKA 与 sHKA 之间的关系。主要结果是确定固有对线的三种方法（aHKA、CT-aHKA、sHKA）的配对均值之间的差异。次要结果包括使用 Bland-Altman 图测试各测量值之间的一致性，并根据不同的关节间隙关节炎模式分析亚组差异。
任何配对比较或组间均无统计学差异（aHKA 与 sHKA：0.1°，p=0.817；aHKA 与 CT-aHKA：0.3°，p=0.643；CT-aHKA 与 sHKA：0.2°，p=0.722；ANOVA，p=0.845）。Bland-Altman 图表明所有比较均具有良好的一致性，约 95%的数值在可接受范围内。在膝关节内侧间室关节炎患者中，三种配对比较（aHKA、CT-aHKA 和 sHKA）之间无差异。然而，这些发现不能复制到外侧间室关节炎的膝关节中。
在本分析中，算术 HKA（无论是使用 CT 还是 X 线片获得）与应力 HKA 之间无显著差异。这些发现进一步验证了术前的算术方法，并支持在 KA TKA 中使用术中的应力 HKA 作为恢复固有下肢对线的技术。
III 级。
