Department of Orthopaedic Surgery, Beijing Huairou Hospital of Beijing Traditional Chinese Medicine, Beijing, China.
Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China.
Orthop Surg. 2022 Sep;14(9):2203-2209. doi: 10.1111/os.13439. Epub 2022 Aug 17.
Predicting the successful preservation of posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) is an important step for preoperative planning to secure the satisfactory outcomes. We aimed to examine the preoperative factors predicting the successful preservation of the PCL in cruciate-retaining TKA and the outcome of sacrificing the PCL.
In this retrospective study, we analyzed TKAs consecutively performed by a single surgeon between January 2019 and August 2021 who had been preoperatively planned to undergo implantation of cruciate-retaining (CR) prostheses. The outcome of the current study was whether the PCL was retained or sacrificed. Anterior-stabilized (AS) tibial bearings when the PCL was sacrificed as needed were used intraoperatively. Age, sex, body mass index (BMI), and preoperative diagnosis from the patients' medical records were obtained. The medial-lateral width of epicondyle (MLW), the medial posterior condyle height (MPCH), the lateral posterior condyle height (LPCH), the ratio of MLW and MPCH, the ratio of MLW and LPCH, the Insall-Salvati index, and the severity of the varus or valgus deformity were measured using preoperative radiographs. Univariate and multivariate regression were fitted to assess the association of these factors with the successful retention of PCL. To examine the influence of sacrifice of the PCL on the surgical procedure, the size of the tibial and femoral components, the thickness of the polyethylene insert, and the rate of patella replacement between the CR group and AS group were also compared using t tests or chi-square tests.
Among 307 TKAs included, PCL was sacrificed with concurrent use of AS prostheses in 89 (29.0%) procedures. Knees with rheumatoid arthritis (P < 0.01), lower Insall-Salvati index (P < 0.01), and more severe varus deformity (P = 0.011) were at a higher risk of sacrificing the PCL intraoperatively. There was no significant difference in age, sex, BMI, MLW, MPCH, LPCH, ratio of MLW and MPCH, ratio of MLW and LPCH, size of the tibial and femoral components, or replacement of the patella between the CR and AS groups. Converting from CR to AS was associated with a higher risk of using a thicker polyethylene insert (P < 0.01).
Rheumatoid arthritis, lower Insall-Salvati index, and more severe varus deformity were associated with an increased risk of sacrificing the PCL in TKAs planned to undergo implantation CR prostheses. Converting to AS tibial bearing may result in a thicker polyethylene insert. These factors should be carefully considered for the appropriate selection of prosthesis type preoperatively.
预测全膝关节置换术（TKA）中后交叉韧带（PCL）的成功保留是术前规划的重要步骤，以确保满意的结果。我们旨在检查预测保留十字韧带保留型（CR）TKA 中 PCL 成功的术前因素和牺牲 PCL 的结果。
在这项回顾性研究中，我们分析了 2019 年 1 月至 2021 年 8 月间由同一位外科医生连续进行的 TKA，这些 TKA 术前计划植入 CR 假体。本研究的结果是 PCL 是否保留或牺牲。术中需要时，将使用前稳定（AS）胫骨轴承来牺牲 PCL。从患者病历中获得年龄、性别、体重指数（BMI）和术前诊断。使用术前 X 线片测量髁间外侧宽度（MLW）、内侧后髁高度（MPCH）、外侧后髁高度（LPCH）、MLW 和 MPCH 的比值、MLW 和 LPCH 的比值、Insall-Salvati 指数和内翻或外翻畸形的严重程度。使用单变量和多变量回归来评估这些因素与 PCL 成功保留的相关性。为了检查 PCL 牺牲对手术过程的影响，还使用 t 检验或卡方检验比较 CR 组和 AS 组之间胫骨和股骨组件的大小、聚乙烯插入物的厚度以及髌骨置换率。
在纳入的 307 例 TKA 中，89 例（29.0%）在术中使用 AS 假体牺牲了 PCL。类风湿关节炎（P<0.01）、较低的 Insall-Salvati 指数（P<0.01）和更严重的内翻畸形（P=0.011）的膝关节更有可能在术中牺牲 PCL。CR 组和 AS 组之间的年龄、性别、BMI、MLW、MPCH、LPCH、MLW 和 MPCH 的比值、MLW 和 LPCH 的比值、胫骨和股骨组件的大小或髌骨置换无显著差异。从 CR 转换为 AS 与使用更厚的聚乙烯插入物的风险增加相关（P<0.01）。
类风湿关节炎、较低的 Insall-Salvati 指数和更严重的内翻畸形与计划植入 CR 假体的 TKA 中 PCL 牺牲的风险增加相关。转换为 AS 胫骨轴承可能导致更厚的聚乙烯插入物。这些因素应在术前仔细考虑，以选择合适的假体类型。
