Kim Jaehyun, Park Jai Hyung, Park Jun Hyoung, Son Dong-Wook, Ahn Ji Hyun
Department of Orthopedic Surgery, Moocheok Joeun Hospital, Paju, Republic of Korea.
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
Knee. 2022 Dec;39:253-260. doi: 10.1016/j.knee.2022.09.013. Epub 2022 Oct 22.
Implant design and surgical techniques affect postoperative knee kinematics in total knee arthroplasty (TKA). This study aimed to compare femoral roll-back between cruciate-retaining (CR) and posterior-stabilized (PS) TKA in the same knee by objectively quantifying the contact point kinematics of the tibiofemoral joint using a sensor.
In the present prospective study, we used an intraoperative sensor to compare medial and lateral roll-back during 0-120° knee flexion in 33 knees that underwent CR and PS TKA. We also examined the relationship between mediolateral balance and the lateral-to-medial roll-back ratio. We defined the contact percentage position as the vertical length to the contact point divided by the anteroposterior length of the tibial plate.
The roll-back percentage following PS TKA (19.8 ± 5.1%) was significantly higher than that after CR TKA in both the medial (19.8 ± 5.1% versus 7.1 ± 2.5%, P < 0.001) and lateral (26.8% ± 3.8% versus 18.7 ± 3.8%, P < 0.001) compartments. The medial contact pressure at 90° was significantly correlated with the increased lateral-to-medial roll-back ratio in both CR and PS TKA (both P < 0.001).
PS TKA resulted in a higher percentage of femoral roll-back in the medial and lateral compartments than CR TKA. CR TKA caused a higher lateral-to-medial roll-back ratio compared to PS TKA. To reproduce medial pivot knee motion similar to that of a normal knee, the medial soft tissue needed to be balanced more tightly than the lateral soft tissue during TKA. These findings provide some clinical evidence of TKA design selection and proper mediolateral balancing for successful TKA.
在全膝关节置换术（TKA）中，植入物设计和手术技术会影响术后膝关节运动学。本研究旨在通过使用传感器客观量化胫股关节的接触点运动学，比较同一膝关节中保留交叉韧带（CR）和后稳定型（PS）TKA的股骨后滚情况。
在本前瞻性研究中，我们使用术中传感器比较了33例接受CR和PS TKA的膝关节在0至120°膝关节屈曲过程中的内侧和外侧后滚情况。我们还研究了内外侧平衡与外侧至内侧后滚比率之间的关系。我们将接触百分比位置定义为接触点的垂直长度除以胫骨平台的前后长度。
PS TKA后的后滚百分比（19.8±5.1%）在内侧（19.8±5.1%对7.1±2.5%，P<0.001）和外侧（26.8%±3.8%对18.7±3.8%，P<0.001）间室均显著高于CR TKA后的后滚百分比。在CR和PS TKA中，90°时的内侧接触压力均与外侧至内侧后滚比率的增加显著相关（均P<0.001）。
与CR TKA相比，PS TKA在内侧和外侧间室导致更高百分比的股骨后滚。与PS TKA相比，CR TKA导致更高的外侧至内侧后滚比率。为了重现类似于正常膝关节的内侧旋转轴膝关节运动，在TKA期间，内侧软组织需要比外侧软组织更紧密地平衡。这些发现为TKA设计选择和成功进行TKA的适当内外侧平衡提供了一些临床证据。
