Hardy William R, Landy David C, Chalmers Brian P, Sabatini Franco M, Duncan Stephen T
Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2023 Jan 12;19:101083. doi: 10.1016/j.artd.2022.101083. eCollection 2023 Feb.
Additional distal femoral resection is a common technique to address a flexion contracture during primary total knee arthroplasty (TKA) but can lead to midflexion instability and patella baja. Prior reports regarding the magnitude of knee extension obtained with additional femoral resection have varied. This study sought to systematically review research describing the effect of femoral resection on knee extension and to perform meta-regression to estimate this relationship.
A systematic review was conducted using MEDLINE, PubMed, and Cochrane databases by combining the terms ("flexion contracture" OR "flexion deformity") AND ("knee arthroplasty" OR "knee replacement") to identify 481 abstracts. In total, 7 articles reporting change in knee extension after additional femoral resection or augmentation across 184 knees were included. The mean value for knee extension, its standard deviation, and the number of knees tested were recorded for each level. Meta-regression was performed using weighted mixed-effects linear regression.
Meta-regression estimated that each 1mm resected from the joint line produced a 2.5° gain of extension (95% confidence interval, 1.7 to 3.2). Sensitivity analyses excluding outlying observations estimated each 1mm resected from the joint line produced a 2.0° gain of extension (95% confidence interval, 1.9 to 2.2).
Each millimeter of additional femoral resection is likely to produce only a 2° improvement in knee extension. Thus, an additional resection of 2 mm is likely to improve knee extension by less than 5°. Alternative techniques, including posterior capsular release and posterior osteophyte resection, should be considered in correcting a flexion contracture during TKA.
在初次全膝关节置换术（TKA）中，额外的股骨远端截骨是解决屈曲挛缩的常用技术，但可能导致膝关节中屈曲不稳定和髌骨低位。先前关于额外股骨截骨后获得的膝关节伸直角度大小的报道各不相同。本研究旨在系统回顾描述股骨截骨对膝关节伸直影响的研究，并进行meta回归以估计这种关系。
通过将术语（“屈曲挛缩”或“屈曲畸形”）与（“膝关节置换术”或“膝关节置换”）相结合，使用MEDLINE、PubMed和Cochrane数据库进行系统回顾，以识别481篇摘要。总共纳入了7篇文章，报告了184个膝关节在额外股骨截骨或增加截骨后膝关节伸直的变化。记录每个水平的膝关节伸直平均值、其标准差和测试的膝关节数量。使用加权混合效应线性回归进行meta回归。
meta回归估计，从关节线每切除1mm可使伸直角度增加2.5°（95%置信区间，1.7至3.2）。排除异常观察值的敏感性分析估计，从关节线每切除1mm可使伸直角度增加2.0°（95%置信区间，1.9至2.2）。
额外的股骨截骨每毫米可能仅使膝关节伸直改善2°。因此，额外切除2mm可能使膝关节伸直改善不到5°。在TKA中纠正屈曲挛缩时，应考虑其他技术，包括后关节囊松解和后骨赘切除。
