Department of Orthopedic Surgery, University of California, Los Angeles, 1250 16th St Suite 2100, Santa Monica, CA, 90404, USA.
David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
J Orthop Surg Res. 2023 Mar 2;18(1):157. doi: 10.1186/s13018-023-03605-y.
Little published data currently exist regarding the potential relationships between spondylolisthesis, mismatch deformity, and clinical outcomes following total knee arthroplasty (TKA). We hypothesize that preexisting spondylolisthesis will result in decreased functional outcomes after TKA.
This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure the degree of spondylolisthesis. Ninety-five TKAs were subsequently available for inclusion and divided into two groups: those with spondylolisthesis and those without. Within the spondylolisthesis cohort, pelvic incidence (PI) and lumbar lordosis (LL) were calculated on lateral radiographs to determine the difference (PI-LL). Radiographs with PI-LL > 10° were then categorized as having mismatch deformity (MD). The following clinical outcomes were compared between the groups: need for manipulation under anesthesia (MUA), total postoperative arc of motion (AOM) both pre-MUA or post-MUA/revision, incidence of flexion contracture, and a need for later revision.
Forty-nine TKAs met the spondylolisthesis criteria, while 44 did not have spondylolisthesis. There were no significant differences in gender, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with spondylolisthesis and concomitant MD were more likely to have MUA (p = 0.016), ROM < 0-120 (p < 0.014), and a decreased AOM (p < 0.02) without interventions.
Preexisting spondylolisthesis by itself may not have adverse effect clinical results following TKA. However, spondylolisthesis increases the likelihood of developing MD. In those with both spondylolisthesis and concomitant mismatch deformities, patients had statistically and clinically significantly decreased in postoperative ROM/AOM and increased need for MUA. Surgeons should consider clinical/radiographic assessments of patients with chronic back pain who present for total joint arthroplasty.
Level 3.
目前关于脊柱滑脱症、不匹配畸形与全膝关节置换术（TKA）后临床结果之间的潜在关系的文献报道较少。我们假设，脊柱滑脱症患者在接受 TKA 后功能结果会降低。
本研究回顾性比较了 2017 年 1 月至 2020 年期间进行的 933 例 TKA。排除未因原发性骨关节炎（OA）进行 TKA 或术前腰椎 X 线片无法获得/不足以测量脊柱滑脱程度的 TKA。随后纳入 95 例 TKA，分为两组：有脊柱滑脱症和无脊柱滑脱症。在脊柱滑脱症组中，在侧位 X 线片上计算骨盆入射角（PI）和腰椎前凸（LL），以确定差值（PI-LL）。然后将 PI-LL>10°的 X 线片归类为存在不匹配畸形（MD）。比较两组之间的以下临床结果：需要在全身麻醉下进行手法复位（MUA）、术前或 MUA 或翻修后的总术后活动度（AOM）、屈曲挛缩的发生率以及后期翻修的需要。
49 例 TKA 符合脊柱滑脱症标准，而 44 例 TKA 无脊柱滑脱症。两组间在性别、体重指数、术前膝关节活动度（ROM）、术前 AOM 或阿片类药物使用方面无显著差异。存在脊柱滑脱症和合并 MD 的 TKA 更有可能需要 MUA（p=0.016）、ROM<0-120（p<0.014）以及未经干预的 AOM 降低（p<0.02）。
单纯存在脊柱滑脱症本身可能不会对 TKA 后的临床结果产生不良影响。然而，脊柱滑脱症增加了发生 MD 的可能性。对于同时存在脊柱滑脱症和合并不匹配畸形的患者，术后 ROM/AOM 明显降低，需要 MUA 的几率增加。对于患有慢性背痛并接受全关节置换术的患者，外科医生应考虑进行临床/影像学评估。
3 级。
