Service de chirurgie orthopédique, Centre chirurgical Emile Gallé, Centre hospitalier universitaire de Nancy, Nancy, France.
Département de chirurgie orthopédique et de médecine du Sport, FIFA Medical Center of Excellence, hôpital de la Croix-Rousse, Centre hospitalier universitaire de Lyon, Lyon, France; Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France.
Orthop Traumatol Surg Res. 2023 Sep;109(5):103592. doi: 10.1016/j.otsr.2023.103592. Epub 2023 Mar 14.
One issue in total knee arthroplasty (TKA) is management of preoperative flexion contracture, which may be associated with poor functional outcome.
The aim of this study was to compare functional results in TKA with or without preoperative flexion contracture, treated according to a standardized algorithm of tissue release and bone cut.
A single-center retrospective case-control study was performed on prospectively collected data for the period 1987-2016. Patients with >10̊ flexion contracture were assigned to the "contracture" group and associated to a selected control group at a ratio of 1:4. Clinical analysis used pre and post-operative International Knee Society (IKS) scores. The significance threshold was set at p<0.05.
Eight hundred and forty-nine cases and 3,304 controls were included, comprising a total of 2,838 male and 1,315 female participants. Mean preoperative extension deficit was 13̊±6̊ in the contracture group and 1̊±2̊ in controls. Preoperative IKS total and functional scores were significantly poorer in the contracture group (38±18 and 54±20) than in controls (52±16 and 59±19) (p<0.001). Postoperatively, the two groups did not significantly differ in IKS functional score (77±22 vs. 79±21, p=0.143). There were differences in IKS knee score (87±12 vs. 88±13, p=0.006) and maximal flexion (114̊±14̊ vs. 119̊±13̊, p<0.0001) that were statistically, but not clinically, significant.
A systematic standardized algorithm for surgical treatment of flexion contracture during primary total knee arthroplasty provided clinical outcomes similar to those of patients without preoperative flexion contracture.
III; case-control study.
全膝关节置换术（TKA）的一个问题是术前屈曲挛缩的处理，这可能与较差的功能结果有关。
本研究的目的是比较有或无术前屈曲挛缩的 TKA 的功能结果，根据组织松解和骨截骨的标准化算法进行治疗。
对 1987 年至 2016 年期间前瞻性收集的数据进行了单中心回顾性病例对照研究。>10°屈曲挛缩的患者被分配到“挛缩”组，并与选择的对照组以 1:4 的比例相关联。临床分析采用术前和术后国际膝关节协会（IKS）评分。显著性阈值设为 p<0.05。
共纳入 849 例病例和 3304 例对照，共包括 2838 名男性和 1315 名女性参与者。挛缩组术前伸直度缺陷平均为 13°±6°，对照组为 1°±2°。挛缩组术前 IKS 总评分和功能评分明显低于对照组（38±18 和 54±20）（p<0.001）。术后，两组 IKS 功能评分无显著差异（77±22 与 79±21，p=0.143）。IKS 膝关节评分（87±12 与 88±13，p=0.006）和最大屈曲度（114°±14°与 119°±13°，p<0.0001）存在差异，但差异无统计学意义。
一种用于初次全膝关节置换术中治疗屈曲挛缩的系统标准化算法，提供了与无术前屈曲挛缩患者相似的临床结果。
III；病例对照研究。
