Department of Orthopaedics, Columbia University Irving Medical Center, New York, New York.
J Arthroplasty. 2023 Jun;38(6S):S196-S203. doi: 10.1016/j.arth.2023.03.042. Epub 2023 Mar 23.
It is hypothesized that suboptimal soft tissue and collateral ligament balance is a cause of patient dissatisfaction following total knee arthroplasty (TKA). This analysis examined the association between compartment pressures during TKA and patient-reported outcome measurements (PROMs).
This single-institution, retrospective cohort study of prospectively collected compartment pressure data measured during TKA comprised 145 patients who underwent surgery between 2015 and 2021 and completed 1-year follow-up PROMs. The primary outcome included pressures, in pounds (lbs), of the medial and lateral compartments in extension (5°), mid-flexion (45°), and flexion (90°), and associated PROMs. The difference been the 1-year and preoperative PROMs was used to separate the top 25% from the bottom 75% performers. Pressures were compared using Student's T-tests and multivariate linear regressions, while controlling for preoperative deformity. A subgroup analysis of the most popular implant was performed.
Higher medial compartment pressures were seen in our total cohort (Knee Society Score (KSS) mid-flexion 24 versus 18 lbs, P = .03, flexion 24 versus 17 lbs P = .01) and within our subgroup analysis (Short form- Mental (SF-M) extension 32 versus 21 lbs P = .01, KSS mid-flexion 27 versus 16 lbs P = .005, extension 31 versus 20 lbs P = .003). This trend persisted in the subgroup analysis when controlling for preoperative deformity (KSS extension +16.22 lbs P ≤ .001, mid-flexion +17.6 lbs. P = .001, and flexion +9.2 lbs, P = .005).
Several groups demonstrated higher medial versus lateral pressures. However, this pattern was not consistent across PROMs, suggesting that compartment pressures at the time of TKA are an important factor but not the sole predictor of patient satisfaction.
人们假设，全膝关节置换术（TKA）后患者不满意的原因是软组织和侧副韧带平衡不佳。本分析研究了 TKA 期间关节间隙压力与患者报告的结果测量（PROM）之间的关系。
本研究为单中心、前瞻性收集 TKA 期间关节间隙压力数据的回顾性队列研究，共纳入 145 例 2015 年至 2021 年期间接受手术并完成 1 年随访 PROM 的患者。主要结局包括伸膝（5°）、屈膝（45°）和屈膝（90°）时关节间隙的内侧和外侧压力（单位磅）以及相关的 PROM。通过使用 Student's T 检验和多元线性回归来比较压力，同时控制术前畸形。对最受欢迎的植入物进行了亚组分析。
在我们的总队列中，内侧关节间隙压力较高（膝关节学会评分（KSS）屈膝 24 磅对 18 磅，P=0.03，屈膝 24 磅对 17 磅，P=0.01），在我们的亚组分析中也是如此（简易精神状态（SF-M）伸膝 32 磅对 21 磅，P=0.01，KSS 屈膝 27 磅对 16 磅，P=0.005，伸膝 31 磅对 20 磅，P=0.003）。当控制术前畸形时，这种趋势在亚组分析中仍然存在（KSS 伸膝增加 16.22 磅，P ≤0.001，屈膝增加 17.6 磅，P=0.001，屈膝增加 9.2 磅，P=0.005）。
几个组显示出内侧压力高于外侧压力。然而，这种模式在不同的 PROM 中并不一致，这表明 TKA 时的关节间隙压力是一个重要因素，但不是患者满意度的唯一预测因素。
