Department of Orthopaedics, Carl T. Hayden Veterans' Administration Medical Center, Phoenix, Arizona.
Department of Orthopaedics, Mayo Clinic, Phoenix, Arizona.
J Arthroplasty. 2023 Jun;38(6S):S209-S214. doi: 10.1016/j.arth.2023.03.065. Epub 2023 Mar 30.
The optimal alignment technique for total knee arthroplasty (TKA) remains controversial. We previously reported 6-month and 2-year results of a randomized controlled trial comparing kinematically versus mechanically aligned TKA. In the present study, we report the mean 13-year (range, 12.6-14.4) follow-up results from this trial.
The original cohort included 88 TKAs (44 kinematically aligned using patient-specific guides and 44 mechanically aligned using conventional instrumentation), performed from 2008 to 2009. After institutional review board approval, the health records of the original 88 patients were queried. Revisions, reoperations, and complications were recorded. There were 26 patients who died, leaving 62 patients for follow-up. Of these, 48 patients (77%) were successfully contacted via phone. Reoperations and complications were documented. Furthermore, a battery of patient-reported outcome measures (PROMs) (including Western Ontario and McMaster University Index, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score Junior, Forgotten Joint Score, Modified-Single Assessment Numerical Evaluation, and patient satisfaction) were obtained.
Of the original 88 patients in the study, 15 patients had at least one reoperation (17%) and 5 patients had undergone complete revision surgery (6%). There was no difference between the 2 alignment methods for major and minor reoperations (P = .66). The kinematically aligned total knees self-reported a nonstatistically significant (P = .16) improved satisfaction (96% versus 82%), but no difference in other PROMs compared to mechanically aligned TKAs.
Kinematically aligned TKA demonstrates excellent mean 13-year results, comparable to mechanically aligned TKA with similar reoperations, complications, and PROMs.
全膝关节置换术（TKA）的最佳对线技术仍存在争议。我们之前报告了一项随机对照试验的 6 个月和 2 年结果，比较了运动学与机械对线 TKA。在本研究中，我们报告了该试验的平均 13 年（范围 12.6-14.4 年）随访结果。
原始队列包括 88 例 TKA（44 例采用患者特异性导板进行运动学对线，44 例采用常规器械进行机械对线），手术时间为 2008 年至 2009 年。经过机构审查委员会批准，查询了原始 88 例患者的健康记录。记录了翻修、再手术和并发症。有 26 例患者死亡，62 例患者可进行随访。其中 48 例（77%）通过电话成功联系。记录了再手术和并发症。此外，还获得了一系列患者报告的结果测量指标（PROMs）（包括 Western Ontario 和 McMaster 大学指数、牛津膝关节评分、膝关节损伤和骨关节炎结果评分青少年版、遗忘关节评分、改良单一评估数字评估和患者满意度）。
在研究中的原始 88 例患者中，有 15 例患者至少进行了一次翻修手术（17%），5 例患者进行了全膝关节翻修手术（6%）。两种对线方法在主要和次要翻修手术方面没有差异（P=0.66）。运动学对线的全膝关节自我报告满意度有非统计学意义的提高（96%比 82%），但与机械对线 TKA 相比，其他 PROMs 没有差异。
运动学对线 TKA 表现出优异的平均 13 年结果，与机械对线 TKA 相似，具有相似的翻修手术、并发症和 PROMs。
