Winkler Tobias, Bell Louisa, Bender Alwina, Trepczynski Adam, Duda Georg N, Baur Alexander J D, Damm Philipp
Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Center for Musculoskeletal Biomechanics and Regeneration (Julius Wolff Institute), Berlin, Germany.
Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin Institute of Health Institute for Regenerative Therapies, Berlin, Germany.
Front Bioeng Biotechnol. 2023 Mar 22;11:1075357. doi: 10.3389/fbioe.2023.1075357. eCollection 2023.
Total knee arthroplasty (TKA) is a highly effective treatment for severe knee osteoarthritis that is increasingly performed in younger, more active patients. As postoperative muscular impairments may negatively affect surgical outcomes and implant longevity, functional muscle recovery gains increasing importance in meeting future patient demands. This study aimed to assess the status of periarticular muscles in the long-term follow-up after TKA and to evaluate its impact on tibio-femoral joint loads. A case series was created, with eight patients with knee osteoarthritis. All subjects received an instrumented knee implant in unilateral TKA. Native computed tomography scans, acquired pre and postoperatively, were used to evaluate distal muscle volumes and fatty infiltration. tibio-femoral joint loads were measured telemetrically during standing, walking, stair climbing and chair rising and were correlated to muscle status. Postoperatively a reduction in fatty infiltration across all periarticular muscles was pronounced. High average peak loads acted in the tibio-femoral joint ranging from 264% during stand-to-sit activities up to 341% body weight (BW) during stair descent. Fatty infiltration of the m. quadriceps femoris and hamstrings were associated with increased tibio-femoral joint contact forces during walking (r = 0.542; 0.412 and 0.766). The findings suggest that a fatty infiltration of periarticular muscles may lead to increased tibio-femoral joint contact forces. However, we only observed weak correlations between these parameters. Improvements in functional mobility and the restoration of a pain-free joint likely explain the observed postoperative reductions in fatty infiltration. Perioperative rehabilitation approaches targeting residual impairments in muscle quality could, contribute to reduced tibio-femoral joint loads and improved long-term outcomes of TKA. However, it has to be pointed out that the study included a small number of patients, which may limit its validity.
全膝关节置换术（TKA）是治疗重度膝关节骨关节炎的一种高效方法，越来越多地应用于更年轻、活动量更大的患者。由于术后肌肉功能障碍可能会对手术效果和植入物使用寿命产生负面影响，因此功能性肌肉恢复对于满足未来患者需求变得越来越重要。本研究旨在评估TKA术后长期随访期间关节周围肌肉的状态，并评估其对胫股关节负荷的影响。创建了一个病例系列，纳入了8例膝关节骨关节炎患者。所有受试者在单侧TKA手术中均接受了带传感器的膝关节植入物。术前和术后获取的原始计算机断层扫描用于评估远端肌肉体积和脂肪浸润情况。在站立、行走、爬楼梯和从椅子上起身时通过遥测法测量胫股关节负荷，并将其与肌肉状态相关联。术后，所有关节周围肌肉的脂肪浸润均明显减少。胫股关节的平均峰值负荷较高，从站立到坐下活动期间为体重的264%，到下楼梯时高达体重（BW）的341%。股四头肌和腘绳肌的脂肪浸润与行走期间胫股关节接触力增加相关（r = 0.542；0.412和0.766）。研究结果表明，关节周围肌肉的脂肪浸润可能导致胫股关节接触力增加。然而，我们仅观察到这些参数之间的弱相关性。功能活动能力的改善和无痛关节的恢复可能解释了术后观察到的脂肪浸润减少的现象。针对肌肉质量残余损伤的围手术期康复方法可能有助于降低胫股关节负荷并改善TKA的长期效果。然而，必须指出的是，该研究纳入的患者数量较少，这可能会限制其有效性。
