Rak Dominik, Klann Lukas, Heinz Tizian, Anderson Philip, Stratos Ioannis, Nedopil Alexander J, Rudert Maximilian
Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074 Würzburg, Germany.
J Pers Med. 2023 Apr 30;13(5):778. doi: 10.3390/jpm13050778.
In total knee arthroplasty (TKA), functional knee phenotypes are of interest regarding surgical alignment strategies. Functional knee phenotypes were introduced in 2019 and consist of limb, femoral, and tibial phenotypes. The hypothesis of this study was that mechanically aligned (MA) TKA changes preoperative functional phenotypes, which decreases the 1-year Forgotten Joint (FJS) and Oxford Knee Score (OKS) and increases the 1-year WOMAC. All patients included in this study had end-stage osteoarthritis and were treated with a primary MA TKA, which was supervised by four academic knee arthroplasty specialists. To determine the limb, femoral, and tibial phenotype, a long-leg radiograph (LLR) was imaged preoperatively and two to three days after TKA. FJS, OKS, and WOMAC were obtained 1 year after TKA. Patients were categorized using the change in functional limb, femoral, and tibial phenotype measured on LLR, and the scores were compared between the different categories. A complete dataset of preoperative and postoperative scores and radiographic images could be obtained for 59 patients. 42% of these patients had a change of limb phenotype, 41% a change of femoral phenotype, and 24% a change of tibial phenotype of more than ±1 relative to the preoperative phenotype. Patients with more than ±1 change of limb phenotype had significantly lower median FJS (27 points) and OKS (31 points) and higher WOMAC scores (30 points) relative to the 59-, 41-, and 4-point scores of those with a 0 ± 1 change ( < 0.0001 to 0.0048). Patients with a more than ±1 change of femoral phenotype had significantly lower median FJS (28 points) and OKS (32 points) and higher WOMAC scores (24 points) relative to the 69-, 40-, and 8-point scores of those with a 0 ± 1 change ( < 0.0001). A change in tibial phenotype had no effect on the FJS, OKS, and WOMAC scores. Surgeons performing MA TKA could consider limiting coronal alignment corrections of the limb and femoral joint line to within one phenotype to reduce the risk of low patient-reported satisfaction and function at 1-year.
在全膝关节置换术（TKA）中，功能性膝关节表型对于手术对线策略具有重要意义。功能性膝关节表型于2019年被引入，包括肢体、股骨和胫骨表型。本研究的假设是，机械对线（MA）TKA会改变术前功能性表型，从而降低1年时的遗忘关节评分（FJS）和牛津膝关节评分（OKS），并提高1年时的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）。本研究纳入的所有患者均患有终末期骨关节炎，并接受了由四位学术性膝关节置换专家监督的初次MA TKA治疗。为了确定肢体、股骨和胫骨表型，术前以及TKA术后两到三天拍摄了长腿X线片（LLR）。TKA术后1年获得FJS、OKS和WOMAC评分。根据LLR测量的功能性肢体、股骨和胫骨表型的变化对患者进行分类，并比较不同类别之间的评分。可以获得59例患者术前和术后评分以及影像学图像的完整数据集。这些患者中，42%的患者肢体表型发生变化，41%的患者股骨表型发生变化，24%的患者胫骨表型相对于术前表型的变化超过±1。与变化为0±1的患者的59分、41分和4分相比，肢体表型变化超过±1的患者的FJS中位数（27分）和OKS中位数（31分）显著更低，WOMAC评分（30分）更高（P<0.0001至0.0048）。与变化为0±1的患者的69分、40分和8分相比，股骨表型变化超过±1的患者的FJS中位数（28分）和OKS中位数（32分）显著更低，WOMAC评分（24分）更高（P<0.0001）。胫骨表型的变化对FJS、OKS和WOMAC评分没有影响。进行MA TKA的外科医生可以考虑将肢体和股骨关节线的冠状面对线矫正限制在一个表型范围内，以降低患者报告的1年满意度和功能较低的风险。
