Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, 318000, Zhejiang, P.R. China.
BMC Musculoskelet Disord. 2023 Jun 15;24(1):492. doi: 10.1186/s12891-023-06597-2.
The objective of this study was to investigate the ankle alignment alterations after the correction of knee varus deformity in MAKO robot-assisted total knee arthroplasty (MA-TKA).
A retrospective analysis was conducted for 108 patients with TKA from February 2021 to February 2022. Patients were divided into two groups based on MAKO robot involvement during the procedure: the MA-TKA group (n = 36) and the conventional manual total knee arthroplasty (CM-TKA) group (n = 72). The patients were divided into four subgroups according to the degree of surgical correction of the knee varus deformity. Seven radiological measurements were evaluated pre and post-surgery: mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), tibial plafond inclination angle (TPIA), talar inclination angle (TIA), and tibiotalar tilt angle (TTTA). TTTA is a quantitative representation of the extent of ankle incongruence.
The number of mTFA, mLDFA, and MPTA outliers in the MA-TKA group was significantly lower compared to the CM-TKA group (P<0.05). Knee varus deformity was properly corrected and the mechanical axis was restored in all patients, regardless of the treatment group. Only for varus corrections ≥ 10° did TTTA change significantly (p < 0.01) and ankle varus incongruence aggravate post-operation. The ΔTTTA correlated negatively with ΔTFA (r=-0.310,P = 0.001) and correlated positively with ΔTPIA (r = 0.490,P = 0.000). When the varus correction was ≥ 7.55°, the probability of ankle varus incongruence exacerbation increased 4.86-fold.
Compared with CM-TKA, MA-TKA osteotomy showed more precision but was unable to reduce post-operation ankle varus incongruence. When the varus correction ≥ 10°, ankle varus incongruence aggravated, while when the varus correction ≥ 7.55°, the probability of ankle varus incongruence increased 4.86-fold. This may occasion the pathogenesis of ankle pain following TKA.
本研究旨在探讨 MAKO 机器人辅助全膝关节置换术（MA-TKA）治疗膝关节内翻畸形后踝关节对线的变化。
回顾性分析 2021 年 2 月至 2022 年 2 月收治的 108 例 TKA 患者。根据手术过程中是否使用 MAKO 机器人，将患者分为 MA-TKA 组（n=36）和常规手动全膝关节置换术（CM-TKA）组（n=72）。根据膝关节内翻畸形的手术矫正程度，将患者分为 4 个亚组。术前和术后评估 7 项影像学测量指标：机械胫股角（mTFA）、机械外侧远端股骨角（mLDFA）、内侧近端胫骨角（MPTA）、外侧远端胫骨角（LDTA）、胫骨平台倾斜角（TPIA）、距骨倾斜角（TIA）和距下关节倾斜角（TTTA）。TTTA 是踝关节对线不匹配程度的定量表示。
MA-TKA 组 mTFA、mLDFA 和 MPTA 异常值的数量明显低于 CM-TKA 组（P<0.05）。所有患者的膝关节内翻畸形均得到适当矫正，力线恢复，与治疗组无关。仅当内翻矫正≥10°时，TTTA 才会发生显著变化（p<0.01），术后踝关节内翻对线不匹配加重。ΔTTTA 与 ΔTFA 呈负相关（r=-0.310，P=0.001），与 ΔTPIA 呈正相关（r=0.490，P=0.000）。当内翻矫正≥7.55°时，踝关节内翻对线不匹配加重的概率增加 4.86 倍。
与 CM-TKA 相比，MA-TKA 截骨更精确，但不能减少术后踝关节内翻对线不匹配。当内翻矫正≥10°时，踝关节内翻对线不匹配加重，而当内翻矫正≥7.55°时，踝关节内翻对线不匹配加重的概率增加 4.86 倍。这可能是 TKA 后踝关节疼痛的发病机制。
