The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Medical School, Australian National University, Canberra, ACT, Australia.
The Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, ACT, Australia; Faculty of Health, University of Canberra, Canberra, ACT, Australia.
J Arthroplasty. 2024 Feb;39(2):343-349.e1. doi: 10.1016/j.arth.2023.08.010. Epub 2023 Aug 10.
A proportion of total knee arthroplasty (TKA) patients are dissatisfied postoperatively, particularly with their ability to perform higher-demand activities including deep-kneeling and step-up where kinematic parameters are more demanding. The purpose of this study was to examine the relationship between knee kinematics of step-up and deep-kneeling and patient-reported outcome measures following TKA.
Sixty-four patients were included at minimum 1-year follow-up. Participants performed a step-up and deep-kneeling task which was imaged via single-plane fluoroscopy. 3-dimensional prosthesis computer-aided design models were registered to the fluoroscopy, yielding in-vivo kinematic data. Associations between kinematics and patient-reported outcome measures, including Oxford Knee Score, American Knee Society Score, surgical satisfaction, and pain were assessed using log-transformed step-wise linear regressions.
A higher total Oxford Knee Score was associated with more external rotation and more adduction at maximal flexion during kneeling and more external rotation and minimum flexion during step-up. Improved American Knee Society Score was associated with increased internal-external rotation during step-up. Improved surgical satisfaction was associated with greater maximum flexion and more external rotation at maximal flexion during deep-kneeling and more femoral internal rotation at terminal extension during step-up. An improved pain score was associated with greater maximum flexion and more femoral external rotation during deep-kneeling, as well as greater internal femoral rotation during step-up.
The ability to move through full flexion/extension range and end-of-range rotation is important kinematic parameters that influence patient-reported outcome measures. Implant designs and postoperative rehabilitation should continue to focus on achieving these kinematic targets for enhanced outcomes after TKA.
部分全膝关节置换术（TKA）患者术后不满意，尤其是在进行高需求活动时，如深蹲和单腿站立，这些活动对运动学参数的要求更高。本研究旨在探讨 TKA 后单腿站立和深蹲时的膝关节运动学与患者报告的结果测量之间的关系。
64 例患者在至少 1 年的随访中被纳入。参与者进行了单腿站立和深蹲任务，该任务通过单平面荧光透视进行成像。通过将 3 维假体计算机辅助设计模型与荧光透视进行注册，得到体内运动学数据。使用对数变换逐步线性回归评估运动学与患者报告的结果测量（包括牛津膝关节评分、美国膝关节协会评分、手术满意度和疼痛）之间的关系。
更高的总牛津膝关节评分与深蹲时最大屈曲时的更多外旋和内收以及单腿站立时更多外旋和最小屈曲有关。美国膝关节协会评分的改善与单腿站立时的内外旋转增加有关。手术满意度的提高与深蹲时最大屈曲和最大屈曲时的更多外旋以及单腿站立时终末伸展时的更多股骨内旋有关。疼痛评分的改善与深蹲时的最大屈曲和更多的股骨外旋以及单腿站立时的股骨内旋转增加有关。
在全屈伸范围和末端旋转范围内运动的能力是影响患者报告的结果测量的重要运动学参数。植入物设计和术后康复应继续关注实现这些运动学目标，以提高 TKA 后的结果。
