胫骨假体尺寸过小与非骨水泥型全膝关节置换术后假体高度移位相关：一项对111例患者进行两年随访的放射立体测量分析数据研究。
Tibial Component Undersizing Is Related to High Degrees of Implant Migration Following Cementless Total Knee Arthroplasty: A Study of Radiostereometric Analysis Data for 111 Patients with 2-Year Follow-up.
作者信息
Andersen Mikkel Rathsach, Winther Nikolaj, Lind Thomas, Schrøder Henrik, Flivik Gunnar, Petersen Michael Mørk
机构信息
Department of Orthopedics, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
出版信息
JB JS Open Access. 2023 Aug 9;8(3). doi: 10.2106/JBJS.OA.23.00032. eCollection 2023 Jul-Sep.
UNLABELLED
Radiostereometric analysis (RSA) studies have shown that the continuous migration of tibial components is predictive of aseptic loosening following total knee arthroplasty (TKA). In the present study, we investigated whether accurate sizing and placement of tibial components are related to the degree of implant migration as measured with use of RSA.
METHODS
A total of 111 patients who underwent TKA surgery with a cementless tibial component were followed for a period of 2 years postoperatively, during which implant migration was assessed with use of RSA. RSA was performed within 7 days postoperatively and after 3, 6, 12, and 24 months. Postoperative radiographs were evaluated for component size and placement in the tibia. The evaluations were performed by experienced knee surgeons who were blinded to the migration data and clinical outcomes. A multivariable linear regression analysis was conducted.
RESULTS
Continuous implant migration (i.e., migration occurring between 12 and 24 months postoperatively) had a negative association with tibial component size (coefficient [B], -0.2; 95% confidence interval [CI], -0.33 to -0.08). Subsidence was associated with the absence of posterior cortical bone support (B, -0.7; 95% CI, -1.09 to -0.28), the absence of lateral cortical bone support (B, 0.8; 95% CI, 0.29 to 1.37), frontal-plane varus malalignment (B, 0.6; 95% CI, 0.12 to 1.16), and component undersizing (B, -0.4; 95% CI, -0.06 to -0.68). Posterior tilt was associated only with undersizing (B, 0.6; 95% CI, 0.27 to 1.11).
CONCLUSIONS
Undersized cementless tibial components are at a higher risk for poor fixation with continuous migration following TKA. Therefore, a higher risk of aseptic loosening should be expected.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
未标注
放射性立体测量分析（RSA）研究表明，胫骨假体的持续移位可预测全膝关节置换术（TKA）后无菌性松动。在本研究中，我们调查了胫骨假体的精确尺寸确定和放置是否与使用RSA测量的假体移位程度相关。
方法
总共111例行TKA手术且使用非骨水泥胫骨假体的患者术后随访2年，在此期间使用RSA评估假体移位情况。RSA在术后7天内以及术后3、6、12和24个月进行。评估术后X线片上假体在胫骨中的尺寸和放置情况。评估由经验丰富的膝关节外科医生进行，他们对移位数据和临床结果不知情。进行多变量线性回归分析。
结果
假体持续移位（即术后12至24个月发生的移位）与胫骨假体尺寸呈负相关（系数[B]，-0.2；95%置信区间[CI]，-0.33至-0.08）。下沉与缺乏后皮质骨支撑（B，-0.7；95%CI，-1.09至-0.28）、缺乏外侧皮质骨支撑（B，0.8；95%CI，0.29至1.37）、额状面内翻畸形（B，0.6；95%CI，0.12至1.16）以及假体尺寸过小（B，-0.4；95%CI，-0.06至-0.68）相关。后倾仅与尺寸过小相关（B，0.6；95%CI，0.27至1.11）。
结论
尺寸过小的非骨水泥胫骨假体在TKA后发生持续移位导致固定不佳的风险更高。因此，应预期无菌性松动的风险更高。
证据水平
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
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