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用于评估内侧单髁膝关节置换术中旋转植入物定位的发散角的可靠性

The Reliability of the Divergence Angle for Evaluating Rotational Implant Positioning in Medial Unicompartmental Knee Replacement.

作者信息

Hardy Vincent, Garaud Marwan, Hetaimish Bandar M, Samargandi Ramy

机构信息

Orthopedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) d'Orléans, Orléans, FRA.

Orthopedic Surgery Department, Faculty of Medicine, University of Jeddah, Jeddah, SAU.

出版信息

Cureus. 2023 Aug 4;15(8):e42956. doi: 10.7759/cureus.42956. eCollection 2023 Aug.

Abstract

Background Unicompartmental knee arthroplasty (UKA) is a highly effective surgical procedure used to treat patients with osteoarthritis affecting a single knee compartment. UKA has gained significant popularity, accompanied by an expansion of its surgical indications. This increasing trend can be attributed to the consistently excellent clinical outcomes associated with UKA, which rival those achieved with total knee arthroplasty (TKA). However, despite these advancements, implant rotation malposition remains a prevalent factor contributing to early failure in UKA cases. The aim of this study is to analyze the rotational positioning of femorotibial implants in UKA and to identify an appropriate angle formed by the femoral component and the tibial component using a newly described angle. Methods This was a retrospective study of patients' data of 40 medial UKA cases of 33 patients who were operated on in our hospital between October 1998 and March 2019. The study introduces a new angle called the "divergence angle." This angle is formed between the lateral portion of the femoral component and the lateral part of the tibial component, as measured on a patellofemoral Merchant view at 30 degrees of knee flexion. The divergence angle was evaluated through radiographic assessment by two independent reviewers. Results According to statistical analysis, the divergence angle was highly reliable with both intra- and inter-observer reproducibility. Intra-observer reproducibility was excellent with an intra-class correlation coefficient (ICC) between 0.901 and 0.933 (p < 0.001). The inter-observer reproducibility was excellent with an ICC of 0.92 (p < 0.001). The Gaussian curve confirmed the normal distribution of the divergence angle values with moderate dispersion of values. The majority of the angles of divergence (85%) measured between the femoral and tibial components were less than 10 degrees (n = 34), with a mean angle of 6.3 ± 4.5°. Conclusion The divergence angle between the femoral and tibial components, measured at 30 degrees of knee flexion using the Merchant view, is an easily accessible, reliable, and reproducible method. This technique enables the assessment of the optimal rotational positioning of implants in medial UKA.

摘要

背景

单髁膝关节置换术(UKA)是一种用于治疗影响单个膝关节间室的骨关节炎患者的高效外科手术。UKA已广受欢迎,其手术适应症也在扩大。这种增长趋势可归因于UKA始终具有出色的临床效果,可与全膝关节置换术(TKA)相媲美。然而,尽管有这些进展,但植入物旋转不良仍是导致UKA病例早期失败的常见因素。本研究的目的是分析UKA中股骨胫骨植入物的旋转定位,并使用一种新描述的角度确定股骨部件和胫骨部件形成的合适角度。

方法

这是一项对1998年10月至2019年3月在我院接受手术的33例患者的40例内侧UKA病例的患者数据进行的回顾性研究。该研究引入了一个名为“发散角”的新角度。这个角度是在膝关节屈曲30度时,在髌股Merchant位片上测量股骨部件外侧部分与胫骨部件外侧部分之间形成的角度。发散角由两名独立的评估者通过影像学评估。

结果

根据统计分析,发散角在观察者内和观察者间的可重复性方面都非常可靠。观察者内可重复性极佳,组内相关系数(ICC)在0.901至0.933之间(p < 0.001)。观察者间可重复性极佳,ICC为0.92(p < 0.001)。高斯曲线证实了发散角值呈正态分布,值的离散程度适中。股骨和胫骨部件之间测量的大多数发散角(85%)小于10度(n = 34),平均角度为6.3±4.5°。

结论

使用Merchant位片在膝关节屈曲30度时测量的股骨和胫骨部件之间的发散角是一种易于获取、可靠且可重复的方法。该技术能够评估内侧UKA中植入物的最佳旋转定位。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fff4/10475295/1aea210b7b55/cureus-0015-00000042956-i01.jpg

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