Micicoi Lolita, Machado Axel, Ernat Justin, Schippers Philipp, Bernard de Dompsure Régis, Bronsard Nicolas, Gonzalez Jean-François, Micicoi Grégoire
University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France.
Unité de Recherche Clinique Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France.
Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):5171-5179. doi: 10.1007/s00167-023-07588-5. Epub 2023 Sep 27.
The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.
This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman's rank correlation coefficient.
During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R = 0.06, p < 0.001) and FJS (R = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R = 0.38), IKS Knee (R = 0.17), IKS function (R = 0.34), SKV (R = 0.08), and FJS (R = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.
Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.
IV, retrospective case series.
单髁膝关节置换术（UKA）后获得的对线会影响失败风险。与机械对线相比，基于卡地亚角恢复的UKA术后运动学对线可能会改善临床结果。本研究的目的是分析采用传统技术的UKA术后植入物对线和原生膝关节恢复对临床结果的影响。
这项回顾性研究纳入了2015年至2020年期间的144例内侧UKA患者。在术前和术后进行影像学测量。异常值定义如下：Δ卡地亚角>3°（术前和术后卡地亚角之差）；ΔMPTA（内侧近端胫骨角）和术后TCA（胫骨冠状位组件角）>3°（胫骨植入物位置与术前近端胫骨畸形之间的差异）。评估膝关节损伤和骨关节炎结果评分（KOOS）、国际膝关节协会（IKS）功能和膝关节评分、遗忘关节评分（FJS）以及主观膝关节值（SKV）。对于非正态数据，使用学生t检验或非参数威尔科克森检验来比较功能评分和角度测量的术前和术后值。通过斯皮尔曼等级相关系数评估术后角度与功能结果的相关性。
在纳入期间，214例患者接受了内侧UKA，71例患者被排除，19例失访，最终纳入124例患者的144个膝关节（20例双侧UKA）进行分析，平均随访时间为54.7个月±22.1（24 - 95）。Δ卡地亚角与IKS功能（R = 0.06，p < 0.001）和FJS（R = 0.05，p < 0.01）评分显著相关。术前MPTA - TCA的Δ与KOOS（R = 0.38）、IKS膝关节（R = 0.17）、IKS功能（R = 0.34）、SKV（R = 0.08）和FJS（R = 0.37）评分显著相关（p < 0.001）。在亚组分析中，与异常值（>3°）患者相比，术前MPTA - TCA的非异常值（<3°）患者具有更好的KOOS评分（Δ = 23.5，p < 0.001）和IKS功能（Δ = 17.7，p < 0.001）。
内侧UKA术后的功能结果可能受冠状面植入物对线的影响，当将胫骨植入物放置在接近术前胫骨畸形处时，临床有轻微改善，而不是受卡地亚角恢复的影响。本系列研究表明了更个性化对线策略的意义，但这些结果还需其他对照研究来证实。
IV，回顾性病例系列。
