Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Department of Orthopedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany.
Medicina (Kaunas). 2023 Oct 18;59(10):1852. doi: 10.3390/medicina59101852.
: There is an ongoing discussion about the best alignment targets in total knee arthroplasty (TKA). Mechanical alignment has been the standard in TKA for years. Alongside the development of various classification systems to describe the native alignment of the knee (knee phenotype), kinematic alignment restoring the individual phenotype of the knee has been advocated more recently. Alignment in TKA becomes even more challenging in knees with preoperative deformities such as valgus osteoarthritis. : The study retrospectively evaluated 158 knees in 135 patients who underwent TKA with a mechanical alignment target for valgus osteoarthritis. Pre- and postoperative hip knee angle, lateral distal femur angle, and medial proximal tibial angle/tibial plate angle (pre-/postoperative) were measured on standing hip-to-ankle radiographs. Knees were grouped according to the coronal plane alignment of the knee (CPAK) classification. Preoperative and postoperative range of motion and patient-related outcome measures (WOMAC, UCLA, SF-12, pain) were assessed. : There was no difference in outcome for mechanically aligned TKA between the different CPAK phenotypes, suggesting that mechanical alignment is an appropriate target for the different phenotypes analyzed in the study. Remaining valgus alignment was associated with decreased postoperative UCLA scores and decreased improvement in SF-12 scores ( = 0.011/ = 0.028). Within CPAK III, mechanical aligned TKA showed better postoperative UCLA Scores than TKA with valgus alignment ( = 0.015). The individual knee phenotype in patients with valgus osteoarthritis did not influence the outcome of mechanical aligned TKA operated with standardized soft-tissue release.
存在关于全膝关节置换术（TKA）中最佳对线目标的持续讨论。机械对线多年来一直是 TKA 的标准。随着各种分类系统的发展，以描述膝关节的固有对线（膝关节表型），最近提倡对线恢复膝关节的个体表型。在术前存在畸形的膝关节中，如外翻性骨关节炎，TKA 的对线变得更加具有挑战性。
该研究回顾性评估了 135 例患者的 158 膝，这些患者接受了外翻性骨关节炎的机械对线 TKA。术前和术后髋关节-膝关节角、外侧远端股骨角和内侧近端胫骨角/胫骨板角（术前/术后）在站立髋关节-踝关节射线照片上进行测量。根据冠状面对线（CPAK）分类对膝关节进行分组。评估术前和术后的活动范围以及与患者相关的结果测量（WOMAC、UCLA、SF-12、疼痛）。
在不同的 CPAK 表型中，机械对线 TKA 的结果没有差异，这表明机械对线是研究中分析的不同表型的合适目标。残留的外翻对线与术后 UCLA 评分降低和 SF-12 评分改善降低相关（ = 0.011/ = 0.028）。在 CPAK III 中，机械对线 TKA 显示出比外翻对线 TKA 更好的术后 UCLA 评分（ = 0.015）。在患有外翻性骨关节炎的患者中，个体膝关节表型并未影响采用标准化软组织松解术进行机械对线 TKA 的结果。
