Bayoumi Tarik, Ten Noever de Brauw Gaby V, Ruderman Lindsey V, van der List Jelle P, Kerkhoffs Gino M M J, Pearle Andrew D, Zuiderbaan Hendrik A
Hospital for Special Surgery, Sports Medicine Institute, Weill Medical College of Cornell University, New York, New York, USA.
Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2024 Feb;32(2):274-286. doi: 10.1002/ksa.12043. Epub 2024 Jan 16.
This study aimed to assess phenotypic variation in the coronal plane of knees with anteromedial osteoarthritis using the functional knee phenotype classification, before and after treatment with medial unicompartmental knee arthroplasty (UKA).
The study comprised 1000 knees of 835 patients (45% females, 55% males, 90% Caucasian) who underwent medial UKA for anteromedial osteoarthritis. Pre and postoperative alignment was evaluated through the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). Knees were classified according to the functional knee phenotype system which combines limb phenotype (HKA), and femoral and tibial knee phenotypes (FMA and TMA, respectively). Restoration of prearthritic coronal alignment following medial UKA was evaluated by phenotype.
Preoperatively, 76 distinct and 25 relevant (prevalence ≥1%) functional knee phenotypes were identified, of which VAR 6°VAR 3°NEU 0° was the most common (9.4% of knees). The most prevalent limb phenotype, VAR 6°, comprised 15 distinct knee phenotypes (FMA and TMA combinations). Postoperatively, 58 distinct and 17 relevant functional knee phenotypes were observed, of which VAR 3°NEU 0°NEU 0° had the highest prevalence at 18.3%. Knees with combined tibial and femoral deformities were associated with a lower probability of restoration of prearthritic coronal alignment following medial UKA, compared to knees without extra-articular deformity, or knees with an isolated tibial or femoral deformity.
Phenotype analysis using the functional knee phenotype system demonstrated a wide diversity of coronal alignment phenotypes among knees with anteromedial osteoarthritis in a predominantly Caucasian population. Following medial UKA, a reduction from 25 preoperative to 17 postoperative relevant phenotypes was observed. Consideration of phenotypic variation can be of importance when aiming to restore prearthritic coronal alignment during medial UKA.
Level III, retrospective cohort study.
本研究旨在使用功能性膝关节表型分类法评估术前和接受内侧单髁膝关节置换术（UKA）治疗后，患有前内侧骨关节炎的膝关节在冠状面的表型变异。
该研究纳入了835例患者的1000个膝关节（女性占45%，男性占55%，90%为白种人），这些患者因前内侧骨关节炎接受了内侧UKA手术。通过髋-膝-踝角（HKA）、股骨机械角（FMA）和胫骨机械角（TMA）评估术前和术后的对线情况。根据功能性膝关节表型系统对膝关节进行分类，该系统结合了肢体表型（HKA）以及股骨和胫骨膝关节表型（分别为FMA和TMA）。通过表型评估内侧UKA术后关节炎前冠状面对线的恢复情况。
术前，识别出76种不同的和25种相关的（患病率≥1%）功能性膝关节表型，其中VAR 6°VAR 3°NEU 0°最为常见（占膝关节的9.4%）。最常见的肢体表型VAR 6°包含15种不同的膝关节表型（FMA和TMA组合）。术后，观察到58种不同的和17种相关的功能性膝关节表型，其中VAR 3°NEU 0°NEU 0°患病率最高，为18.3%。与没有关节外畸形的膝关节或仅有孤立胫骨或股骨畸形的膝关节相比，合并胫骨和股骨畸形的膝关节在内侧UKA术后恢复关节炎前冠状面对线的可能性较低。
使用功能性膝关节表型系统进行的表型分析表明，在以白种人为主的人群中，患有前内侧骨关节炎的膝关节在冠状面对线表型上存在广泛差异。内侧UKA术后，观察到相关表型从术前的25种减少到术后的17种。在内侧UKA手术中，若旨在恢复关节炎前冠状面对线，考虑表型变异可能具有重要意义。
III级，回顾性队列研究。
