Tarassoli Payam, Warnock Jonathan M, Lim Yoong Ping, Jagota Ishaan, Parker David
Sydney Orthopaedic Research Institute, St Leonards, Australia.
The University of Sydney, Camperdown, Australia.
Knee Surg Sports Traumatol Arthrosc. 2024 Feb;32(2):432-444. doi: 10.1002/ksa.12044. Epub 2024 Jan 31.
This study sought to examine if achieved postoperative alignment when compared to the native anatomy would lead to a difference in Patient Reported Outcome Measures (PROMs), and whether the achieved alignment could be broadly categorised by an accepted alignment strategy.
A retrospective cohort study of prospectively collected data on patients undergoing single primary or bilateral simultaneous total knee arthroplasty (TKA) was carried out. CT scans were used to determine the mean change ("delta values") between the pre and postoperative; hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle and femoral implant rotation. Femoral implant flexion and tibial implant slope were measured postoperatively. The primary outcome was the relationship of the variables to the change in KOOS pain subscale after one year. The secondary outcome was the number of knees which could be categorised postoperatively to an alignment strategy, and the mean PROMs in each cohort.
A total of 296 knees in 261 patients were available for analysis. With regards to the primary outcome, the delta values for each variable did not demonstrate any association with the change in knee injury and osteoarthritis outcome score (KOOS) pain score. Approximately 46% of knees could not be categorised to an alignment strategy based on postoperatively measured alignment, with no significant difference between each cohort with regards to the change in KOOS Pain score.
Achieved alignment does not consistently match accepted alignment strategies, and appears to confer no benefit to clinical outcomes when the native anatomy is most closely approximated, nor results in poorer outcomes in outliers. This study highlights the importance of routine three dimensional pre and postoperative imaging in clinical practice and for the valid analysis of outcomes in studies on alignment.
Level III, retrospective cohort study.
本研究旨在探讨与自然解剖结构相比，术后实现的对线是否会导致患者报告结局测量指标（PROMs）出现差异，以及实现的对线是否可以通过一种公认的对线策略进行大致分类。
对前瞻性收集的接受初次单侧或双侧同时全膝关节置换术（TKA）患者的数据进行回顾性队列研究。使用CT扫描确定术前和术后之间的平均变化（“差值”）；髋-膝-踝角、股骨远端外侧角、胫骨近端内侧角和股骨假体旋转。术后测量股骨假体屈曲和胫骨假体倾斜度。主要结局是这些变量与一年后膝关节损伤和骨关节炎疗效评分（KOOS）疼痛亚量表变化之间的关系。次要结局是术后可归类为一种对线策略的膝关节数量，以及每个队列中的平均PROMs。
共有261例患者的296个膝关节可供分析。关于主要结局，每个变量的差值与膝关节损伤和骨关节炎疗效评分（KOOS）疼痛评分的变化均无关联。根据术后测量的对线情况，约46%的膝关节无法归类为一种对线策略，各队列之间在KOOS疼痛评分变化方面无显著差异。
实现的对线并不总是与公认的对线策略相符，当最接近自然解剖结构时，似乎对临床结局没有益处，在偏离值较大的情况下也不会导致更差的结局。本研究强调了临床实践中常规三维术前和术后成像对于有效分析对线研究结局的重要性。
III级，回顾性队列研究。
