Chaudhary Chintan, Kothari Udit, Shah Samarth, Pancholi Deval
Department of Orthopedics, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, IND.
Department of Orthopedics, Aashray Orthopaedic Hospital, Modasa, IND.
Cureus. 2024 Jan 16;16(1):e52415. doi: 10.7759/cureus.52415. eCollection 2024 Jan.
A key to successful patient outcomes following knee procedures like total knee arthroplasty (TKA) is achieving normal knee alignment. Normal mechanical balance in the joints must be restored in order to lessen the failure rate of TKA, and precise assessment of lower extremity alignment and component location is thought to be the primary determinant of a good clinical outcome over the long term.
The aim of this study was to assess the early functional and clinical outcomes of TKA by analyzing post-operative mechanical axis and Knee Society Score (KSS) data. The study also aimed to investigate the importance of achieving neutral mechanical alignment in TKA for long-term results.
A prospective and retrospective observational study was conducted, involving 40 patients with primary osteoarthritis who underwent bilateral or unilateral TKA. Demographic information, pre-operative comorbidities, knee abnormalities, and radiographic assessment were collected. Post-operative mechanical axis and implant placement were evaluated using CT scanograms. Clinical and functional assessments were performed using the Knee Society Score at regular intervals. The KSS scores were obtained at six-month intervals following surgery. The scores were categorized as excellent, very good, good, fair, or poor based on predefined criteria.
A total of 47 knees from 40 patients were analyzed. The mean age of the study population was 65.6 years. Female patients accounted for 67.5% of the sample. The majority of patients (57.4%) achieved an excellent KSS score, followed by very good (25.5%) and good (17%) scores. The mean KSS score significantly improved from 177 points pre-surgery to 225 points post-surgery. The post-operative mechanical axis ranged from 1.1 degrees valgus to 9 degrees valgus, with a mean value of 3.5 degrees valgus. The range of motion improved from 10 to 90 degrees post-operatively, with a mean range of 0-110 degrees.
This study suggests that total knee replacement surgery resulted in positive outcomes, with most patients achieving excellent or very good scores on the Knee Society scale. Proper axial and rotational alignment of the components during TKA enhanced functional outcomes and contributed to long-term clinical success. Restoration of neutral mechanical alignment and optimal component placement may lead to lower revision rates and increased durability after TKA. Further studies with larger sample sizes are needed to validate these findings.
全膝关节置换术（TKA）等膝关节手术成功实现患者良好预后的关键在于达到正常的膝关节对线。必须恢复关节的正常力学平衡，以降低TKA的失败率，而下肢对线和假体部件位置的精确评估被认为是长期良好临床结局的主要决定因素。
本研究旨在通过分析术后力学轴线和膝关节协会评分（KSS）数据来评估TKA的早期功能和临床结局。该研究还旨在探讨TKA中实现中立力学对线对长期结果的重要性。
进行了一项前瞻性和回顾性观察性研究，纳入40例接受双侧或单侧TKA的原发性骨关节炎患者。收集了人口统计学信息、术前合并症、膝关节异常情况以及影像学评估资料。使用CT扫描图像评估术后力学轴线和假体植入位置。定期使用膝关节协会评分进行临床和功能评估。术后每隔六个月获取KSS评分。根据预先定义的标准，将评分分为优秀、非常好、良好、中等或差。
共分析了40例患者的47个膝关节。研究人群的平均年龄为65.6岁。女性患者占样本的67.5%。大多数患者（57.4%）获得了优秀的KSS评分，其次是非常好（25.5%）和良好（17%）评分。KSS评分从术前的177分显著提高到术后的225分。术后力学轴线范围为外翻1.1度至外翻9度，平均值为外翻3.5度。术后活动范围从10度改善到90度，平均范围为0至110度。
本研究表明，全膝关节置换手术产生了积极的结果，大多数患者在膝关节协会量表上获得了优秀或非常好的评分。TKA过程中假体部件正确的轴向和旋转对线改善了功能结局，并有助于长期临床成功。恢复中立力学对线和优化假体部件位置可能导致TKA术后翻修率降低和耐用性提高。需要更大样本量的进一步研究来验证这些发现。
