St John of God Hospital Subiaco and Midland Hospitals, Subiaco, Western Australia, Australia.
Perth Hip and Knee Clinic, Subiaco, Western Australia, Australia.
Knee Surg Sports Traumatol Arthrosc. 2024 May;32(5):1317-1323. doi: 10.1002/ksa.12087. Epub 2024 Mar 21.
Loose flexion gaps are associated with poor functional outcomes and instability in total knee arthroplasty (TKA). The effect of a trapezoidal flexion gap in a functionally aligned TKA remains unknown. The aim of this study was to investigate the effect of a larger lateral flexion gap in a robotic-assisted (RA), functionally aligned (FA) and cruciate-retaining (CR) TKA on clinical outcomes.
Data from 527 TKA in 478 patients from 2018 to 2020 were collected. All patients underwent an RA (MAKO, Stryker), FA and CR TKA. Gap measurements were collected intraoperatively. Patient-reported outcome measures (PROMs), pain Visual analogue score (VAS) and range of motion were collected postoperatively. Patients were also asked about the ease of stair ascent and descent and kneeling on a 5-point scale. The minimum follow-up was 2 years. Patients were stratified into three groups based on lateral flexion laxity.
At 2 years postoperatively, the group with a looser gap (3-6 mm) had higher mean PROMs when compared with the group with a gap of 2-3 mm. There were no differences detected in any other outcomes at 2 years. A total of 70.9% of patients in the group with a 3-6 mm gap reported being able to walk down a flight of stairs 'easily', compared with 56.7% in the 2-3 mm group and 54% in the <2 mm group (p = 0.04).
The study shows that a loose lateral flexion gap in functionally aligned CR TKA does not adversely affect outcomes in the short term.
Level III, retrospective cohort study.
在全膝关节置换术（TKA）中，松动的屈伸间隙与功能不良和不稳定有关。功能对线 TKA 中梯形屈伸间隙的影响尚不清楚。本研究旨在探讨机器人辅助（RA）、功能对线（FA）和保留交叉韧带（CR）TKA 中较大的外侧屈伸间隙对临床结果的影响。
收集了 2018 年至 2020 年期间 478 名患者的 527 例 TKA 数据。所有患者均接受 RA（MAKO，Stryker）、FA 和 CR TKA。术中采集间隙测量值。术后采集患者报告的结果测量（PROM）、疼痛视觉模拟评分（VAS）和活动范围。还询问患者上下楼梯和跪地的难易程度，使用 5 分制进行评分。最低随访时间为 2 年。根据外侧屈伸松弛程度，患者分为三组。
术后 2 年，松弛间隙（3-6mm）组的 PROM 平均值高于 2-3mm 组。在其他任何结果方面，两组在 2 年内均无差异。3-6mm 组中有 70.9%的患者报告能够“轻松”地走下一段楼梯，而 2-3mm 组为 56.7%，<2mm 组为 54%（p=0.04）。
研究表明，功能对线 CR TKA 中较大的外侧屈伸间隙在短期内不会对结果产生不利影响。
III 级，回顾性队列研究。
