Sarzaeem Mohammad Mahdi, Movahedinia Mohammad, Mirahmadi Alireza, Abolghasemian Mansour, Tavakoli Mahdi, Amouzadeh Omrani Farzad
Department of Orthopedic Surgery and Traumatology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Arthroplasty. 2024 Sep;39(9):2234-2240. doi: 10.1016/j.arth.2024.03.045. Epub 2024 Mar 25.
The aim of this study was to compare the clinical results of kinematic alignment (KA) with those of mechanical alignment (MA) in single-stage bilateral total knee arthroplasty.
In this double-blinded randomized controlled trial, 65 patients who had bilateral knee osteoarthritis underwent simultaneous bilateral total knee arthroplasty. One knee was randomly selected to be operated on with the calipered-KA technique and the other with MA. The participants were assessed via the Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, and visual analog scale before the surgery and the same plus the Forgotten Joint Score at their last follow-up visit, 2 years postoperatively. Maximum knee flexion and the time reaching maximum knee flexion, named the recovery time, were also recorded. Hip-knee-ankle angle, medial proximal tibial angle, and lateral distal femoral angle were measured before and after the surgery using 3-joint-view radiographs.
At 2 years, there were significant differences between the KA and MA techniques in terms of duration of surgery, recovery time, and final Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and maximum flexion range in favor of KA (P < .05), but no significant difference in visual analog scale score or Oxford Knee Score. In patients who have a preferred knee, the KA knee was preferred over the MA knee by most patients. No prosthetic failure or revision was reported in either group.
The KA technique yields acceptable functional outcomes compared to the MA technique. The KA technique was associated with a shorter surgery time, a faster recovery time, and higher patient satisfaction in 2-year follow-ups. Larger multicenter studies with longer follow-ups are warranted to confirm these findings.
I.
本研究旨在比较单阶段双侧全膝关节置换术中运动学对线（KA）与机械学对线（MA）的临床结果。
在这项双盲随机对照试验中，65例双侧膝关节骨关节炎患者同时接受双侧全膝关节置换术。随机选择一侧膝关节采用带卡尺的KA技术进行手术，另一侧采用MA技术。在手术前通过牛津膝关节评分、西安大略和麦克马斯特大学骨关节炎指数问卷以及视觉模拟量表对参与者进行评估，在术后2年的最后一次随访时采用相同的评估方法，同时增加遗忘关节评分。还记录了最大膝关节屈曲度以及达到最大膝关节屈曲度的时间，即恢复时间。使用三联关节位X线片在手术前后测量髋-膝-踝角、胫骨近端内侧角和股骨远端外侧角。
在2年时，KA和MA技术在手术持续时间、恢复时间以及最终西安大略和麦克马斯特大学骨关节炎指数、遗忘关节评分和最大屈曲范围方面存在显著差异，KA技术更具优势（P < 0.05），但在视觉模拟量表评分或牛津膝关节评分方面无显著差异。在有偏好膝关节的患者中，大多数患者更喜欢KA技术的膝关节。两组均未报告假体失败或翻修情况。
与MA技术相比，KA技术产生了可接受的功能结果。在2年随访中，KA技术与更短的手术时间、更快的恢复时间和更高的患者满意度相关。需要进行更大规模、随访时间更长的多中心研究来证实这些发现。
I级
