Richardson Glen, Kivell Matthew J, Dunbar Michael J, Laende Elise K
Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada.
J Arthroplasty. 2024 Sep;39(9):2241-2247.e5. doi: 10.1016/j.arth.2024.04.021. Epub 2024 Apr 26.
The influence of tibial slope on tibial component migration following total knee arthroplasty has not been widely studied, although excessive posterior slope has been implicated in some failures. As implant micromotion measured with radiostereometric analysis can indicate successful fixation, the purpose of this study was to determine the associations between tibial slope, tibial component migration, and inducible displacement.
Radiostereometric analyses at 6 visits over 2 years quantified implant migration for 200 cemented total knee arthroplasties. Longitudinal data analysis examined the influence of postoperative tibial slope on implant migration (overall maximum total point motion (MTPM) migration and anterior-posterior tilt migration), accounting for age, sex, and body mass index. The correlations of tibial slope with 1-year migration, continuous migration, and inducible displacements were also examined. Additionally, the amount of change in slope was compared to migration.
The mean posterior tibial slope was 8.0° (standard deviation [SD] 3.8°) preoperatively and 3.8° (SD 3.1°) postoperatively, with a mean reduction in slope of 4.2° (SD 4.7°). Postoperative tibial slope (range 14.0° posterior slope to 3.4° anterior slope) was not associated with longitudinal overall migration (P = .671) or anterior-posterior tilt migration (P = .704). There was no association between postoperative tibial slope and migration at 1 year postoperatively (P = .441 for MTPM migration, P = .570 for tilt migration), change in migration from 1 to 2 years (P = .951), or inducible displacement (P = .970 MTPM, P = .730 tilt). The amount of change in tibial slope was also not associated with migration or inducible displacement.
Residual and change in postoperative tibial slope were not associated with implant migration into tilt or overall migration, or inducible displacement for a single implant design. These findings support positioning tibial implants in a range of slopes, which may support patient-specific approaches to implant alignment.
尽管后倾角度过大被认为与一些全膝关节置换术失败有关，但胫骨坡度对全膝关节置换术后胫骨假体移位的影响尚未得到广泛研究。由于通过放射立体测量分析测得的植入物微动可表明固定是否成功，本研究的目的是确定胫骨坡度、胫骨假体移位和诱导性移位之间的关联。
对200例骨水泥型全膝关节置换术进行了为期2年的6次随访放射立体测量分析，以量化植入物移位情况。纵向数据分析研究了术后胫骨坡度对植入物移位（总体最大总点数运动（MTPM）移位和前后倾斜移位）的影响，并考虑了年龄、性别和体重指数。还研究了胫骨坡度与1年移位、连续移位和诱导性移位之间的相关性。此外，将坡度变化量与移位情况进行了比较。
术前胫骨平均后倾角度为8.0°（标准差[SD]3.8°），术后为3.8°（SD 3.1°），平均坡度降低4.2°（SD 4.7°）。术后胫骨坡度（范围从后倾14.0°到前倾3.4°）与纵向总体移位（P = 0.671）或前后倾斜移位（P = 0.704）无关。术后胫骨坡度与术后1年移位（MTPM移位P = 0.441，倾斜移位P = 0.570）、1至2年移位变化（P = 0.951）或诱导性移位（MTPM P = 0.970，倾斜P = 0.730）之间均无关联。胫骨坡度变化量与移位或诱导性移位也无关联。
对于单一植入物设计，术后胫骨坡度的残余值和变化与植入物向倾斜方向的移位、总体移位或诱导性移位均无关联。这些发现支持在一定坡度范围内定位胫骨植入物，这可能有助于采用针对患者的植入物对线方法。
