Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, Texas.
J Arthroplasty. 2024 Aug;39(8S1):S206-S211. doi: 10.1016/j.arth.2024.04.057. Epub 2024 Apr 26.
Ideal target limb alignment remains a debated topic in total knee arthroplasty (TKA). We aimed to determine the effect of limb alignment correction on patient-reported outcomes and knee range of motion (ROM) following TKA.
In this retrospective analysis, patients (N = 409) undergoing primary TKA at a single institution were studied. Using full leg-length radiographs, limb alignment was measured preoperatively and postoperatively. Patients were categorized by preoperative (Preop) alignment (varus > 0°; valgus < 0°). Preop varus patients were then divided as follows based on postoperative alignment: neutral (VAR-NEUT, 0°± 2), remaining in varus (VAR-rVAR, ≥3°), and cross-over to valgus (VAR-CO, ≤-3°). Similarly, Preop valgus patients were divided as follows for postoperative alignment: neutral (VAL-NEUT, 0°± 2), remaining in valgus (VAL-rVAL, ≤-3°), and cross-over to varus (VAL-CO, ≥3°). The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement survey scores were collected at preoperatively as well as at 6 weeks, 3, 6, and 12 months postoperatively. Knee ROM was collected at 2 weeks, 6 to 12 weeks, and >6 months postoperatively. An analysis of variance repeated on time followed by a Bonferroni post hoc test was used to compare outcomes for the postoperative alignment subgroups.
Preop Varus patients: Those in the VAR-CO group (overcorrected to -4.03° ± 1.95) were observed to have lower Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at 3, 6, and 12 months postoperatively compared to those in the NEUT group (P < .05). This finding was paired with reduced ROM at 6 to 12 weeks postoperatively in the VAR-CO group compared to VAR-NEUT and VAR-rVAR (P < .05). Preop Valgus patients: Those in the VAL-rVal group (left in -4.39° ± 1.39) were observed to have reduced knee flexion at 6 to 12 weeks postoperatively compared to VAL-NEUT and VAL-CO.
These findings indicate that postoperative valgus alignment via either crossing over to valgus (VAR-CO) or remaining in valgus (VAL-rVAL) alignment may result in less preferable outcomes than correction to neutral or slightly varus alignment.
在全膝关节置换术（TKA）中，理想的目标肢体对线仍然是一个有争议的话题。我们旨在确定肢体对线校正对 TKA 后患者报告的结果和膝关节活动范围（ROM）的影响。
在这项回顾性分析中，对在一家单机构接受初次 TKA 的 409 例患者进行了研究。使用全长下肢 X 线片，在术前和术后测量肢体对线。根据术前（Preop）对线（内翻＞0°；外翻＜0°）对患者进行分类。然后，根据术后对线将术前内翻患者进一步分为以下几类：中立（VAR-NEUT，0°±2）、仍保持内翻（VAR-rVAR，≥3°）和外翻交叉（VAR-CO，≤-3°）。同样，将术前外翻患者分为以下几类用于术后对线：中立（VAL-NEUT，0°±2）、仍保持外翻（VAL-rVAL，≤-3°）和内翻交叉（VAL-CO，≥3°）。术前和术后 6 周、3、6 和 12 个月收集膝关节损伤和骨关节炎结果评分（关节置换调查评分）。术后 2 周、6 至 12 周和＞6 个月收集膝关节 ROM。采用方差分析重复时间，然后进行 Bonferroni 事后检验，比较术后对线亚组的结果。
术前内翻患者：VAR-CO 组（过度矫正至-4.03°±1.95）在术后 3、6 和 12 个月的膝关节损伤和骨关节炎结果评分（关节置换调查评分）低于 NEUT 组（P＜0.05）。这一发现与 VAR-CO 组在术后 6 至 12 周的 ROM 降低有关，与 VAR-NEUT 和 VAR-rVAR 相比，ROM 降低（P＜0.05）。术前外翻患者：VAL-rVal 组（仍保持-4.39°±1.39）在术后 6 至 12 周的膝关节屈曲度低于 VAL-NEUT 和 VAL-CO。
这些发现表明，通过外翻交叉（VAR-CO）或保持外翻（VAL-rVAL）对线的术后外翻对线可能导致不如矫正为中立或轻度内翻对线更有利的结果。
