Inokuchi Takao, Muratsu Hirotsugu, Kamenaga Tomoyuki, Tsubosaka Masanori, Nakano Naoki, Hayashi Shinya, Kuroda Ryosuke, Matsumoto Tomoyuki
Department of Orthopaedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Knee Surg Sports Traumatol Arthrosc. 2025 Jan;33(1):296-307. doi: 10.1002/ksa.12327. Epub 2024 Jun 21.
The study aimed to determine the impact of intraoperative lateral laxity at extension on clinical and functional outcomes 1 year after posterior-stabilised total knee arthroplasty (PS-TKA).
In total, 91 varus-type osteoarthritic knees that underwent PS-TKA using the medial preservation gap technique were included. After the femoral trial component placement and patellofemoral joint reduction, the soft-tissue balance was assessed using an offset-type tensor with a 40-lb joint-distraction force. Patients were divided into the following three groups according to the intraoperative lateral laxity at extension (i.e., varus ligament balance) using the mean ± 1 standard deviation: Groups A, ≤0°; B, 0-4°; and C, >4°. The 2011 Knee Society Score (KSS) and 3-m timed up-and-go test (TUG) time 1-year postoperatively, and their improvements were compared among the groups.
While significant improvements were observed in all subscales of the 2011 KSS and TUG post-TKA (p < 0.05), the improvement of functional activities and TUG time were significantly lower in Group C than in Group B (p < 0.05). However, no significant differences were observed in symptom improvement, patient satisfaction or patient expectation scores among the groups.
An excessive lateral laxity (varus angle) >4° at extension was associated with lower improvement in functional ability 1-year postoperatively. Therefore, excessive intraoperative lateral laxity should be avoided in PS-TKA.
Level IV.
本研究旨在确定后稳定型全膝关节置换术（PS-TKA）后1年，术中伸直位外侧松弛对临床和功能结局的影响。
总共纳入91例采用内侧保留间隙技术行PS-TKA的内翻型骨关节炎膝关节。在股骨试模组件放置和髌股关节复位后，使用具有40磅关节牵张力的偏置型张量评估软组织平衡。根据术中伸直位外侧松弛度（即内翻韧带平衡），采用均值±1标准差将患者分为以下三组：A组，≤0°；B组，0-4°；C组，>4°。比较术后1年时的2011年膝关节协会评分（KSS）和3米计时起立行走测试（TUG）时间，以及各组之间的改善情况。
虽然TKA后2011年KSS和TUG的所有子量表均有显著改善（p<0.05），但C组的功能活动改善和TUG时间显著低于B组（p<0.05）。然而，各组之间在症状改善、患者满意度或患者期望评分方面未观察到显著差异。
伸直位时外侧松弛过度（内翻角度）>4°与术后1年功能能力改善较低相关。因此，PS-TKA术中应避免外侧松弛过度。
四级。
