Department of Orthopedic Surgery, Steward Healthcare, Flagstaff, Arizona.
Clinical Innovation, Corin, Raynham, Massachusetts.
J Knee Surg. 2024 Dec;37(14):941-948. doi: 10.1055/a-2376-7085. Epub 2024 Jul 31.
The objective of this study was to determine relationships between intraoperative posterior cruciate ligament (PCL) sacrificing posterior stabilized (PS) total knee arthroplasty (TKA) laxity measurements throughout flexion and patient outcomes at 2 years post-TKA and to define clinically relevant laxity thresholds to optimize patient outcomes.In a single-surgeon study, PCL sacrificing TKA using a robotics-assisted platform with a digital joint tensioning device was performed in 115 knees in 115 patients. Final intraoperative joint laxity was recorded, and 2-year Knee Injury and Osteoarthritis Outcome Scores (KOOSs) were obtained. A Simulated Annealing optimization algorithm was used to identify medial and lateral laxity windows which maximized the 2-year KOOS pain score. Wilcoxon nonparametric tests were used to compare outcomes between groups.Significant associations were found between intraoperative joint laxity and 2-year KOOS pain outcomes throughout flexion. Clinically relevant laxity windows were defined medially and laterally in mid-flexion and flexion for improved outcomes, whereas only a lateral laxity window could be defined in extension. When all laxity windows were satisfied, a 14.5-KOOS point improvement was found (97.2 vs. 77.8, = 0.0060) compared to knees which did not satisfy any window. Improvements in Activities of Daily Living (Δ8.8, = 0.0143), Sports (Δ22.5, = 0.0108), and Quality of Life (Δ18.7, = 0.0011) KOOS subscores were also found in knees which satisfied all windows versus 0-1 window.Intraoperative joint laxity is associated with postoperative outcomes in a PS knee design, wherein patients balanced within identified laxity targets reported improved outcomes over those that did not. Clinically significant thresholds were defined and were predominately found in mid-flexion and flexion for medial and lateral laxity. When target windows were combined further improved outcomes were identified.
本研究旨在确定术中后交叉韧带（PCL）切除后稳定型（PS）全膝关节置换术（TKA）松弛度测量值与 2 年 TKA 后患者结局之间的关系，并确定优化患者结局的临床相关松弛度阈值。在一项单外科医生研究中，对 115 名患者的 115 膝进行了使用机器人辅助平台和数字关节张力装置的 PCL 切除 TKA。记录最终术中关节松弛度，并获得 2 年膝关节损伤和骨关节炎结果评分（KOOS）。使用模拟退火优化算法确定最大化 2 年 KOOS 疼痛评分的内侧和外侧松弛度窗口。采用 Wilcoxon 非参数检验比较组间结果。在整个屈曲过程中，术中关节松弛度与 2 年 KOOS 疼痛结果之间存在显著相关性。在中屈曲和屈曲时定义了内侧和外侧的临床相关松弛度窗口，以获得更好的结果，而在伸展时只能定义外侧松弛度窗口。当所有松弛度窗口都得到满足时，与未满足任何窗口的膝关节相比，发现 KOOS 评分提高了 14.5 分（97.2 比 77.8，=0.0060）。在满足所有窗口的膝关节中，还发现日常生活活动（Δ8.8，=0.0143）、运动（Δ22.5，=0.0108）和生活质量（Δ18.7，=0.0011）的 KOOS 亚评分也有所提高。在 PS 膝关节设计中，术中关节松弛度与术后结果相关，在满足确定的松弛度目标的患者中，报告的结果优于未满足目标的患者。定义了具有临床意义的阈值，主要在中屈曲和屈曲时发现内侧和外侧松弛度的阈值。当目标窗口结合在一起时，进一步发现了更好的结果。
