Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, China; Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, China.
School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China; Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai, China.
Comput Methods Programs Biomed. 2024 Oct;255:108330. doi: 10.1016/j.cmpb.2024.108330. Epub 2024 Jul 31.
The progression of osteoarthritis in lateral compartment has been identified as a primary complication in medial unicompartmental knee arthroplasty (UKA) revisions, irrespective of whether employing fixed bearing (FB) or mobile bearing (MB) designs. Compared to the previous contact point analyses, the tibiofemoral contacts during knee movements are comprehended by a more comprehensive understanding of joint spaces. This study aims to dynamically map the joint spaces in the lateral compartment during the single-leg lunge following FB and MB UKA procedures, and compare them with the respective contralateral native knees. It is hypothesized that the significant change in joint space for post-UKA compared to their native knees.
Twelve patients with unilateral medial FB UKA and eleven patients with unilateral medial MB UKA were included and underwent computed tomography scans. The exclusion criteria included anterior cruciate ligament deficiency, postoperative knee pain, any postoperative complications, and musculoskeletal illnesses. A dual fluoroscopic imaging system was utilized to capture the single-leg lunge, and 2D-to-3D registration facilitated the visualization of knee motion. According to the knee motions, joint spaces on tibial and femoral surfaces in the lateral compartments of native, FB, and MB UKA knees were calculated and mapped.
In comparison to the native knees, FB UKA knees exhibited significant increases in medial, lateral, central, and posterior joint spaces in the lateral compartment (p < 0.05), while MB UKA knees showed significant increases only in central and posterior joint spaces (p < 0.05). Moreover, FB UKA demonstrated greater increases in medial, central, and posterior joint spaces compared to MB UKA. Tibial varus and valgus during lunges, as well as the Oxford Knee Score (OKS) and Hip-Knee-Ankle angle (HKA), correlated with joint spaces.
Dynamic joint space analysis provided a more comprehensive insight into contact dynamics. FB UKA led to an enlargement of joint spaces, whereas MB UKA resulted in joint spaces closer to native knees. These findings contribute to understanding potential postoperative complication in UKAs.
外侧间室的骨关节炎进展已被确定为内侧单髁膝关节置换术（UKA）翻修的主要并发症，无论采用固定轴承（FB）还是活动轴承（MB）设计。与之前的接触点分析相比，膝关节运动过程中的胫股接触通过更全面地了解关节间隙来理解。本研究旨在动态绘制 FB 和 MB 单侧 UKA 手术后单腿下蹲时外侧间室的关节间隙，并将其与相应的对侧自然膝关节进行比较。假设与自然膝关节相比，UKA 后关节间隙有显著变化。
纳入 12 例单侧内侧 FB UKA 患者和 11 例单侧内侧 MB UKA 患者，并进行 CT 扫描。排除标准包括前交叉韧带缺失、术后膝关节疼痛、任何术后并发症和肌肉骨骼疾病。使用双荧光透视成像系统捕获单腿下蹲，2D-3D 配准有助于可视化膝关节运动。根据膝关节运动，计算并绘制自然、FB 和 MB UKA 膝关节外侧间室胫骨和股骨表面的关节间隙。
与自然膝关节相比，FB UKA 膝关节外侧间室的内侧、外侧、中央和后关节间隙明显增加（p < 0.05），而 MB UKA 膝关节仅中央和后关节间隙明显增加（p < 0.05）。此外，FB UKA 与 MB UKA 相比，内侧、中央和后关节间隙的增加更大。下蹲时的胫骨内翻和外翻，以及牛津膝关节评分（OKS）和髋膝踝角（HKA）与关节间隙相关。
动态关节间隙分析提供了对接触动力学更全面的了解。FB UKA 导致关节间隙扩大，而 MB UKA 导致关节间隙更接近自然膝关节。这些发现有助于了解 UKA 术后的潜在并发症。
