Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan.
J Hand Surg Asian Pac Vol. 2024 Oct;29(5):397-407. doi: 10.1142/S2424835524500450. Epub 2024 Aug 30.
Accurate implant placement in the optimal position is important to obtain favourable clinical outcomes and prevent complications in total joint arthroplasty. We aimed to assess the accuracy of implant placement based on three-dimensional (3D) preoperative planning for unlinked total elbow arthroplasty (TEA) and to clarify the effect of implant placement on clinical outcomes. This study included 20 patients (22 elbows, 17 with rheumatoid arthritis and 5 with osteoarthritis, with a mean follow-up period of 47 months) who underwent TEA with an unlinked-type implant after computed tomography (CT)-based 3D preoperative planning. Implant placement was planned preoperatively and several parameters were set to reflect it intraoperatively. TEA was performed based on the plan, and postoperative CT was conducted to evaluate differences in implant placement by comparing the preoperative plan and postoperative implant placement. Furthermore, we evaluated the relationship between implant placement differences and postoperative clinical outcomes, including range of motion, Visual Analogue Scale, Mayo Elbow Performance Score 1 year after surgery and complications at the last follow-up. The mean absolute translation was within 2 mm, the mean absolute tilt was within 4°, the mean absolute rotation of the humeral component was within 4° and the mean absolute rotation of the ulnar component was 10.2° ± 6.8°. In the ulnar components, 15/22 (68%) cases were externally rotated, and the mean external rotation was 7.1° ± 10.2°. We defined the absolute ulnar component's rotational difference of more than 10° as a 'malrotation' group ( = 8) and 10° or less as a 'control' group ( = 14). We compared the clinical outcomes between both groups, however, no significant differences were observed in clinical outcomes and complications. We observed notable malrotation in the postoperative positioning of the ulnar component. Intraoperative support devices may be necessary to accurately reproduce the preoperative plan in the surgical field. Level IV (Therapeutic).
准确地将植入物放置在最佳位置对于获得良好的临床结果和预防全关节置换术并发症至关重要。我们旨在评估基于三维（3D）术前规划的非连接型全肘人工关节置换术（TEA）中植入物放置的准确性，并阐明植入物放置对临床结果的影响。本研究纳入了 20 名患者（22 个肘部，17 例类风湿关节炎，5 例骨关节炎，平均随访时间为 47 个月），他们在基于计算机断层扫描（CT）的 3D 术前规划后接受了非连接型植入物的 TEA。植入物的放置在术前进行规划，并设置了几个参数来反映术中的情况。TEA 是根据计划进行的，术后进行 CT 检查，通过比较术前计划和术后植入物的位置来评估植入物放置的差异。此外，我们评估了植入物放置差异与术后临床结果之间的关系，包括术后 1 年的活动范围、视觉模拟量表、梅奥肘部功能评分以及最后随访时的并发症。肱骨组件的平均绝对旋转为 4°以内，尺骨组件的平均绝对旋转为 10.2°±6.8°。在尺骨组件中，15/22（68%）例发生外旋，平均外旋角度为 7.1°±10.2°。我们将尺骨组件的绝对旋转差异超过 10°定义为“旋转移位”组（n=8），10°或以下定义为“对照组”（n=14）。我们比较了两组之间的临床结果，但在临床结果和并发症方面没有观察到显著差异。我们观察到术后尺骨组件的位置存在明显的旋转移位。术中可能需要支撑装置来准确地在手术区域重现术前计划。IV 级（治疗）。
