固定平台后稳定型全膝关节置换术后，术中屈膝位内侧关节间隙松弛与主观膝关节不稳的相关性。
Association of intraoperative medial joint gap laxity in the flexion position with subjective knee instability after fixed-bearing posterior-stabilised total knee arthroplasty.
作者信息
Ueyama Hideki, Nakagawa Shigeru, Minoda Yukihide, Fukunaga Kenji, Takemura Susumu, Koyanagi Junichiro, Yamamura Mitsuyoshi
机构信息
Department of Orthopedic Surgery, Osaka Rosai Hospital 1179-3 Nagasonecho, Kitaku, Sakaishi, Osaka, Japan.
Department of Orthopedic Surgery, Hanwa Memorial Hospital 3-5-8 Minamisumiyoshi, Sumiyoshiku, Osaka, Japan.
出版信息
Knee. 2024 Dec;51:65-73. doi: 10.1016/j.knee.2024.08.005. Epub 2024 Sep 5.
BACKGROUND
Postoperative subjective knee instability is an important clinical outcome after total knee arthroplasty (TKA), however the association with intraoperative soft tissue balance remains unclear. This study aimed to assess the association between intraoperative soft tissue balance and postoperative subjective knee instability in fixed-bearing posterior-stabilised (PS) TKA.
METHODS
This retrospective case-control study included 457 patients who underwent fixed-bearing PS TKA. Intra-articular distraction force was quantitatively applied to measure the gap parameters (length and angle) during surgery. The intraoperative joint gap parameters and postoperative clinical outcomes between the patients with (n = 90) and without (n = 367) subjective knee instability were compared. The risk factors for subjective postoperative knee instability were analysed using multivariate logistic regression analysis.
RESULTS
The patients with subjective knee instability demonstrated a medially wider intra-articular gap angle and worse Knee Society Score 2011 symptoms (18 vs. 21; p < 0.01), satisfaction (27 vs. 30; p < 0.01), functional activity (55 vs. 65; p < 0.01), and Forgotten Joint Score 12 items (51 vs. 65; p < 0.01) than those in the patients without subjective knee instability. The use of measured resection technique (odds ratio, 2.3; 95% CI, 1.1-4.8; p = 0.02) and the medial laxity of joint gap balance in the flexion position (odds ratio, 1.2; 95% CI, 1.0-1.4; p = 0.04) were detected as risk factors for postoperative subjective knee instability.
CONCLUSION
In fixed-bearing PS TKA, intraoperative medial joint laxity in the flexion position was associated with postoperative subjective knee instability, and surgical techniques to achieve sufficient soft tissue balance contributed to improve postoperative subjective clinical outcomes.
LEVEL OF EVIDENCE
Ⅲ (case-control study).
背景
膝关节置换术后主观膝关节不稳定是全膝关节置换术（TKA）后的一项重要临床结果，然而其与术中软组织平衡之间的关联仍不明确。本研究旨在评估固定平台后稳定型（PS）TKA术中软组织平衡与术后主观膝关节不稳定之间的关联。
方法
这项回顾性病例对照研究纳入了457例行固定平台PS TKA的患者。术中定量施加关节内牵张力以测量间隙参数（长度和角度）。比较了有（n = 90）和无（n = 367）主观膝关节不稳定患者的术中关节间隙参数和术后临床结果。采用多因素逻辑回归分析术后主观膝关节不稳定的危险因素。
结果
与无主观膝关节不稳定的患者相比，有主观膝关节不稳定的患者关节内间隙角度更宽，2011年膝关节协会症状评分更差（18分对21分；p < 0.01），满意度更低（27分对30分；p < 0.01），功能活动评分更低（55分对65分；p < 0.01），12项遗忘关节评分更低（51分对65分；p < 0.01）。测量截骨技术的使用（比值比，2.3；95%可信区间，1.1 - 4.8；p = 0.02）以及屈曲位关节间隙平衡的内侧松弛（比值比，1.2；95%可信区间，1.0 - 1.4；p = 0.04）被检测为术后主观膝关节不稳定的危险因素。
结论
在固定平台PS TKA中，术中屈曲位内侧关节松弛与术后主观膝关节不稳定相关，实现充分软组织平衡有助于改善术后主观临床结果。
证据级别
Ⅲ（病例对照研究）。
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