Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, 6-10-1 Shiraniwadai Ikoma- city, Nara, 630-0136, Japan.
Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka-city, 545-8585, Osaka, Japan.
Int Orthop. 2024 Dec;48(12):3067-3074. doi: 10.1007/s00264-024-06337-8. Epub 2024 Oct 1.
Total knee arthroplasty (TKA) is highly effective for end-stage knee osteoarthritis, providing long-term benefits and anticipated increased prevalence. The study compares Medial Pivot TKA's (MP-TKA) historical success for varus deformities with recent findings suggesting comparable outcomes for valgus deformities. Despite prevalent use of Posterior Stabilized TKA (PS-TKA) for valgus deformities, this research explores the unexplored comparative efficacy of MP-TKA vs. PS-TKA in knee osteoarthritis patients with valgus deformity.
This single-centre cohort study focused on 57 knees in 53 patients undergoing TKA for knee osteoarthritis with valgus deformity. Conducted between January 2013 and April 2021, the study compared MP-TKA and PS-TKA. Surgeries adhered to a medial parapatellar approach and modified gap technique, with perioperative interventions for pain, bleeding, and swelling. Outcome measurements included knee joint range of motion, radiographic evaluation, patients-reported outcomes, operative time, blood laboratory tests, estimated blood loss, and postoperative adverse events, and analyzed between the two groups.
Postoperative hip-knee-ankle angles showed no significant difference between MP-TKA and PS-TKA. The pie crust technique was similarly used in both groups, and deformity correction showed no significant difference. Range of motion and clinical outcomes, measured by WOMAC and JOA scores, were comparable postoperatively. MP-TKA had a shorter surgical duration (p = 0.01), and PS-TKA exhibited higher estimated blood loss (p = 0.01) without significant complications in either group.
This pioneering study compares the outcomes of MP TKA and PS TKA in patients with valgus-deformed osteoarthritic knees. Compared to PS TKA, MP TKA shows a prolonged operative duration and increased blood loss, likely due to the requirement for patellar replacement. However, postoperative range of motion and clinical outcomes are similar. Both groups exhibit favorable midterm clinical results, supporting the viability of MP TKA for valgus deformed knees. The study, consistent in surgical approach, highlights MP TKA's effectiveness for valgus deformities.
全膝关节置换术（TKA）对于终末期膝骨关节炎非常有效，可提供长期获益，并预计其患病率会增加。本研究比较了内侧铰链膝关节置换术（MP-TKA）治疗内翻畸形的历史成功率，以及近期研究结果提示其在治疗外翻畸形方面具有相似的结果。尽管后稳定型膝关节置换术（PS-TKA）常用于治疗外翻畸形，但本研究探索了在患有外翻畸形的膝骨关节炎患者中，MP-TKA 与 PS-TKA 之间未经探索的比较疗效。
本单中心队列研究纳入了 2013 年 1 月至 2021 年 4 月期间 53 例因膝骨关节炎伴外翻畸形行 TKA 的 57 例膝关节患者。研究比较了 MP-TKA 和 PS-TKA。手术采用内侧髌旁入路和改良间隙技术，围手术期干预包括疼痛、出血和肿胀。术后评估包括膝关节活动度、影像学评估、患者报告的结果、手术时间、血液实验室检查、估计失血量和术后不良事件，并对两组进行了分析。
术后髋膝踝角在 MP-TKA 和 PS-TKA 之间无显著差异。两组均采用馅饼皮技术，且畸形矫正无显著差异。WOMAC 和 JOA 评分评估的关节活动度和临床结果在术后相似。MP-TKA 的手术时间更短（p=0.01），PS-TKA 的估计失血量更高（p=0.01），但两组均无明显并发症。
本研究比较了内侧铰链膝关节置换术和后稳定型膝关节置换术治疗外翻畸形膝骨关节炎患者的疗效。与 PS-TKA 相比，MP-TKA 的手术时间延长，失血量增加，这可能是由于需要置换髌骨。然而，术后关节活动度和临床结果相似。两组均获得了良好的中期临床结果，支持 MP-TKA 治疗外翻畸形膝关节的可行性。本研究在手术入路方面保持一致，强调了 MP-TKA 治疗外翻畸形的有效性。
