Jegierski Dawid, Maciąg Bartosz Michał, Żarnovsky Krystian, Kordyaczny Tomasz, Świercz Maciej, Maciąg Grzegorz Jan, Stolarczyk Artur
Department of Orthopedics and Rehabilitation, Międzyleski Specialist Hospital, Medical University of Warsaw, Poland.
Reumatologia. 2024;62(4):235-241. doi: 10.5114/reum/190256. Epub 2024 Jul 2.
Total knee arthroplasty (TKA) is the most effective treatment of late osteoarthritis (OA) and is considered among the most successful surgical procedures in general. However, about 20% of patients remain dissatisfied. An important aspect of TKA is the proper choice of implant type - posterior stabilized (PS) or cruciate retaining (CR). Both have their indications for use based on intraoperative functional examination, but no objective radiological criteria have yet been developed. The aim of this study was to investigate the relationship between the posterior subluxation of the tibia on preoperative radiograms and implant type used.
A series of 52 patients undergoing TKA were included in the study. All patients were over 50 years old, had clinically and radiologically confirmed primary OA of grade IV on the Kellgren-Lawrence scale and were undergoing a primary total knee replacement (TKR) with a PS or CR design. Preoperative lateral radiographs were analysed retrospectively. The tibial translation ratio was calculated as a percentage of subluxation in the length of the tibial plateau.
There were no significant differences between implant types in regard to investigated parameters. However, there was a significant difference between the groups CR and PS in regard to age (68.5 [60.0-72.0] vs. 72.5 [68.0-75.0], = 0.006).
This study revealed that preoperative tibial translation does not significantly correlate with the choice of implant type and so probably not with posterior cruciate ligament (PCL) function and efficiency either. Additionally, this study showed that PCL insufficiency is related to the age of the patients, because of the more frequent choice of the PS implant type for the surgery in older patients than in the case of the CR implant type.
全膝关节置换术（TKA）是晚期骨关节炎（OA）最有效的治疗方法，总体上被认为是最成功的外科手术之一。然而，约20%的患者仍不满意。TKA的一个重要方面是正确选择植入物类型——后稳定型（PS）或保留交叉韧带型（CR）。两者都有基于术中功能检查的使用指征，但尚未制定客观的放射学标准。本研究的目的是探讨术前X线片上胫骨后脱位与所用植入物类型之间的关系。
本研究纳入了52例行TKA的患者。所有患者年龄均超过50岁，临床和放射学证实为Kellgren-Lawrence分级IV级的原发性OA，且正在接受PS或CR设计的初次全膝关节置换术（TKR）。对术前侧位X线片进行回顾性分析。胫骨平移率以胫骨平台长度半脱位的百分比计算。
在研究参数方面，植入物类型之间无显著差异。然而，CR组和PS组在年龄方面存在显著差异（68.5 [60.0 - 72.0] 对 72.5 [68.0 - 75.0]，P = 0.006）。
本研究表明，术前胫骨平移与植入物类型的选择无显著相关性，因此可能也与后交叉韧带（PCL）的功能和效率无关。此外，本研究表明PCL功能不全与患者年龄有关，因为老年患者手术中选择PS植入物类型的频率高于CR植入物类型。
