Jagota Ishaan, Twiggs Joshua, Miles Brad, Baré Jonathan V
Research and Development 360 Med Care Sydney New South Wales Australia.
Research and Development Enovis ANZ Sydney New South Wales Australia.
J Exp Orthop. 2024 Oct 26;11(4):e70039. doi: 10.1002/jeo2.70039. eCollection 2024 Oct.
Optimal reproduction of the native three-dimensional (3D) alignment in total knee arthroplasty (TKA) influences outcomes; however, much of the modern TKA alignment research, such as the coronal plane alignment of the knee (CPAK), focuses only on coronal alignment. Tibial, femoral and tibiofemoral measurements on the axial and sagittal planes were evaluated for their relationship to the arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO). These 3D anatomical measurements are also evaluated across CPAK groups.
A retrospective analysis of the 360 Med Care computed tomography (CT) database was performed. Patient CT scans were segmented and landmarked. Linear regression analysis compared 12 axial and sagittal plane measurements (representing tibial, femoral and tibiofemoral rotation, tibial slope and femoral flexion) with both aHKA and JLO. Nonparametric tests assessed these anatomical measurements across the different CPAK groups, while Cohen's delta () determined the effect size.
With a sample size of 7450 osteoarthritic knees, significant but weak relationships ( < 0.30) were observed between all 12 anatomical measurements and both aHKA and JLO. Tibiofemoral rotations between Insall's axis and both the posterior condylar and the surgical transepicondylar axes demonstrated large effect sizes ( > 0.80). However, trivial to small effect sizes ( < 0.50) were broadly observed across the 12 axial and sagittal measurements, underscoring their limited clinical significance.
While useful for describing coronal knee anatomy, CPAK phenotypes fail to differentiate tibial, femoral and tibiofemoral rotation, tibial slope or femoral flexion-crucial aspects of 3D surgical planning. Therefore, more comprehensive knee phenotyping solutions are required to guide individualised TKA alignment strategies.
Level II.
全膝关节置换术（TKA）中实现原生三维（3D）对线的最佳重现会影响手术效果；然而，许多现代TKA对线研究，如膝关节冠状面排列（CPAK），仅关注冠状面对线。评估了轴向和矢状面上的胫骨、股骨和胫股测量值与算术髋-膝-踝角（aHKA）和关节线倾斜度（JLO）之间的关系。还对不同CPAK组的这些3D解剖测量值进行了评估。
对360例医疗保健计算机断层扫描（CT）数据库进行回顾性分析。对患者的CT扫描进行分割并标记。线性回归分析将12个轴向和矢状面测量值（代表胫骨、股骨和胫股旋转、胫骨坡度和股骨屈曲）与aHKA和JLO进行比较。非参数检验评估不同CPAK组的这些解剖测量值，而科恩效应量（Cohen's delta）确定效应大小。
样本量为7450个骨关节炎膝关节，观察到所有12个解剖测量值与aHKA和JLO之间存在显著但微弱的关系（<0.30）。Insall轴与后髁轴和手术经髁轴之间的胫股旋转显示出较大的效应量（>0.80）。然而，在12个轴向和矢状面测量中广泛观察到微小至小的效应量（<0.50），这突出了它们有限的临床意义。
虽然CPAK表型有助于描述膝关节冠状面解剖结构，但未能区分胫骨、股骨和胫股旋转、胫骨坡度或股骨屈曲——这些是3D手术规划的关键方面。因此，需要更全面的膝关节表型分析解决方案来指导个体化的TKA对线策略。
二级。
