Demir Ekin Barış, Barça Fatih, Dinçer Abdullah, Atilla Halis Atıl, Akdoğan Mutlu, Ateş Yalım
Ankara Etlik Şehir Hastanesi Ortopedi ve Travmatoloji Kliniği, 06170 Yenimahalle, Ankara, Türkiye.
Jt Dis Relat Surg. 2025 Jan 2;36(1):129-136. doi: 10.52312/jdrs.2025.1973. Epub 2024 Dec 10.
This study aims to compare the radiographic results with and without postoperative metal augmentation in varus knee patients with primary total knee arthroplasty (TKA) with a hip-knee-ankle (HKA) angle >10° and to determine a cut-off value using radiographic parameters to predict the need for metal augmentation.
Between October 2022 and April 2024, a total of 87 knees (51 right and 36 left) of 82 patients (11 males, 71 females; mean age: 68.7±8 years; range, 53 to 86 years) who underwent primary TKA were retrospectively analyzed. The patients were divided into two groups as patients who underwent primary TKA with and without tibial metal augmentation. There were 39 patients and 42 knees in the group with metal augmentation and 43 patients and 45 knees in the group without metal augmentation. The HKA angles and amount of preoperative planned tibial resection (ETR) were evaluated. Cut-off values for preoperative HKA angle and ETR were determined using receiver operating characteristic (ROC) analysis.
The mean pre- and postoperative HKA angles were 18.98±4.42° and 6.58±3.48°, respectively and the mean ETR was 13.91±3.02 mm. Both groups were comparable in terms of postoperative HKA angles p=0.283). The mean preoperative HKA and ETR were significantly higher in TKAs with augmentation (p<0.001 for both). The probability of needing augmentation was approximately six times higher in knees with a preoperative HKA angle of >20.6° (OR=5.909, 95% CI: 2.065-16.91, p<0.001) or ETR of >12.52 mm (OR=5.816, 95% CI: 2.202-15.359, p<0.001).
In TKA with advanced varus deformity, tibial metal augment is a method that can be used to provide soft tissue balance. The need for metal augmentation should be kept in mind, particularly if the preoperative evaluation indicates that the HKA angle exceeds 20.6° or ETR exceeds 12.5 mm.
本研究旨在比较初次全膝关节置换术（TKA）中，髋-膝-踝（HKA）角>10°的内翻膝患者术后有无金属增强物时的影像学结果，并使用影像学参数确定一个截断值，以预测是否需要金属增强物。
回顾性分析2022年10月至2024年4月期间82例（11例男性，71例女性；平均年龄：68.7±8岁；范围53至86岁）接受初次TKA的患者的87个膝关节（51个右侧，36个左侧）。患者被分为两组，即接受有和没有胫骨金属增强物的初次TKA的患者。有金属增强物的组有39例患者和42个膝关节，没有金属增强物的组有43例患者和45个膝关节。评估HKA角和术前计划的胫骨切除量（ETR）。使用受试者工作特征（ROC）分析确定术前HKA角和ETR的截断值。
术前和术后HKA角的平均值分别为18.98±4.42°和6.58±3.48°，平均ETR为13.91±3.02mm。两组术后HKA角具有可比性（p=0.283）。有增强物的TKA术前HKA和ETR的平均值显著更高（两者p<0.001）。术前HKA角>20.6°（OR=5.909，95%CI：2.065-16.91，p<0.001）或ETR>12.52mm（OR=5.816，95%CI：2.202-15.359，p<0.001）的膝关节需要增强物的概率大约高出六倍。
在严重内翻畸形的TKA中，胫骨金属增强是一种可用于实现软组织平衡的方法。应牢记需要金属增强物的情况，特别是如果术前评估表明HKA角超过20.6°或ETR超过12.5mm。
