Pflüger Patrick, Pedrazzini Alberto, Jud Lukas, Vlachopoulos Lazaros, Hodel Sandro, Fucentese Sandro F
Department of Orthopedics, Balgrist University Hospital University of Zurich Zurich Switzerland.
J Exp Orthop. 2024 Dec 30;12(1):e70128. doi: 10.1002/jeo2.70128. eCollection 2025 Jan.
The goals of this study were (1) to assess whether the preoperative difference between modalities and extent of deformity are associated with a higher difference between planned and achieved surgical correction and (2) if they yield a higher probability of intraoperative adjustments.
Retrospective single-centre analysis of patients undergoing patient-specific instrumented (PSI) total knee arthroplasty (TKA). Preoperative radiographic parameters were analysed on weightbearing (WB) long-leg radiographs (LLR) and nonweightbearing (NWB) computed tomography (CT). The 2D/3D difference was calculated as the difference between preoperative WB-LLR (2D) hip-knee-ankle angle (HKA), and NWB CT (3D) HKA. Surgical records were screened to retrieve intraoperative adjustments to the preoperative plan. Postoperative assessment was performed on WB LLR.
Two-hundred-eighty-two knees of 263 patients were analysed. The difference of postoperative achieved to planned HKA (HKA) was 2.2° ± 1.7°. The preoperative 2D HKA showed the highest correlation with HKA ( = -0.37, 95% confidence interval [CI]: -0.48 to -0.26, < 0.001). Intraoperative adjustments were performed in 60% ( = 170) of all knees. Patients with a preoperative coronal deformity of >7.8° had 10.55 higher odds for an intraoperative coronal adjustment (95% CI: 4.60-24.20, < 0.001).
The extent of deformity is associated with residual coronal deformity following PSI-TKA. Patients with extensive coronal malalignment may benefit from an adaptation of the preoperative surgical plan to avoid unintended postoperative coronal malalignment. Despite the advancements with 3D preoperative planning, intraoperative adjustments in PSI-TKA are frequently performed, in particular in patients with a higher preoperative varus/valgus deformity.
Level III.
本研究的目的是（1）评估术前不同模式与畸形程度之间的差异是否与计划手术矫正和实际手术矫正之间的较大差异相关，以及（2）它们是否会增加术中调整的可能性。
对接受定制器械（PSI）全膝关节置换术（TKA）的患者进行回顾性单中心分析。在负重（WB）长腿X线片（LLR）和非负重（NWB）计算机断层扫描（CT）上分析术前影像学参数。二维/三维差异计算为术前WB-LLR（二维）髋-膝-踝角（HKA）与NWB CT（三维）HKA之间的差异。筛查手术记录以检索对术前计划的术中调整。在WB LLR上进行术后评估。
分析了263例患者的282个膝关节。术后实际达到的HKA与计划的HKA之差为2.2°±1.7°。术前二维HKA与HKA的相关性最高（=-0.37，95%置信区间[CI]：-0.48至-0.26，<0.001）。所有膝关节中有60%（=170）进行了术中调整。术前冠状面畸形>7.8°的患者术中冠状面调整的几率高10.55倍（95%CI：4.60-24.20，<0.001）。
畸形程度与PSI-TKA术后残留冠状面畸形相关。冠状面严重排列不齐的患者可能受益于术前手术计划的调整，以避免意外的术后冠状面排列不齐。尽管术前三维规划有了进展，但PSI-TKA术中仍经常进行调整，特别是在术前内翻/外翻畸形较高的患者中。
三级。
