Theeuwen D M J, Bemelmans Y F L, Boonen B, Haveman I, van der Weegen W, Schotanus M G M
Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr H vd Hoffplein 1, 6162 AG, Sittard-Geleen, the Netherlands.
Department of Orthopaedic Surgery, St. Anna Hospital, bogardeind 2, 5664 EH, Geldrop, the Netherlands.
J Clin Orthop Trauma. 2024 Dec 12;60:102834. doi: 10.1016/j.jcot.2024.102834. eCollection 2025 Jan.
After total knee arthroplasty (TKA), dissatisfaction rates are described up to 30 %. Optimal alignment of the prosthesis in TKA is believed to improve clinical outcome and survival rates. Radiological outliers after TKA are used to define this alignment. Limited evidence is available on the cumulative effect of these outliers on survival or clinical outcome. The purpose of this study is to assess whether the amount of postoperative femoral and/or tibial radiological outliers, measured in different planes, influences the survival and clinical outcome after TKA.
Prospective data were used from a previously published randomized trial, with a mean follow-up of 5-years after surgery. Data of 168 patients who received TKA were assessed. Patients were divided into four groups: 0, 1, 2 or ≥3 postoperative radiological outliers of the femoral and/or tibial component in different planes (e.g. frontal, sagittal). Revision rates were analysed and clinical outcome was assessed using PROMs. The study used a general linear model for repeated measures to compare the difference of each questionnaire over time between the groups.
No statistically significant differences were found between patients with 0, 1, 2 or ≥3 outliers regarding improvement of postoperative PROMs. Data was underpowered to detect a possible relationship between the number of outliers and the survival of the prosthesis.
The number of postoperative radiological outliers did not influence clinical outcome after TKA. High-powered studies are needed to examine the influence of these outliers on survival rates.
全膝关节置换术（TKA）后，患者不满意率高达30%。TKA中假体的最佳对线被认为可改善临床结局和生存率。TKA后的放射学异常值用于定义这种对线情况。关于这些异常值对生存率或临床结局的累积影响，现有证据有限。本研究的目的是评估在不同平面测量的术后股骨和/或胫骨放射学异常值的数量是否会影响TKA后的生存率和临床结局。
使用先前发表的一项随机试验的前瞻性数据，术后平均随访5年。对168例行TKA的患者数据进行评估。患者被分为四组：不同平面（如额面、矢状面）的股骨和/或胫骨组件术后放射学异常值为0、1、2或≥3个。分析翻修率，并使用患者报告结局量表（PROMs）评估临床结局。本研究采用重复测量的一般线性模型来比较各组间每个问卷随时间的差异。
在术后PROMs改善方面，异常值为0、1、2或≥3个的患者之间未发现统计学上的显著差异。数据不足以检测异常值数量与假体生存率之间的可能关系。
术后放射学异常值的数量并未影响TKA后的临床结局。需要开展效能强大的研究来检验这些异常值对生存率的影响。
