Sun Chao, Wang Chunyan, Li Jintang, Liu Chengyan, Wei Zhilin, Bi Zhiguo, Li Yeran, Li Shuqiang
Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Jilin University, Changchun, China.
Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Jilin University, Changchun, China.
Orthop Surg. 2025 May;17(5):1397-1405. doi: 10.1111/os.70025. Epub 2025 Mar 19.
In patients with varus deformity of the knee, the redistribution of the subchondral bone mineral density (BMD) of the tibia leads to sclerotic zones that may cause osteoarthritis. Drilling the sclerotic area of the tibia prior to cementing during total knee arthroplasty is advisable practice. However, the extent of the sclerotic area and the effect of drilling on the tibial component are not well defined. We aimed to quantify the BMD and sclerotic bone distribution of the knee to clarify the effect of drilling on the stability of the prosthesis.
Our retrospective cohort study enrolled a total of 97 patients from December 2018 to December 2019, categorized into drilled and nondrilled groups, with their computed tomography (CT) knee joint images documented. The proximal tibia image was divided into nine regions, the BMD of each region calculated, and CT values compared between the affected and normal sides. We established finite element models to analyze the drilling and stress distribution. The differences in CT values were assessed using the paired t test and Wilcoxon signed-rank test.
The mean thickness of sclerotic bone was 7.7 ± 1.4 mm, and the surface area was 441.9 ± 89.4 mm. The CT values of the affected anteromedial, anterolateral, mediomedial, mediolateral, posteromedial, posteromedian, and posterolateral tibial areas were significantly higher than their normal counterparts. Stress concentration around the boreholes in all finite element models is minimal, with stress values ranging from 0.01 to 3.73 MPa, markedly lower than the 13.93 MPa observed in the undrilled model.
Abnormal stress in the proximal tibia alters the distribution pattern of BMD, and drilling in the sclerotic area is associated with improved prosthesis stability.
在膝内翻畸形患者中，胫骨软骨下骨矿物质密度（BMD）的重新分布会导致硬化区，可能引发骨关节炎。在全膝关节置换术中，在骨水泥固定前对胫骨硬化区域进行钻孔是一种可取的做法。然而，硬化区域的范围以及钻孔对胫骨部件的影响尚不明确。我们旨在量化膝关节的骨密度和硬化骨分布，以阐明钻孔对假体稳定性的影响。
我们的回顾性队列研究共纳入了2018年12月至2019年12月期间的97例患者，分为钻孔组和未钻孔组，并记录了他们的膝关节计算机断层扫描（CT）图像。将胫骨近端图像分为九个区域，计算每个区域的骨密度，并比较患侧和正常侧的CT值。我们建立了有限元模型来分析钻孔和应力分布。使用配对t检验和Wilcoxon符号秩检验评估CT值的差异。
硬化骨的平均厚度为7.7±1.4mm，表面积为441.9±89.4mm。患侧胫骨前内侧、前外侧、中内侧、中外侧、后内侧、后正中及后外侧区域的CT值显著高于正常对应区域。所有有限元模型中钻孔周围的应力集中最小，应力值范围为0.01至3.73MPa，明显低于未钻孔模型中观察到的13.93MPa。
胫骨近端的异常应力改变了骨密度的分布模式，在硬化区域进行钻孔与改善假体稳定性相关。
