Koutserimpas Christos, Garibaldi Riccardo, Olivier Flora, Servien Elvire, Batailler Cécile, Lustig Sébastien
Department of Orthopaedics Surgery and Sports Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
Department of Orthopedic Surgery and Traumatology, Cantonal Hospital Fribourg, University of Fribourg, Fribourg, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2025 Mar 25. doi: 10.1002/ksa.12659.
Functional alignment (FA) aims to restore knee kinematics by balancing laxities and adapting implant positioning. This study evaluates safety and outcomes of >3° varus tibial positioning in patients with varus deformity undergoing robotic-assisted total knee arthroplasty (TKA).
This retrospective study included 337 patients with varus deformity undergoing robotic-assisted TKA with FA principles with a minimum of 2-year follow-up. Patients were divided into two groups based on tibial varus positioning: ≤3° varus: Group A and >3° varus: Group B. Preoperative and postoperative coronal alignment, implant positioning, and outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score (FJS) at final follow-up. The primary outcome was implants' survivorship, and secondary outcomes included complication rates and functional scores. Statistical analyses included Mann-Whitney and Chi-square tests for group comparisons, Kaplan-Meier survival analysis for implant survivorship, and multivariate regression for key covariates.
Implant survivorship was 99.4% in Group B over a median follow-up of 30 months, with one revision due to aseptic loosening and 100% in Group A (p = 0.36). The overall complication rates were 12.7% in Group A and 10.2% in B (p = 0.48). The median KSS-knee and function scores were 94.5 and 90 in Group A and 94 and 90 in B (p = 0.88 and 0.8, respectively). The final FJS was 82 in Group A and 84 in B (p = 0.8). No significant differences were observed in postoperative knee range of motion between the two groups. Multivariate regression analysis showed that none of the included covariates were statistically significant predictors of implant failure.
FA in robotic-assisted TKA with tibial positioning >3° varus seems to be safe and reliable in patients with varus deformity, demonstrating similar revision rates, implant survivorship, and outcomes compared to the ≤3° tibial varus group.
Level III.
功能对线（FA）旨在通过平衡松弛度和调整植入物位置来恢复膝关节运动学。本研究评估了在接受机器人辅助全膝关节置换术（TKA）的内翻畸形患者中，胫骨内翻定位>3°的安全性和结果。
这项回顾性研究纳入了337例接受基于FA原则的机器人辅助TKA的内翻畸形患者，随访至少2年。根据胫骨内翻定位将患者分为两组：内翻≤3°：A组和内翻>3°：B组。在最终随访时，使用膝关节协会评分（KSS）和遗忘关节评分（FJS）评估术前和术后的冠状面排列、植入物位置和结果。主要结局是植入物的生存率，次要结局包括并发症发生率和功能评分。统计分析包括用于组间比较的Mann-Whitney检验和卡方检验、用于植入物生存率的Kaplan-Meier生存分析以及用于关键协变量的多变量回归分析。
B组在中位随访30个月时植入物生存率为99.4%，有1例因无菌性松动翻修，A组为100%（p = 0.36）。A组总体并发症发生率为12.7%，B组为10.2%（p = 0.48）。A组KSS膝关节和功能评分中位数分别为94.5和90，B组为综合94和90（分别为p = 0.88和0.8）。A组最终FJS为82，B组为84（p = 0.8）。两组术后膝关节活动范围无显著差异。多变量回归分析表明，纳入的协变量均不是植入物失败的统计学显著预测因素。
在机器人辅助TKA中，胫骨定位内翻>3°的FA在患有内翻畸形的患者中似乎是安全可靠的，与胫骨内翻≤3°组相比，翻修率、植入物生存率和结果相似。
III级。
