Innocenti Matteo, Leggieri Filippo, Stimolo Davide, Civinini Alessandro, Matassi Fabrizio, Civinini Roberto
Department of Clinical Orthopaedics, University of Florence, Florence, Italy.
J Arthroplasty. 2025 May 9. doi: 10.1016/j.arth.2025.05.011.
Sagittal imbalance leads to adjustments in the pelvis, hips, and knees to keep a level gaze with minimal energy use. People who have a stiff spine adjust their posture by extending their hips, bending their knees, and tilting their pelvis back. This study hypothesized that type IIB spino-pelvic imbalance may influence the occurrence of flexion contracture after total knee arthroplasty (TKA).
We retrospectively evaluated all patients who received a robotic-assisted TKA between 2019 and 2024 at a single center.
patients who had a postoperative range of motion (ROM) > 90°, a residual postoperative flexion contracture > 0°, and a final surgery report from the robotic platform confirming full extension at the end of the surgery.
hip osteoarthritis or arthroplasty, preoperative stiff knees (full ROM < 70°), and limb length discrepancy > 1 cm. Patients were divided into the IA-IB-IIA-IIB categories according to the 2021 Journal of the American Academy of Orthopaedic Surgeons spino-pelvic classification. There were two different knee surgeons who meticulously measured the residual flexion contracture with a goniometer. Linear regressions were used to assess whether spino-pelvic alignment would be associated with flexion contracture. Logistic regressions assessed whether a type IIB independently predicted residual flexion contracture. Preoperative ROM, hip-knee-ankle angle, age, and body mass index were set as potential confounders. The model's fit was assessed using the Hosmer-Lemeshow (P > 0.43).
A total of 112 patients were included. The postoperative median flexion contracture was two (interquartiles range, one to four) in Cohort 1 and 10 (interquartiles range 7.2 to 14) at the final follow-up. There were 31 patients who were type IA (27.7%), 20 patients (17.9%) type IB, eight patients (7.1%) IIA, and 53 patients (47.3%) IIB. A higher incidence of residual flexion contracture was found in IIB patients (24.1, P < 0.001). Logistic regression revealed IIB as an independent predictor of postoperative flexion contracture (B = 0.7, SE = 0.3, Wald = 5.6, P = 0.016, 95% confidence interval= 4.3 to 6.9).
The sagittal spino-pelvic alignment is a predictor of residual postoperative flexion contracture following TKA.
矢状面失衡会导致骨盆、髋关节和膝关节进行调整，以保持水平视线并尽量减少能量消耗。脊柱僵硬的人会通过伸展髋关节、弯曲膝关节和向后倾斜骨盆来调整姿势。本研究假设IIB型脊柱-骨盆失衡可能会影响全膝关节置换术（TKA）后屈曲挛缩的发生。
我们回顾性评估了2019年至2024年在单一中心接受机器人辅助TKA的所有患者。
术后活动范围（ROM）>90°、术后残留屈曲挛缩>0°且机器人平台的最终手术报告证实手术结束时完全伸直的患者。
髋骨关节炎或关节置换术、术前膝关节僵硬（全ROM<70°）以及肢体长度差异>1cm。根据2021年《美国矫形外科医师学会杂志》的脊柱-骨盆分类，将患者分为IA-IB-IIA-IIB类别。有两位不同的膝关节外科医生用角度计仔细测量了残留的屈曲挛缩。采用线性回归评估脊柱-骨盆对线是否与屈曲挛缩相关。逻辑回归评估IIB型是否独立预测残留屈曲挛缩。将术前ROM、髋-膝-踝角、年龄和体重指数设定为潜在混杂因素。使用Hosmer-Lemeshow检验评估模型的拟合优度（P>0.43）。
共纳入112例患者。队列1术后屈曲挛缩的中位数为2（四分位间距，1至4），最终随访时为10（四分位间距7.2至14）。IA型患者31例（27.7%），IB型20例（17.9%），IIA型8例（7.1%），IIB型53例（47.3%）。IIB型患者残留屈曲挛缩的发生率更高（24.1，P<0.001）。逻辑回归显示IIB型是术后屈曲挛缩的独立预测因素（B=0.7，SE=0.3，Wald=5.6，P=0.016，95%置信区间=4.3至6.9）。
矢状面脊柱-骨盆对线是TKA术后残留屈曲挛缩的预测因素。
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