Stroobant Lenka, Vermue Hannes, Jacobs Ewoud, Arnout Nele, Sadones Catho, Van Onsem Stefaan, Victor Jan
Department Orthopaedic Surgery, University Hospital Ghent, Ghent, Belgium.
Department of Rehabilitation Sciences, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium.
Arch Orthop Trauma Surg. 2025 May 19;145(1):302. doi: 10.1007/s00402-025-05882-0.
BACKGROUND: The global increase in revision total knee arthroplasties (rTKA) imposes a significant healthcare challenge. As instability is one of the leading indications, a standardized preoperative assessment of the knee stability is imperative. This study used the Telos Stress Device (TSD) to evaluate coronal laxity in patients scheduled for rTKA, (1) aiming at assessing measurement reliability in order to standardize TSD usage in the preoperative evaluation, (2) evaluating varus and valgus laxity in rTKA patients and comparing them to those of the primary TKA population, and (3) investigating if the objective joint laxity varies among instability, malalignment or aseptic loosening as indications for revision. MATERIAL AND METHODS: Twenty seven patients undergoing rTKA in 2022-2023 were included. Standardized coronal stress radiographs (150N) in 10-20° flexion and in supine position were captured using the TSD before revision surgery. Two independent raters measured the angulation between the femoral and tibial components on all radiographs, with valgus laxity defined as a lateral force applied while evaluating the medial joint opening, and varus laxity defined as the opposite. (1) Reliability was evaluated using intra-class correlation coefficient (ICC). (2) The laxity values in the study population were interpreted and compared to the general TKA population based on a literature review. (3) Laxity measurements were compared across instability, malalignment and aseptic loosening as indications for revision, with an emphasis on the correlation between alignment and laxity measurements. RESULTS: (1) Excellent inter- (ICC = 0.983) and intra-rater reliability (ICC = 0.992 and ICC = 0.983) were observed. (2) Mean valgus and varus laxity in patients scheduled for revision were 5.8° (SD, 3.3) and 4.9° (SD, 4.1), respectively. Valgus laxity in patients scheduled for revision TKA differed significantly from the observed postoperative valgus laxity (4°) in the general TKA population without need for revision, while varus laxity was comparable. (3) No significant difference in laxity were noted among instability, malalignment and aseptic loosening as indications for revision. A significant correlation was found between valgus laxity and mLDFA (p = 0.031). CONCLUSION: This paper revealed that for revision patients valgus laxity is notably higher compared to the general TKA population. Increased valgus laxity may therefore play an important role in patient dissatisfaction following total knee arthroplasty. As revision surgery is no exploratory surgery, all information necessary should be objectively collected via a standardized protocol, especially when the role of instability in symptoms is uncertain. Telos stress testing can be easily implemented in this flow and is highly reliable.
背景:全球翻修全膝关节置换术(rTKA)数量的增加给医疗保健带来了重大挑战。由于不稳定是主要指征之一,因此对膝关节稳定性进行标准化的术前评估势在必行。本研究使用Telos应力装置(TSD)评估计划进行rTKA的患者的冠状面松弛度,(1)旨在评估测量可靠性,以便在术前评估中规范TSD的使用,(2)评估rTKA患者的内翻和外翻松弛度,并将其与初次全膝关节置换术(TKA)人群的松弛度进行比较,(3)研究客观关节松弛度在作为翻修指征的不稳定、对线不良或无菌性松动之间是否存在差异。 材料与方法:纳入2022年至2023年接受rTKA的27例患者。在翻修手术前,使用TSD在仰卧位10 - 20°屈曲位拍摄标准化冠状面应力X线片(150N)。两名独立评估者测量所有X线片上股骨和胫骨组件之间的角度,外翻松弛度定义为在评估内侧关节开口时施加的侧向力,内翻松弛度定义为相反情况。(1)使用组内相关系数(ICC)评估可靠性。(2)根据文献综述解释研究人群中的松弛度值,并与一般TKA人群进行比较。(3)比较作为翻修指征不稳定、对线不良和无菌性松动之间的松弛度测量值,重点是对线与松弛度测量之间的相关性。 结果:(1)观察到评估者间(ICC = 0.983)和评估者内可靠性极佳(ICC = 0.992和ICC = 0.983)。(2)计划进行翻修的患者的平均外翻和内翻松弛度分别为5.8°(标准差,3.3)和4.9°(标准差,4.1)。计划进行翻修TKA的患者的外翻松弛度与一般无需翻修的TKA人群术后观察到的外翻松弛度(4°)有显著差异,而内翻松弛度相当。(3)作为翻修指征的不稳定、对线不良和无菌性松动之间的松弛度无显著差异。发现外翻松弛度与mLDFA之间存在显著相关性(p = 0.031)。 结论:本文表明,与一般TKA人群相比,翻修患者的外翻松弛度明显更高。因此,外翻松弛度增加可能在全膝关节置换术后患者不满意方面起重要作用。由于翻修手术并非探索性手术,所有必要信息应通过标准化方案客观收集,尤其是当不稳定在症状中的作用不确定时。Telos应力测试可轻松纳入此流程且可靠性高。
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