Vermue Hannes, Mesnard Guillaume, Servien Elvire, Batailler Cécile, Lustig Sébastien
Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, 69004 Lyon, France - Department of Orthopedic Surgery, Ghent University Hospital, 9000 Ghent, Belgium.
Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, 69004 Lyon, France.
SICOT J. 2025;11:33. doi: 10.1051/sicotj/2025018. Epub 2025 Jun 6.
Total knee arthroplasty (TKA) utilizing deep-dish tibial inserts has gained interest due to its high congruency and enhanced stability. However, due to the advent of more personalized alignment philosophies, the combination of a rotating-platform deep-dish TKA design with restricted kinematic alignment (rKA) might improve patient satisfaction. Therefore, this study evaluated the five-year clinical and functional outcomes of rKA with a deep-dish TKA design.
A retrospective analysis was conducted on patients who underwent primary TKA with a rotating-platform deep-dish design and rKA. Of 143 eligible patients, 123 completed five-year follow-up. Clinical and radiographic assessments included the five-year postoperative results: Knee Society Score (KSS), patient satisfaction, range of motion, coronal limb and implant alignment, postoperative complications and implant survivorship. Statistical analyses compared preoperative and postoperative outcomes with paired analyses.
Median KSS Knee and Function scores significantly improved from 70 (IQR 5) and 60 (IQR 26) preoperatively to 90 (IQR 20) and 93 (IQR 21) postoperatively (p < 0.001). Postoperative coronal alignment in this study encompassed a hip-knee-ankle angle was 178.1° ± 3.5, a Lateral Distal Femoral Angle of 89.9° ± 2.6, and a Medial Proximal Tibial Angle of 88.6° ± 2.2. At five years, 94% of patients were either satisfied or very satisfied. The revision-free survival rate was 98%. Periprosthetic joint infection and arthrofibrosis were the most common complications (1.6% for both groups separately), followed by aseptic loosening of a cementless femoral component (0.8%) and patellar dislocation (0.8%).
Rotating-platform deep-dish TKA with restricted kinematic alignment results in excellent functional outcomes, high patient satisfaction, and low complication rates at five-year follow-up. These findings support its viability as a surgical strategy, though long-term studies are warranted to assess implant durability and survivorship beyond 10 years.
采用深盘式胫骨假体的全膝关节置换术（TKA）因其高度匹配性和增强的稳定性而受到关注。然而，由于更个性化的对线理念的出现，旋转平台深盘式TKA设计与受限运动学对线（rKA）相结合可能会提高患者满意度。因此，本研究评估了采用深盘式TKA设计的rKA的五年临床和功能结果。
对接受旋转平台深盘式设计和rKA的初次TKA患者进行回顾性分析。在143例符合条件的患者中，123例完成了五年随访。临床和影像学评估包括术后五年结果：膝关节协会评分（KSS）、患者满意度、活动范围、冠状位肢体和假体对线、术后并发症和假体生存率。统计分析采用配对分析比较术前和术后结果。
KSS膝关节和功能评分中位数从术前的70（四分位间距5）和60（四分位间距26）显著提高到术后的90（四分位间距20）和93（四分位间距21）（p<0.001）。本研究中的术后冠状位对线包括髋-膝-踝角为178.1°±3.5，股骨远端外侧角为89.9°±2.6，胫骨近端内侧角为88.6°±2.2。五年时，94%的患者满意或非常满意。无翻修生存率为98%。假体周围关节感染和关节纤维化是最常见的并发症（两组分别为1.6%），其次是无骨水泥股骨部件的无菌性松动（0.8%）和髌骨脱位（0.8%）。
受限运动学对线的旋转平台深盘式TKA在五年随访时可带来优异的功能结果、较高的患者满意度和较低的并发症发生率。这些发现支持了其作为一种手术策略的可行性，不过仍需要长期研究来评估假体超过10年的耐用性和生存率。
