Outrequin Antoine, Manon Julie, Ancion Amaury, Thienpont Emmanuel
Cliniques Universitaires Saint-Luc, Brussels, Belgium.
, Department of Orthopedics and Trauma, ZAS-Cadix Hospital, Antwerpen, Belgium, Belgium.
Arch Orthop Trauma Surg. 2025 Jul 3;145(1):364. doi: 10.1007/s00402-025-05971-0.
Proper knee alignment is critical for optimizing postoperative function and implant longevity in total knee arthroplasty (TKA). While robotic-assisted surgery offers precision in bone resections, most surgeons still rely on conventional instrumentation. This study evaluates the relationship between pre- and postoperative frontal knee alignment and bone resections in TKA performed without precision-enabling devices to establish a correlation between thickness of resection and frontal angular correction.
This retrospective, single-center study analyzed data from patients undergoing TKA for end-stage osteoarthritis between June 2021 and April 2024. Intraoperative cuts were measured in a standard way. All procedures were performed by a single experienced surgeon without precision-enabling devices. Preoperative and six-week postoperative weight-bearing goniometry and anteroposterior (AP) radiographs were collected. The cohort consisted of 130 patients: 69 varus (= 177° HKA), 30 neutral (177°-183° HKA) and 31 valgus (= 183° HKA) knees. Patients were 36.9% male, with a mean age of 70.1 years (SD 8.2) and a BMI of 30.8 kg/m (SD 5.6). Hip-knee-ankle (HKA) angle, anatomical and mechanical tibiofemoral angles and joint line convergence angles (JLCA) were measured. Statistical analysis was conducted to determine correlations between resection measurements and angular parameters.
The correlation between tibial resection (ΔT) and medial proximal tibial angle modification measured on goniometry (ΔMPTA(g)) followed a linear regression with a Spearman's correlation coefficient (r = 0.553). A weak positive correlation was observed between ΔT and ΔMPTA on AP radiographs (r = 0.505), as well as between distal femoral resection (ΔDF) and lateral distal femoral angle modification (ΔLDFA(g)) on goniometry (r = 0.350) and on AP radiographs ΔLDFA(s) (r = 0.187).
This study suggests a moderate correlation between tibial resection thickness and angular correction in the coronal plane. However, the high variability observed indicates that surgical planning should not rely solely on this correlation.
正确的膝关节对线对于优化全膝关节置换术（TKA）的术后功能和植入物使用寿命至关重要。虽然机器人辅助手术在骨切除方面具有精确性，但大多数外科医生仍依赖传统器械。本研究评估了在未使用精确设备的情况下进行的TKA中术前和术后膝关节额状面的对线与骨切除之间的关系，以建立切除厚度与额状面角度矫正之间的相关性。
这项回顾性单中心研究分析了2021年6月至2024年4月期间因终末期骨关节炎接受TKA的患者的数据。术中切口以标准方式测量。所有手术均由一名经验丰富的外科医生在未使用精确设备的情况下进行。收集术前和术后六周的负重测角法数据以及前后位（AP）X线片。该队列包括130名患者：69例内翻（=177° 髋膝踝角[HKA]）、30例中立位（177°-183° HKA）和31例外翻（=183° HKA）膝关节。患者中男性占36.9%，平均年龄为70.1岁（标准差8.2），体重指数为30.8 kg/m²（标准差5.6）。测量髋膝踝（HKA）角、解剖学和机械性胫股角以及关节线汇聚角（JLCA）。进行统计分析以确定切除测量值与角度参数之间的相关性。
胫骨切除（ΔT）与测角法测量的胫骨近端内侧角改变（ΔMPTA(g)）之间的相关性遵循线性回归，Spearman相关系数（r = 0.553）。在AP X线片上观察到ΔT与ΔMPTA之间存在弱正相关（r = 0.505），在测角法上股骨远端切除（ΔDF）与股骨远端外侧角改变（ΔLDFA(g)）之间也存在弱正相关（r = 0.350），在AP X线片上ΔLDFA(s)之间的相关性为（r = 0.187）。
本研究表明胫骨切除厚度与冠状面角度矫正之间存在中度相关性。然而，观察到的高变异性表明手术规划不应仅依赖于这种相关性。
