King Samuel W, Silvestrini Nicolas, Lübbeke Anne, Pandit Hemant, Miozzari Hermes H
Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK.
Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, UK.
Arthroplast Today. 2025 Jun 26;34:101750. doi: 10.1016/j.artd.2025.101750. eCollection 2025 Aug.
Current femoral components may produce a nonanatomical trochlea position with kinematic alignment (KA). This study compared effects of alignment on patellar tilt and patient-reported outcomes in medially stabilized total knee arthroplasty (MS-TKA).
MS-TKA patients from a prospective registry-based consecutive cohort were subdivided by alignment technique and patella resurfacing status. Impact of alignment technique stratified by patellar resurfacing on 1-year patellar tilt was investigated with analysis of variance. For alignment technique impact stratified by patellar resurfacing on 1-year Western Ontario and McMaster Universities Arthritis Index (WOMAC), analysis of covariance including preoperative WOMAC pain and function scores as covariates were performed. Spearman's rank correlation was computed for patellar tilt vs WOMAC pain and function at 1 year.
295 MS-TKAs were included: mechanical alignment in 168 (56.9%), patella resurfaced in 137 (46.4%), mean age 68.0 years, mean body mass index 30.6 kg/m. More women had nonresurfaced patellae (74.3%; = .011), otherwise baseline demographics, radiological parameters, WOMAC, and lateral release rates were similar between groups. At 1 year, patellar tilt was higher for KA vs mechanical alignment (7.31 vs 5.90; = .028) in both resurfaced and nonresurfaced TKA. No effect of alignment on baseline-adjusted WOMAC at 1 year was found in both resurfaced and nonresurfaced TKA. One-year patellar tilt did not correlate with WOMAC pain (r = -0.004; = .954) or function (r = 0.016; = .832).
Despite greater patellar tilt at 1year with KA, this study suggests alignment technique in MS-TKA does not adversely impact patella-femoral joint in a clinically significant manner, leading to similar patient-reported outcomes regardless of patellar resurfacing status.
当前的股骨假体组件在采用运动学对线（KA）时可能会产生非解剖学的滑车位置。本研究比较了对线方式对内侧稳定型全膝关节置换术（MS-TKA）中髌骨倾斜度及患者报告结局的影响。
来自基于前瞻性注册的连续队列研究中的MS-TKA患者，根据对线技术和髌骨表面置换状态进行分组。采用方差分析研究按髌骨表面置换分层的对线技术对1年时髌骨倾斜度的影响。对于按髌骨表面置换分层的对线技术对1年时西安大略和麦克马斯特大学骨关节炎指数（WOMAC）的影响，进行协方差分析，将术前WOMAC疼痛和功能评分作为协变量。计算1年时髌骨倾斜度与WOMAC疼痛和功能之间的Spearman等级相关性。
共纳入295例MS-TKA患者：168例（56.9%）采用机械对线，137例（46.4%）进行了髌骨表面置换，平均年龄68.0岁，平均体重指数30.6kg/m²。未进行髌骨表面置换的女性更多（74.3%；P = 0.011），除此之外，两组间的基线人口统计学、放射学参数、WOMAC及外侧松解率相似。在1年时，无论髌骨表面是否置换，KA组的髌骨倾斜度均高于机械对线组（分别为7.31°和5.90°；P = 0.028）。在进行髌骨表面置换和未进行髌骨表面置换的TKA中，均未发现对线方式对1年时经基线调整的WOMAC有影响。1年时的髌骨倾斜度与WOMAC疼痛（r = -0.004；P = 0.954）或功能（r = 0.016；P = 0.832）均无相关性。
尽管KA组在1年时髌骨倾斜度更大，但本研究表明，MS-TKA中的对线技术不会以具有临床意义的方式对髌股关节产生不利影响，无论髌骨表面置换状态如何，患者报告结局相似。
