Tsuda Takashi, Hino Kazunori, Kutsuna Tatsuhiko, Watamori Kunihiko, Kinoshita Tomofumi, Horita Yusuke, Takao Masaki
Department of Orthopaedic Surgery, Graduate School of Medicine, Ehime University, Ehime, Japan.
Department of Joint Reconstruction, Graduate School of Medicine, Ehime University, Ehime, Japan.
J Bone Joint Surg Am. 2025 Aug 7;107(18):2069-76. doi: 10.2106/JBJS.24.01098.
Managing soft-tissue balance and selecting an appropriate alignment target are crucial factors in modern total knee arthroplasty (TKA). Medial soft-tissue release has been widely performed in posterior-stabilized (PS) TKA; however, recent approaches to medial structure management have been reconsidered. This retrospective study aimed to assess the effectiveness of minimizing medial structure invasion using personalized alignment (PA) with precise additional bone cutting in PS-TKA compared with conventional mechanically aligned (MA) PS-TKA.
Overall, 188 patients who underwent PS-TKA were enrolled; propensity score matching on the basis of preoperative patient characteristics was used to ensure that the groups were similar. Additional medial soft-tissue release was performed if necessary in the MA group for inappropriate ligament balance. Adequate bone recutting, as an alternative to medial release, was performed in the PA group, permitting a maximum of 3° tibial varus alignment.
Additional medial soft-tissue release was performed in 33 knees (35.1%) in the MA group, whereas bone recutting was performed in 37 knees (39.4%) in the PA group. The PA group had a significantly more varus postoperative medial proximal tibial angle than the MA group (mean ± standard deviation, 89.1° ± 1.2° versus 90.3° ± 1.8°; p < 0.0001). The postoperative patient satisfaction score of the 2011 New Knee Society Score (KSS) in the PA group was significantly higher than that in the MA group (mean, 29.4 ± 6.7 versus 27.5 ± 7.3; p = 0.04). Moreover, PA with bone recutting resulted in a significantly greater postoperative extension angle (mean, -1.5° ± 3.7° versus -3.0° ± 3.5°; p = 0.02) and higher KSS patient satisfaction (30.1 ± 7.7 versus 26.7 ± 7.2; p = 0.04) compared with MA with medial release.
This novel surgical strategy achieved appropriate balance without excessive medial release and resulted in superior clinical outcomes in PS-TKA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
在现代全膝关节置换术（TKA）中，管理软组织平衡和选择合适的对线目标是关键因素。内侧软组织松解在后稳定型（PS）TKA中已被广泛应用；然而，最近对内侧结构管理的方法已被重新审视。这项回顾性研究旨在评估与传统机械对线（MA）的PS-TKA相比，在PS-TKA中使用个性化对线（PA）并精确额外截骨以尽量减少内侧结构侵犯的有效性。
总共纳入了188例行PS-TKA的患者；基于术前患者特征进行倾向评分匹配，以确保两组相似。MA组如有必要，因韧带平衡不当会进行额外的内侧软组织松解。PA组则进行适当的再次截骨作为内侧松解的替代方法，允许最大3°的胫骨内翻对线。
MA组33例膝关节（35.1%）进行了额外的内侧软组织松解，而PA组37例膝关节（39.4%）进行了再次截骨。PA组术后胫骨近端内侧角内翻明显大于MA组（均值±标准差，89.1°±1.2°对90.3°±1.8°；p<0.0001）。PA组2011年新膝关节协会评分（KSS）的术后患者满意度得分显著高于MA组（均值，29.4±6.7对27.5±7.3；p = 0.04）。此外，与内侧松解的MA组相比，再次截骨的PA组术后伸直角度明显更大（均值，-1.5°±3.7°对-3.0°±3.5°；p = 0.02），KSS患者满意度更高（30.1±7.7对26.7±7.2；p = 0.04）。
这种新的手术策略在不过度内侧松解的情况下实现了适当的平衡，并在PS-TKA中带来了更好的临床结果。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
