Tian Hao, Ma Yang, Zhang Jinrui, Liu Enbo, Zhang Zhuo, Zuo Jianlin
Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Orthop Surg. 2025 Sep;17(9):2717-2725. doi: 10.1111/os.70134. Epub 2025 Aug 7.
Osteoarthritis (OA) is the most prevalent joint disease in the elderly population, and primary computer-assisted navigation total knee arthroplasty (CA-TKA) remains a critical therapeutic intervention for OA. The presence of physiologic radiolucent lines (RLLs) beneath the tibial base plate following CA-TKA carries significant long-term clinical implications and is regarded as a potential indicator of prosthetic loosening. However, the specific risk factors for RLL development in CA-TKA, despite its theoretical precision advantages, remain poorly understood. This study aimed to characterize the clinical features of physiologic RLLs and identify associated risk factors.
A retrospective nested case-control study was conducted using a cohort of OA patients who underwent primary CA-TKA between January 2021 and September 2024. Physiologic RLLs were diagnosed according to the 1989 Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Patients with physiologic RLLs under the tibial base plate at follow-up were assigned to the RLLs group, while controls were matched 1:1 from the cohort based on follow-up time (±14 days). Covariates included age, gender, body mass index, smoking, alcohol consumption, hypertension, diabetes, surgical side, hospital stay duration, operative time, anesthesia type, continuous passive motion use, periprosthetic joint infection, total perioperative blood loss, preoperative/postoperative hip-knee-ankle angle (HKA), tibial cement mantle quality, cement penetration, and perioperative medial proximal tibial angle. Univariate and multivariate analyses were performed to identify risk factors.
The cohort comprised 407 patients, of whom 113 developed physiologic RLLs under the tibial base plate. Univariate analysis identified age, preoperative HKA, tibial cement mantle defects, and cement penetration as statistically significant risk factors (all p < 0.05). Multivariate logistic regression analysis revealed that preoperative HKA (OR = 0.919, 95% CI = 0.876-0.963, p < 0.001), tibial cement mantle defects (OR = 2.638, 95% CI = 1.043-6.668, p = 0.040), and cement penetration (OR = 0.205, 95% CI = 0.126-0.332, p < 0.001) were independent risk factors for physiologic RLLs under the tibial base plate after primary CA-TKA in OA patients. Age was not an independent risk factor.
The overall incidence and clinical characteristics of physiologic RLLs under the tibial base plate after primary CA-TKA were comparable to those reported for conventional TKA techniques. This nested case-control study identified preoperative HKA, tibial cement mantle defects, and cement penetration as independent risk factors for physiologic RLLs, whereas age was not.
骨关节炎（OA）是老年人群中最常见的关节疾病，原发性计算机辅助导航全膝关节置换术（CA-TKA）仍然是治疗OA的关键干预措施。CA-TKA术后胫骨基板下方出现生理性透亮线（RLLs）具有重大的长期临床意义，被视为假体松动的潜在指标。然而，尽管CA-TKA具有理论上的精确优势，但其RLLs形成的具体危险因素仍知之甚少。本研究旨在描述生理性RLLs的临床特征并确定相关危险因素。
采用回顾性巢式病例对照研究，研究对象为2021年1月至2024年9月期间接受原发性CA-TKA的OA患者队列。根据1989年膝关节协会全膝关节置换术X线评估和评分系统诊断生理性RLLs。随访时胫骨基板下方出现生理性RLLs的患者被纳入RLLs组，而对照组根据随访时间（±14天）从队列中按1:1匹配。协变量包括年龄、性别、体重指数、吸烟、饮酒、高血压、糖尿病、手术侧、住院时间、手术时间、麻醉类型、持续被动运动使用情况、假体周围关节感染、围手术期总失血量、术前/术后髋-膝-踝角（HKA）、胫骨骨水泥套质量、骨水泥渗透情况以及围手术期胫骨近端内侧角。进行单因素和多因素分析以确定危险因素。
该队列包括407例患者，其中113例在胫骨基板下方出现生理性RLLs。单因素分析确定年龄、术前HKA、胫骨骨水泥套缺陷和骨水泥渗透为具有统计学意义的危险因素（均p<0.05）。多因素逻辑回归分析显示，术前HKA（OR=0.919，95%CI=0.876-0.963，p<0.001）、胫骨骨水泥套缺陷（OR=2.638，95%CI=1.043-6.668，p=0.040）和骨水泥渗透（OR=0.205，95%CI=0.126-0.332，p<0.001）是OA患者原发性CA-TKA术后胫骨基板下方生理性RLLs的独立危险因素。年龄不是独立危险因素。
原发性CA-TKA术后胫骨基板下方生理性RLLs的总体发生率和临床特征与传统TKA技术报道的情况相当。这项巢式病例对照研究确定术前HKA、胫骨骨水泥套缺陷和骨水泥渗透是生理性RLLs的独立危险因素，而年龄不是。
