解剖学和组件旋转不匹配会对全膝关节置换术后的结果产生负面影响。
Anatomical and component rotational mismatches negatively affect postoperative outcomes in total knee arthroplasty.
作者信息
Kawaguchi Kohei, Yamagami Ryota, Kono Kenichi, Zhang Junfeng, Taketomi Shuji, Inui Hiroshi, Tanaka Sakae
机构信息
Department of Orthopaedic Surgery The University of Tokyo Tokyo Japan.
Department of surgery Auckland University Auckland New Zealand.
出版信息
J Exp Orthop. 2025 Sep 9;12(3):e70415. doi: 10.1002/jeo2.70415. eCollection 2025 Jul.
PURPOSE
Anatomical rotational mismatch (ARM) refers to postoperative malrotation between the femur and tibia, and component rotational mismatch (CRM) refers to malrotation between the femoral and tibial components in total knee arthroplasty (TKA). This study aimed to quantify ARM and CRM and assess their individual and combined effects on postoperative outcomes.
METHODS
This retrospective study analysed 224 knees that underwent primary TKA. Postoperative axial rotational angles between the femoral and tibial components (component rotational angle [CRA]) and between the femur and tibia (anatomical rotational angle [ARA]) were measured using computed tomography. Internal tibial or tibial component rotation relative to the femur or femoral component was assigned a positive value. Rotational mismatch was defined as CRA and ARA over ±10°. Clinical outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) 1 year postoperatively. Hierarchical cluster analysis categorised knees into two groups based on CRA and ARA (Groups 1 and 2).
RESULTS
The mean ± standard deviation (SD) postoperative ARA was 5.2° ± 5.3°, with ARM present in 16.1% of cases (36 knees). Knees with ARM showed significantly worse improvement in the KOOS pain subscale than those without ARM ( = 0.02). Postoperative CRA was 1.5° ± 4.5°, with CRM observed in 2.7% of cases (6 knees), but CRM alone did not significantly affect postoperative outcomes. Cluster analysis identified two groups (Group 1: 185 knees; Group 2: 39 knees), with Group 2 exhibiting greater CRAs and ARAs compared to Group 1 (both < 0.01). Group 2 also had significantly worse KOOS pain and activities of daily living improvement relative to Group 1 ( < 0.01, 0.04).
CONCLUSIONS
Both CRM and ARM were observed following TKA. ARM negatively impacted postoperative outcomes, and the combined presence of CRM and ARM further worsened clinical results.
LEVEL OF EVIDENCE
Level IV.
目的
解剖旋转不匹配（ARM）是指股骨和胫骨术后出现的旋转不良，而组件旋转不匹配（CRM）是指全膝关节置换术（TKA）中股骨和胫骨组件之间的旋转不良。本研究旨在量化ARM和CRM，并评估它们对术后结果的单独及联合影响。
方法
这项回顾性研究分析了224例行初次TKA的膝关节。使用计算机断层扫描测量股骨和胫骨组件之间的术后轴向旋转角度（组件旋转角度[CRA]）以及股骨和胫骨之间的角度（解剖旋转角度[ARA]）。胫骨或胫骨组件相对于股骨或股骨组件的内旋被赋予正值。旋转不匹配定义为CRA和ARA超过±10°。术后1年使用膝关节损伤和骨关节炎结局评分（KOOS）评估临床结果。基于CRA和ARA，层次聚类分析将膝关节分为两组（第1组和第2组）。
结果
术后ARA的平均值±标准差（SD）为5.2°±5.3°，16.1%的病例（36个膝关节）存在ARM。有ARM的膝关节在KOOS疼痛亚量表上的改善明显比没有ARM的膝关节差（P = 0.02）。术后CRA为1.5°±4.5°，2.7%的病例（6个膝关节）观察到CRM，但单独的CRM对术后结果没有显著影响。聚类分析确定了两组（第1组：185个膝关节；第2组：39个膝关节），与第1组相比，第2组的CRA和ARA更大（均P < 0.01）。与第1组相比，第2组在KOOS疼痛和日常生活活动改善方面也明显更差（P < 0.01，P = 0.04）。
结论
TKA后观察到CRM和ARM。ARM对术后结果有负面影响，CRM和ARM同时存在会进一步恶化临床结果。
证据水平
IV级。
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