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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Unexplained Pain Following Total Knee Arthroplasty – Is Rotational Malalignment the Problem?
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Unexplained Pain Following Total Knee Arthroplasty – Is Rotational Malalignment the Problem?

机译：全膝关节置换术后无法解释的疼痛-旋转不正直是问题所在吗？

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Objective: Malrotation of both tibial and femoral components has been suggested as a potential source of pain following total knee arthroplasty (TKA). However previous studies have been small, with variable control groups. The aim of this study was to compare component rotational alignment in TKA patients with unexplained pain to a control group with well-functioning TKA. Method: Seventy-one patients presenting with unexplained pain following primary TKA were included in this retrospective, comparative study. Diagnostic work-up included clinical examination, blood tests, x-rays, long-leg films, and CT scan. Patients with an identifiable diagnosis or with initially well-functioning TKAs were excluded. A control group of 41 patients with well-functioning TKAs also underwent CT scans. Femoral component rotation was measured relative to the surgical epicondylar axis, and tibial component rotation relative to the medial third of the tibial tubercle using a previously validated method involving 3D-image reconstruction. Findings were compared between painful and control TKA groups. Results: We found no difference in femoral component rotation between the painful and control groups (mean 0.6° vs 1.0° external rotation (ER), p=0.4), and no difference in tibial component rotation (mean 11.2° vs 9.5° internal rotation(IR), p=0.3). Fifty-nine percent of patients in the painful group had tibial component rotation >9°IR versus 49% in the control group. 6% of patients in the painful group and 2% in the control group had femoral component rotation >3°IR. There was no difference in overall coronal alignment between groups (mean 1.3° varus vs 0.5° varus, p=0.23). Conclusion: In this the largest study yet reported on component rotation in TKA, we found no difference in the incidence of tibial or femoral component malalignment in painful versus well-functioning TKAs. Tibial component IR in particular appears to be a common finding, and its significance when evaluating the painful TKA should be interpreted with caution.
机译：目的：胫骨和股骨组件的旋转不良被认为是全膝关节置换术（TKA）术后疼痛的潜在来源。但是，以前的研究很少，有可变的对照组。这项研究的目的是将患有无法解释的疼痛的TKA患者与功能良好的TKA的对照组进行组件旋转对准的比较。方法：该回顾性比较研究纳入了71例原发性TKA后出现无法解释的疼痛的患者。诊断检查包括临床检查，血液检查，X射线，长腿胶片和CT扫描。明确诊断或TKA最初功能良好的患者被排除在外。对照组41名功能良好的TKA患者也接受了CT扫描。使用先前经过验证的涉及3D图像重建的方法，测量股骨相对于外科epi上轴的旋转，以及胫骨相对于胫骨结节的内侧三分之一的旋转。比较疼痛组和对照组的TKA结果。结果：我们发现疼痛组和对照组之间的股骨成分旋转没有差异（平均0.6°vs. 1.0°外旋（ER），p = 0.4），胫骨成分旋转也没有差异（平均11.2°vs 9.5°内旋（IR），p ＝ 0.3）。疼痛组中有59％的患者胫骨组件旋转> 9°IR，而对照组为49％。疼痛组中有6％的患者和对照组中有2％的患者股骨旋转> 3°IR。各组之间的总冠状排列没有差异（平均1.3°内翻vs 0.5°内翻，p = 0.23）。结论：在这项关于TKA组件旋转的最大研究中，我们发现疼痛性TKA和功能良好的TKA中胫骨或股骨组件错位的发生率没有差异。尤其是胫骨成分IR似乎是一个常见发现，在评估疼痛性TKA时应谨慎考虑其重要性。

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