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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Does Patient Specific Factors or Alignment Influence Total Knee Arthroplasty Clinical and Functional Outcomes?
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Does Patient Specific Factors or Alignment Influence Total Knee Arthroplasty Clinical and Functional Outcomes?

机译：患者的特定因素或对准影响全膝关节成形术临床和功能性结果吗？

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Objectives: Knee alignment following total knee arthroplasty (TKA) may be the most important factor determining the long-term survival of the prosthesis. Despite proper alignment of implants being strongly associated with greater stability and a lower rate of loosening, literature still finds conflicting results regarding the influence of TKA alignment in patients clinical scores. The present study sought to address what is the optimal postoperative TKA alignment. Methods: We retrospectively selected 100 consecutive primary knee replacements performed for primary knee osteoarthritis. Pre-operative full length weight bearing x-rays were used to evaluate native knee anatomic alignment, as well as proximal tibial and distal femoral coronal alignment. Pos-operative full length weight bearing x-rays were also used to evaluate TKA alignment, tibial and femoral components coronal alignment, tibial position, tibial slope and femoral flexion angle. Extension anteroposterior (AP) and profile at 30o of flexion x-rays were used. Functional assessment was conducted including the VAS, the Oxford Knee and the Kujala scores, as well as range of motion (ROM). Results: Regarding ROM, only 8 patients didn’t presented full range of motion. Regarding the native knee, the average anatomical angle was 174 ± 4o. The average femoral distal coronal angle was 88±4o and the average tibial proximal coronal angle was 89±6o. The average post-operative angles were: 175±3o for the TKA tibia-femoral coronal angle, 88±6o for the coronal femoral angle and 89±3o for the coronal tibial angle. Regarding tibial tray position, when referring to the medial cortex of the proximal tibia, our sample had a tray in average 1±1mm more lateral than the medial cortex, with the worst positioned tibial components being 3,2mm medial or lateral to the medial cortex. When considering the proximal tibia lateral cortex, our patients had in average a tibial tray 1±2mm more medial than the lateral cortex, with the worst positioned tibial components being 4,2mm medial or 2,2mm lateral to the lateral cortex. Regarding the TKA sagittal alignment, the average TKA tibial slope was of 3±4o, and the average femoral flexion angle was 10±3o. Gender, IMC or age didn’t seem to influence TKA clinical results, either regarding pain (VAS) or function (Kujala or Osxford Scores). Comparing patients with post-operative alignment within of 5o of the native knee anatomical alignment, with patients with greater differences, no significant differences were obtained regarding pain or function. Also comparing patients with pos-operative coronal femoral or tibial angle within 85-95o, with patients with greater differences, no significant differences were reached regarding clinical outcomes. Besides that, tibial tray coronal position also didn’t seem to influence patient results. In regard to sagittal alignment, neither the femoral flexion angle or the tibial slope showed and correlation to post-operative outcomes. Regarding TKA size, the tibial tray or polytene size didn’t seem to influence clinical outcomes, however the femoral component size showed correlation with the functional scores, with smaller femoral sizes associated with greater Oxford scores (p=0,0029). Conclusion: Most patients of our sample seem to have well aligned TKA, with an difference of only 1o between the native knee anatomic angle and the TKA alignment. Regarding tibial tray position, most surgeons opted for a tibial tray smaller than the tibial plateau, however these differences were of 1 millimeter medially and laterally, which probably is not clinically significant. The tibial slope is also within the desired values of 0-7o. We verified that most errors in tibial tray regard positioning it more medially than laterally, however we can assume that the tibial tray is, in most patients, correctly sized and positioned. Regarding femoral sagittal alignment, our sample showed a greater femoral flexion than previously described, however the clinical relevance of this measurement is sill controverse. Despite some papers describing an association between greater femoral flexion angle and patellofemoral instability, in our sample this angle didn’t seem to influence the Kujala score. No differences in pain or functional results were obtain in regard to TKA alignment, however this can be explained by the fact that most patients presented well aligned TKAs.
机译：目的：膝关节关节置换术（TKA）的膝关节对齐可能是确定假体的长期存活的最重要因素。尽管植入物适当对准植入物强烈地与更高的稳定性和较低的松动速度相关，但文献仍然发现关于TKA对准在患者临床评分中的影响的矛盾的结果。本研究寻求解决最佳术后TKA对准的原因。方法：我们回顾性地选择了对初级膝关节骨关节炎进行的100个连续的初级膝关节置换替代品。使用前轴承X射线的术前全长重量X射线来评估天然膝关胞解剖学对准，以及近端胫骨和远端股骨冠状对准。 POS操作全长轴承轴承X射线还用于评估TKA对准，胫骨和股骨部件冠状对准，胫骨位置，胫骨斜率和股骨屈曲角度。使用屈光X射线30O的延伸前剂（AP）和曲线。进行功能评估，包括VAS，牛津膝关节和Kujala评分，以及运动范围（ROM）。结果：关于ROM，只有8名患者没有出现全方位的运动。关于本地膝关节，平均解剖角为174±40。平均股骨远端冠状角为88±40，平均胫骨近端冠状角为89±60。平均术后角度为：TKA胫骨冠状角为：175±3o，冠状股骨角88±60，冠状胫骨角89±3o。关于胫骨托盘位置，当提到近端胫骨的内侧皮质时，我们的样品平均托盘平均比内侧皮质更高，胫骨最差的胫骨部件为3,2mm内侧或侧向内侧皮质。在考虑近端胫骨外侧皮质时，我们的患者平均平均胫骨托盘1±2mm，比外侧皮质更多，最差定位的胫骨部件是4,2mm内侧或2,2mm侧向皮层的侧面。关于TKA矢状比对，平均TKA胫骨斜率为3±40，平均股骨屈曲角度为10±3o。性别，IMC或AGE似乎没有影响TKA临床结果，关于疼痛（VAS）或功能（Kujala或Osxford得分）。将患者比较在原生膝关节解剖学对齐的50术后，患者患有更大差异，对疼痛或功能没有显着差异。同时将患有POS术冠状股骨头或胫骨角度的患者与患有更大差异的患者，对临床结果没有达到显着差异。此外，胫骨托盘冠状位置也没有影响患者的结果。关于矢状比对，股骨屈曲角度或胫骨斜率既不显示出与后术后结果的相关性。关于TKA尺寸，胫骨托盘或多苯尺寸似乎没有影响临床结果，然而股骨部件尺寸与功能分数显示相关性，较小的股骨尺寸与大型牛津分数相关（P = 0,0029）。结论：大多数我们的样本患者似乎有很好的对齐TKA，在天然膝盖解剖角和TKA对齐之间仅有1o差异。关于胫骨托盘位置，大多数外科医生选择小于胫骨平台的胫骨托盘，然而这些差异为1毫米和横向，这可能在临床上显着。胫骨斜率也在0-7o的所需值范围内。我们验证了胫骨托盘中的大多数误差如何比横向向上定位它，但是我们可以假设在大多数患者中，胫骨托盘是正确的，正确的大小和定位。关于股骨矢状比对，我们的样品显示比前述更大的股骨屈曲，但是该测量的临床相关性是略微触控。尽管一些论文描述了更大的股骨屈曲角度和Patelloforal不稳定性之间的关联，但在我们的样本中，这种角度似乎没有影响kujala得分。在TKA对准方面没有疼痛或功能结果的差异，但这可以通过大多数患者提出良好的TKAS的事实来解释。

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