The Restoration of the Prearthritic Joint Line Does Not Guarantee the Natural Knee Kinematics: A Gait Analysis Evaluation Following Primary Total Knee Arthroplasty

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-12-01 DOI:10.1016/j.artd.2024.101586
Andrea Giordano Salvi MD , Pieralberto Valpiana MD , Bernardo Innocenti PhD , Stefano Ghirardelli MD , Matteo Bernardi BSc , Giuseppe Petralia MD , Giuseppe Aloisi MD , Karlos Zepeda MS , Christian Schaller MD , Pier Francesco Indelli MD, PhD
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Abstract

Background

Unrestricted kinematic alignment (uKA) in total knee arthroplasty (TKA) has the theoretical advantage of reproducing patients' constitutional alignment and restoring the pre-arthritic joint line position and obliquity. However, modifications of the original uKA technique have been proposed due to the potential risk of mechanical failure and instability. Given the significant variability in soft tissue behavior within the same bony morphology group, uKA pure knee resurfacing could be occasionally detrimental. This study aimed to kinematically compare the outcomes of uKA TKA with those of a robotic-assisted KA TKA technique based on specific soft-tissue boundaries.

Methods

In this retrospective gait analysis study, 24 TKA patients and 12 healthy controls were recruited. Inclusion criteria were a 9-month minimum follow-up from successfully, primary medial-pivot or medially-congruent TKA performed for isolated degenerative joint disease. Preoperatively, patients were randomly assigned to two surgical groups: A) uKA (#12) and B) robot-assisted (#12), KA (hybrid-kinematic) with boundaries (±3° from hip-knee-ankle neutral axis) and a slight intercompartmental gap asymmetry (max 2 mm lateral-opening). The gait analysis was performed using instrumented treadmills equipped with 3D cameras.

Results

Sagittal knee kinematic data: during the early-stance phase of gait, the uKA group showed a less consistent weight-acceptance phase and a less efficient transition between the first knee-flexion peak and mid-stance-extension plateau with respect to the hybrid-kinematic alignment group. Spatiotemporal and overall gait quality data: no significant differences were found between the two TKA groups regarding walking speed (P = .51) and step length (P = .8534). Control group patients walked more efficiently compared to TKA groups, showing inferior trunk flexion and inferior variation in step length (P < .0001).

Conclusions

This study showed that restoring the pre-arthritic joint line, as advocated by surgeons following the uKA philosophy, does not guarantee a closer-to-normal knee kinematics.
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关节炎前关节线的恢复并不能保证膝关节的自然运动学:一次全膝关节置换术后的步态分析评估。
背景:全膝关节置换术(TKA)中的无限制运动学对齐(uKA)在理论上具有再现患者的体位对齐和恢复关节炎前关节线位置和斜度的优势。然而,由于潜在的机械故障和不稳定风险,已经提出了对原始uKA技术的修改。考虑到同一骨形态组中软组织行为的显著差异,uKA纯膝关节置换有时可能是有害的。本研究旨在从运动学角度比较uKA TKA和基于特定软组织边界的机器人辅助KA TKA技术的结果。方法:在这项回顾性步态分析研究中,招募了24名TKA患者和12名健康对照者。纳入标准是对孤立性退行性关节疾病进行成功的、原发性中枢轴或中枢轴全膝关节置换术的至少9个月随访。术前,患者被随机分配到两个手术组:A) uKA(#12)和B)机器人辅助(#12),KA(混合-运动学)具有边界(从髋关节-膝关节-踝关节中性轴±3°)和轻微的室间间隙不对称(最大2mm外侧开口)。步态分析使用配备了3D摄像头的仪器跑步机进行。结果:矢状膝关节运动学数据:在步态的早期站立阶段,与混合运动学对齐组相比,uKA组表现出不太一致的体重接受阶段,并且在第一个膝关节屈曲高峰和站立-伸展中期平台之间的转换效率较低。时空和整体步态质量数据:两个TKA组在步行速度(P = 0.51)和步长(P = 0.8534)方面无显著差异。与TKA组相比,对照组患者行走效率更高,表现为下躯干屈曲和步长变化较小(P < 0.0001)。结论:本研究表明,按照uKA的理念,外科医生所提倡的恢复关节炎前关节线并不能保证更接近正常的膝关节运动学。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Arthroplasty Today
Arthroplasty Today Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
258
审稿时长
40 weeks
期刊介绍: Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.
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