In functionally aligned total knee arthroplasty, femoral component rotation follows the transepicondylar axis to achieve flexion balance.

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-01-22 DOI:10.1002/ksa.12590

Joss Moore, Victor A Van de Graaf, Jil A Wood, Darren B Chen, Samuel J MacDessi

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Abstract

Purpose: In functionally aligned (FA) total knee arthroplasty (TKA), femoral component rotation (FCR) is personalised to optimise flexion gap balance. As axial malalignment has been attributed to patellofemoral complications, this study assessed FA FCR in relation to the surgical transepicondylar axis (TEA) and early implant survivorship.

Methods: We analysed 446 robotic-assisted primary TKAs in 393 patients using FA with preresection gap balancing. Femoral and tibial coronal resection boundaries were 6° valgus to 3° varus and 6° varus to 3° valgus, respectively. The TEA and posterior condylar axis (PCA) were identified on preoperative computed tomographic scans. Intraoperatively, FCR was initially set parallel to the PCA, then rotated to achieve flexion balance within 6° boundaries to the TEA. The primary outcome was the mean angular difference between the TEA and final FCR and the proportion of patients with FCR within 2°, 4° and 6° from the TEA. Secondary outcomes included all-cause revisions for the robotic-assisted TKAs in this series from our in-house database and a national joint replacement registry at a mean of 3.3 years postoperatively (range 2.2-5.5).

Results: Mean FCR was 0.0° (SD 2.1°) relative to the TEA and 1.8° (SD 1.4°) externally rotated to the PCA. Final FCR was within 2° in 74.9%, within 4° in 97.3% and within 6° in 99.6% of patients relative to the TEA. There were seven postoperative procedures (1.6%) within the study period: two reoperations (0.5%) for early arthrotomy failure requiring repair (both exhibiting FCR within 1° to the TEA) and three revisions (0.7%) for deep surgical site infection (one after early traumatic arthrotomy failure, one revision for instability and one manipulation for stiffness).

Conclusion: In FA TKA, femoral components more closely align to the TEA than the PCA to achieve a balanced flexion gap. In conjunction with a low incidence of revision surgeries, this suggests the FA technique does not result in significant patellofemoral complications.

Level of evidence: Level III.

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在功能对齐全膝关节置换术中，股骨假体沿经髁轴旋转以达到屈曲平衡。

目的：在功能对齐（FA）全膝关节置换术（TKA）中，个体化股骨假体旋转（FCR）以优化屈曲间隙平衡。由于轴向失调归因于髌股并发症，本研究评估了FA FCR与手术经髁轴（TEA）和早期种植体存活的关系。方法：我们分析了393例使用FA并切除前间隙平衡的446例机器人辅助原发性tka患者。股骨和胫骨冠状面切除边界分别为6°外翻至3°内翻和6°内翻至3°外翻。术前计算机断层扫描确定TEA和后髁轴（PCA）。术中，FCR最初平行于PCA，然后旋转以达到与TEA 6°边界内的屈曲平衡。主要终点是TEA与最终FCR之间的平均角度差，以及FCR在TEA 2°、4°和6°范围内的患者比例。次要结果包括来自我们内部数据库和国家关节置换术登记处的机器人辅助tka的全因修订，平均术后3.3年（范围2.2-5.5）。结果：相对于TEA的平均FCR为0.0°（SD 2.1°），相对于PCA外旋的平均FCR为1.8°（SD 1.4°）。相对于TEA， 74.9%的患者最终FCR在2°以内，97.3%在4°以内，99.6%在6°以内。在研究期间，有7例（1.6%）术后手术：2例（0.5%）因早期关节切开术失败需要修复（均表现为与TEA在1°内的FCR）， 3例（0.7%）因深部手术部位感染翻修（1例因早期外伤性关节切开术失败，1例因不稳定翻修，1例因僵硬翻修）。结论：在FA TKA中，股骨假体比PCA更紧密地与TEA对齐，以实现平衡的屈曲间隙。结合低发生率的翻修手术，这表明FA技术不会导致显著的髌股并发症。证据等级：三级。

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

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).