Journal of Joint Surgery and Research最新文献_第6页

Radiological evaluation of cemented acetabular component in primary total hip arthroplasty with or without interface bioactive bone cement technique 采用或不采用界面生物活性骨水泥技术的初次全髋关节置换术中骨水泥髋臼假体的放射学评价

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.10.003

Kazutaka Watanabe , Takkan Morishima , Hiromi Otsuka , Tatsunori Ikemoto , Kohei Hashimoto , Hiroshi Fujita , Nobunori Takahashi

Purpose

We evaluated the medium-term radiological outcomes of the interface bioactive bone cement (IBBC) technique used in the acetabular component in primary cemented total hip arthroplasty (THA).

Methods

In total, 79 patients (88 hips) who underwent primary THA at our hospital between January 2004 and April 2009 were divided into the non-IBBC (NIBBC; n = 39 patients, 44 hips) and IBBC (n = 40 patients, 44 hips) groups. A clear zone (CZ) at the cement-bone interface around the cup was evaluated 5 and 10 years postoperatively. The CZ score, which indicates the spread of the CZ, and loosening of the cup (CZ > 2 mm on all sides or movement of the cup >4°) were also evaluated.

Results

No patient had loosening of the cup. The mean patient age at surgery was 66.5 ± 9.2 years in the NIBBC group and 61.9 ± 7.7 years in the IBBC group (p = 0.012). At 5 years postoperatively, the incidence of CZ was 36.4 % in the NIBBC group and 18.2 % in the IBBC group (p = 0.056). At 10 years postoperatively, the incidence of CZ was 36.4 % in the NIBBC group and 20.1 % in the IBBC group (p = 0.098). Age at surgery (p = 0.045) significantly affected the incidence of CZ at 5 years but not at 10 years. The IBBC technique (p = 0.042) and age at surgery (p = 0.028) significantly affected the CZ score at 5 years. The IBBC technique (p = 0.036) significantly affected the CZ score at 10 years.

Conclusions

The IBBC technique resulted in a significantly lower CZ score than the NIBBC technique in patients undergoing THA.

目的评价界面生物活性骨水泥(IBBC)技术用于首次骨水泥全髋关节置换术(THA)髋臼假体的中期放射学效果。方法将2004年1月至2009年4月在我院行原发性全髋关节置换术的79例患者(88髋)分为非全髋关节置换术组(NIBBC;n = 39例，44髋)和IBBC组(n = 40例，44髋)。术后5年和10年评估杯周围水泥-骨界面的清晰区(CZ)。CZ分数，表示CZ的扩散程度，以及杯子的松动程度(CZ >还评估了杯口两侧2mm或杯口运动(gt;4°)。结果所有患者均无杯套松动。NIBBC组的平均手术年龄为66.5±9.2岁，IBBC组的平均手术年龄为61.9±7.7岁(p = 0.012)。术后5年，NIBBC组CZ发生率为36.4%，IBBC组为18.2% (p = 0.056)。术后10年，NIBBC组CZ发生率为36.4%，IBBC组为20.1% (p = 0.098)。手术年龄(p = 0.045)对5岁时CZ的发生率有显著影响，但对10岁时无显著影响。IBBC技术(p = 0.042)和手术年龄(p = 0.028)显著影响5年时CZ评分。IBBC技术显著影响10年CZ评分(p = 0.036)。结论在全髋关节置换术中，IBBC技术的CZ评分明显低于NIBBC技术。

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引用次数: 0

Preserving the medial arm of the iliofemoral ligament in total hip arthroplasty using the anterolateral approach: Surgical outcomes and patient-reported outcome measure with 2 years follow-up 前外侧入路全髋关节置换术中保留髂股韧带内侧臂：手术结果和患者报告的2年随访结果

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.07.003

Yoshifumi Harada , Yuji Yamamoto , Kazuki Oishi , Ryo Inoue , Koichi Akaishi , Yasuyuki Ishibashi

Purpose

Iliofemoral ligament (ILFL) is a capsular ligament located in the anterosuperior part of the hip joint capsule and contributes to hip joint stability. The purpose of this study was to compare the surgical outcomes of resection versus preservation procedure of the medial arm of the ILFL in total hip arthroplasty (THA) using the anterolateral approach.

Methods

Perioperative outcomes, complication, implant placement and patient-reported outcome measures (PROMs) were evaluated in 42 patients in the resection group and 38 patients in the preservation group. As a PROM, the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), was administered at 6 months, 1 year and 2 years postoperatively.

Results

There was no significant difference in perioperative outcomes, complication and implant placement between the two groups. Satisfaction for the hip joint condition (80.6 ± 22.4 vs 89.2 ± 20.1), JHEQ pain score (21.5 ± 4.5 vs 24.1 ± 5.2) at 6 months, and JHEQ pain score (21.6 ± 5.1 vs 23.5 ± 5.5) at 1 year were significantly better in the preservation group than in the resection group. At 2 years postoperatively, no significant difference was found in PROMs between the two groups.

Conclusion

Our results indicate that preservation of the medial arm of the ILFL in THA improves pain during the first postoperative year without increased complications or disadvantages of implant placement. Preserving the medial arm of the ILFL may be a safe and effective option to improve the early clinical outcomes after THA using the anterolateral approach.

目的股外侧韧带（ILFL）是一种位于髋关节囊前上部的囊膜韧带，有助于髋关节的稳定性。本研究的目的是比较在使用前外侧入路的全髋关节置换术（THA）中，切除和保留ILFL内侧臂的手术结果。方法对42例切除组患者和38例保存组患者的围手术期结果、并发症、植入位置和患者报告的预后指标（PROM）进行评估。作为PROM，日本骨科协会髋关节疾病评估问卷（JHEQ）在术后6个月、1年和2年进行。结果两组患者的围手术期结果、并发症及植入位置无显著差异。髋关节状况满意度（80.6±22.4对89.2±20.1），JHEQ疼痛评分（21.5±4.5对24.1±5.2）和JHEQ疼痛评分（21.6±5.1对23.5±5.5）在1年时在保存组中明显优于切除组。术后2年，两组胎膜早破的发生率无显著差异。结论我们的研究结果表明，在THA中保留ILFL的内侧臂可以改善术后第一年的疼痛，而不会增加植入物的并发症或缺点。保留ILFL的内侧臂可能是使用前外侧入路改善THA后早期临床结果的安全有效的选择。

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引用次数: 0

Effect of component rotational alignment on femorotibial rotational alignment in total knee arthroplasty: comparison between mobile and fixed bearing 组件旋转对齐对全膝关节置换术中股骨-胫骨旋转对齐的影响：移动轴承和固定轴承的比较

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.03.003

Kohei Kawaguchi, Hiroshi Inui, Ryota Yamagami, Kenichi Kono, Tomofumi Kage, Ryo Muramakami, Takahiro Arakawa, Shuji Taketomi, Sakae Tanaka

Purpose

“Rotational self-alignment mechanism" was designed for mobile-bearing total knee arthroplasty (MB TKA) to maintain a natural femorotibial rotational alignment independent of component rotational alignment. However, it is clinically unknown if the influence of component rotational alignment on a postoperative anatomical femorotibial rotational angle (FTRA) in MB TKA is eliminated. This study aimed to determine the effect of component rotational alignments on postoperative anatomical FTRA in MB TKA as compared to fixed-bearing TKA (FB TKA).

Methods

This research comprised a total of 161 knees: 54 MB TKAs and 107 FB TKAs. In computed tomography, the postoperative FTRA and rotational alignment of tibial and femoral components to anatomical axes were assessed, and the association between the postoperative FTRA and perioperative radiographic data, including component rotational alignments, was examined.

Result

Rotational alignments of both tibial and femoral components did not correlate postoperative FTRA in MB TKA (tibial component: r = −0.15, p = 0.26, femoral component: r = 0.22, p = 0.10), however, in FB TKA, rotational alignment of tibial component did correlate postoperative FTRA, while that of femoral component did not (tibial component: r = −0.65, p < 0.01, femoral component: r = 0.17, p = 0.07). In both groups, preoperative FTRA was substantially associated with postoperative FTRA (MB TKA: r = 0.65, p < 0.01, FB TKA: r = 0.33, p < 0.01).

Conclusions

Component rotational alignments did not affect postoperative anatomical rotational femorotibial alignment in MB TKA. Whereas the rotational alignment of the tibial component has a significant impact on the postoperative femorotibial rotational alignment in FB TKA.

目的“旋转自对准机构”是为移动轴承全膝关节置换术（MB TKA）设计的，以保持独立于部件旋转对准的自然股关节旋转对准。然而，临床上尚不清楚部件旋转对准是否对术后解剖股关节旋转角（FTRA）的影响MB中的TKA被消除。本研究旨在确定与固定支承TKA（FB TKA）相比，MB TKA的组件旋转对齐对术后解剖FTRA的影响MB TKA和107 FB TKA。在计算机断层扫描中，评估了术后FTRA以及胫骨和股骨组件与解剖轴的旋转对齐，并检查了术后FTIA与围手术期放射学数据（包括组件旋转对齐）之间的相关性。结果在MB TKA中，胫骨和股骨组件的旋转对齐与术后FTRA无关（胫骨组件：r=−0.15，p=0.26，股骨组件：r=0.22，p=0.10），然而，在FB TKA中，胫骨组件的旋转对齐确实与术后FTRA相关，而股骨组件的旋转排列则不相关（胫骨组件：r=−0.65，p<；0.01，股骨成分：r=0.17，p=0.07）。在两组中，术前FTRA与术后FTRA显著相关（MB TKA:r=0.65，p<；0.01，FB TKA:r=0.33，p<；0.01）。而胫骨组件的旋转对齐对FB TKA术后股骨-胫骨旋转对齐有显著影响。

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引用次数: 0

What are the causes of failure after total knee arthroplasty? 全膝关节置换术后失败的原因是什么？

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2022.12.002

Hiroshi Inui , Ryota Yamagami , Kenichi Kono , Kohei Kawaguchi

Purpose

This study aimed to review the causes of failure after total knee arthroplasty (TKA), focusing on the causes of revision and persistent pain.

Methods

A literature search was conducted in the databases of PubMed, Cochrane Library, and Google Scholar for articles published before October 4, 2022. In addition, registry data from 11 countries were obtained from national registry archives.

Results

National registry data and recent articles show that aseptic loosening, infection, instability, patellofemoral complication, and pain are major overall causes of TKA revisions. The most common etiologies of TKA revisions were aseptic loosening in six countries and infection in four countries. In contrast, polyethylene wear has become one of the minor reasons for revision, although it used to be one of the major causes of revision. Additionally, various causes of persistent pain include improper component placement, oversizing, patellofemoral overstuffing, ligament imbalance, elevated joint lines, kinematic abnormalities, and preoperative psychological factors such as catastrophizing state and central sensitization of pain.

Conclusions

With the evolution of surgical techniques and prosthetic designs, a paradigm shift in the etiology of failure mechanisms after TKA might have occurred. However, the number of patients with TKA failure suffering from persistent pain and requiring revision is increasing. Thus, orthopedic surgeons must understand the current situations of TKA failures to improve clinical outcomes and reduce post-TKA dissatisfaction.

目的本研究旨在回顾全膝关节置换术（TKA）失败的原因，重点关注翻修和持续疼痛的原因。方法在PubMed、Cochrane Library和Google Scholar的数据库中检索2022年10月4日之前发表的文章。此外，从国家登记档案中获得了11个国家的登记数据。结果国家注册中心的数据和最近的文章表明，无菌性松动、感染、不稳定、髌股并发症和疼痛是TKA翻修的主要原因。TKA翻修术最常见的病因是6个国家的无菌性松动和4个国家的感染。相比之下，聚乙烯磨损已成为翻修的次要原因之一，尽管它曾经是翻修的主要原因之一。此外，持续疼痛的各种原因包括组件放置不当、尺寸过大、髌股过度填充、韧带失衡、关节线抬高、运动学异常以及术前心理因素，如灾难性状态和疼痛的中枢敏感性。结论随着外科技术和假体设计的发展，TKA术后失败机制的病因可能发生了范式转变。然而，TKA失败患者持续疼痛并需要翻修的人数正在增加。因此，整形外科医生必须了解TKA失败的现状，以改善临床结果并减少TKA后的不满。

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引用次数: 0

Hip disorders and spinopelvic alignment: a current literature review 髋关节疾病与脊柱骨盆对齐：一项最新文献综述

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.01.002

Toshiyuki Tateiwa , Tsunehito Ishida , Takuya Kusakabe , Toshinori Masaoka , Kenji Endo , Takaaki Shishido , Yasuhito Takahashi , Kengo Yamamoto

Purpose

The importance of considering the influence of spinal alignment on the pathology of the hip joint has been widely accepted. The primary objective of this study is to give a comprehensive view of recent findings on the influence of sagittal spinopelvic alignment on hip osteoarthritis (HOA) and total hip arthroplasty (THA).

Methods

An English-language literature search was performed with PubMed and Medline databases to identify peer-reviewed studies published within the last 5 years (2017–2022) on the topic of hip disorders and spinopelvic alignment.

Results and conclusions

It was reported that the risk of developing primary HOA may increase in patients with high sacral slope (SS) and low pelvic tilt (PT), whereas that of secondary HOA based on acetabular dysplasia (AD) may increase in patients with high lumbar lordosis (LL), SS, and pelvic incidence (PI). In addition, surgeons need to consider that the hip–spine motion may change from the preoperative one owing to changes in some spinopelvic parameters following THA. However, the significance of these changes is not consistent across the studies. Since low PI, PI-LL mismatch, and low SS during sitting and standing may contribute to the risk of prosthetic impingement followed by dislocation, great care should be taken regarding the loss of spinopelvic mobility after spinal fusion surgery.

目的考虑脊柱排列对髋关节病理学的影响的重要性已被广泛接受。本研究的主要目的是全面了解最近关于矢状棘骨盆对齐对髋关节骨关节炎（HOA）和全髋关节置换术（THA）影响的研究结果疾病和脊柱骨盆对齐。结果和结论据报道，高骶骨斜率（SS）和低骨盆倾斜（PT）患者发生原发性HOA的风险可能增加，而基于髋臼发育不良（AD）的继发性HOA在高腰椎前凸（LL）、SS和骨盆发病率（PI）患者中可能增加。此外，外科医生需要考虑的是，由于THA后一些脊柱参数的变化，髋关节-脊柱的运动可能会与术前有所不同。然而，这些变化的意义在各研究中并不一致。由于坐着和站着时PI、PI-LL不匹配和SS低可能会增加假体撞击后脱位的风险，因此应特别注意脊柱融合术后脊柱骨盆活动能力的丧失。

{"title":"Hip disorders and spinopelvic alignment: a current literature review","authors":"Toshiyuki Tateiwa , Tsunehito Ishida , Takuya Kusakabe , Toshinori Masaoka , Kenji Endo , Takaaki Shishido , Yasuhito Takahashi , Kengo Yamamoto","doi":"10.1016/j.jjoisr.2023.01.002","DOIUrl":"10.1016/j.jjoisr.2023.01.002","url":null,"abstract":"<div><h3>Purpose</h3><p>The importance of considering the influence of spinal alignment on the pathology of the hip joint has been widely accepted. The primary objective of this study is to give a comprehensive view of recent findings on the influence of sagittal spinopelvic alignment on hip osteoarthritis (HOA) and total hip arthroplasty (THA).</p></div><div><h3>Methods</h3><p>An English-language literature search was performed with PubMed and Medline databases to identify peer-reviewed studies published within the last 5 years (2017–2022) on the topic of hip disorders and spinopelvic alignment.</p></div><div><h3>Results and conclusions</h3><p>It was reported that the risk of developing primary HOA may increase in patients with high sacral slope (SS) and low pelvic tilt (PT), whereas that of secondary HOA based on acetabular dysplasia (AD) may increase in patients with high lumbar lordosis (LL), SS, and pelvic incidence (PI). In addition, surgeons need to consider that the hip–spine motion may change from the preoperative one owing to changes in some spinopelvic parameters following THA. However, the significance of these changes is not consistent across the studies. Since low PI, PI-LL mismatch, and low SS during sitting and standing may contribute to the risk of prosthetic impingement followed by dislocation, great care should be taken regarding the loss of spinopelvic mobility after spinal fusion surgery.</p></div>","PeriodicalId":100795,"journal":{"name":"Journal of Joint Surgery and Research","volume":"2 ","pages":"Pages 62-69"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949705123000026/pdfft?md5=24d4f1f6f547896136415fdc649210c2&pid=1-s2.0-S2949705123000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50194915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predictors of subsequent contralateral total knee arthroplasty in moderate-to-severe bilateral medial knee osteoarthritis 对侧全膝关节置换术治疗中重度双侧内侧膝骨关节炎的预测因素

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.09.002

Naohisa Miyatake , Takehiko Sugita , Seiya Miyamoto , Akira Sasaki , Maeda Ikuo , Midori Miyatake , Masayuki Kamimura , Takashi Aki , Toshimi Aizawa

Purpose

In patients with moderate-to-severe bilateral medial knee osteoarthritis, it is difficult to determine the necessity of the subsequent contralateral total knee arthroplasty (TKA) after performing the first procedure. This study aimed to compare patient characteristics and clinical outcomes between patients who underwent staged bilateral TKA (group B) and those who underwent unilateral TKA (group U) to identify predictors of contralateral TKA requirement.

Methods

Among 153 patients with bilateral medial knee osteoarthritis of Kellgren-Lawrence grade 3 or 4, 43 and 110 patients underwent unilateral and bilateral TKA, respectively. Clinical evaluations using the patient-reported outcome measure (the Japanese Knee Osteoarthritis Measure [JKOM]), the Knee Society Score (KSS), and the timed “Up and Go” test (TUG) were performed preoperatively, at 12 months, and once every year up to 5 years after the unilateral and the contralateral TKA in groups U and B, respectively. Receiver Operating Characteristic (ROC) analysis was used to determine the cut-off value for preoperative JKOM score that indicates the contralateral TKA.

Results

There were no significant differences in patient characteristics between groups B and U. The preoperative JKOM scores were significantly worse in group B. Postoperative improvements in JKOM, KSS, and TUG were statistically significant in both groups; however, there were no significant differences in post-procedure scores between the two groups. ROC analysis showed that the optimal cut-off value of the preoperative JKOM score was 41.5 points.

Conclusion

A preoperative JKOM score of ≥41.5 is a possible predictor of the contralateral TKA in patients with moderate-to-severe bilateral medial knee osteoarthritis.

目的在中重度双侧内侧膝骨关节炎患者中，很难确定在进行第一次手术后对侧全膝关节置换术（TKA）的必要性。本研究旨在比较分期双侧TKA（B组）和单侧TKA（U组）患者的患者特征和临床结果，以确定对侧TKA需求的预测因素。方法在153例Kellgren-Lawrence 3级或4级双侧膝内侧骨关节炎患者中，分别对43例和110例患者进行了单侧和双侧TKA。U组和B组分别在术前、术后12个月和术后5年内每年进行一次临床评估，使用患者报告的结果测量（日本膝关节骨性关节炎测量[JKOM]）、膝关节学会评分（KSS）和定时“上下”测试（TUG）。受试者操作特征（ROC）分析用于确定术前JKOM评分的临界值，该值指示对侧TKA。结果B组和U组的患者特征没有显著差异，TUG在两组中均具有统计学意义；然而，两组患者术后评分无显著差异。ROC分析显示，术前JKOM评分的最佳截止值为41.5分。结论术前JKOM评分≥41.5可能是中重度双侧内侧膝骨关节炎患者对侧TKA的预测指标。

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引用次数: 0

Instability in total hip arthroplasty: A literature review 全髋关节置换术中的不稳定性：文献综述

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.03.004

Daisuke Takahashi, Tomohiro Shimizu, Takuji Miyazaki, Takuya Ogawa, Norimasa Iwasaki

Purpose

To introduce prevention and treatment methods for instability after total hip arthroplasty (THA) on the basis of the results of several recent studies.

Methods

We comprehensively summarized and evaluated the results of several studies on the frequency, causes, countermeasures, and treatments after THA.

Results

We found that surgeon experience, mobility of the lumbosacral spine, and femoral head size influence the dislocation rate after THA, and that dual-mobility acetabular components, lipped liners, and intraoperative support systems, including navigation and robotics, can decrease the dislocation rate.

Conclusions

Dual-mobility and lipped liners improve stability after THA; however, their indications should be carefully considered. Judicious use of postoperative mobility restriction may benefit some patients.

目的根据近年来的研究结果，介绍全髋关节置换术后不稳定的预防和治疗方法。方法我们全面总结和评估了几项关于THA术后脱位频率、原因、对策和治疗的研究结果。结果我们发现，外科医生的经验、腰骶棘的活动性和股骨头的大小会影响THA后的脱位率，并且双活动性髋臼组件、唇衬和术中支撑系统，包括导航和机器人技术在内的其他技术可以降低位错率。结论双侧活动性和唇状衬垫可提高THA术后的稳定性；然而，应该仔细考虑它们的迹象。明智地使用术后活动受限可能对一些患者有益。

引用次数: 0

Causes of failure after total hip arthroplasty: A narrative review of literatures 全髋关节置换术后失败原因的文献综述

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.01.006

Naomi Kobayashi, Yohei Yukizawa

Purpose

Innovations in materials and implant design, as well as refinement of procedures and countermeasures for various complications, have led to improved outcomes for patients undergoing total hip arthroplasty (THA). However, various issues remain. Here we performed a comprehensive review of literatures regarding clinical failure of THA and discuss the current situation regarding specific issues.

Methods

A narrative review was conducted focusing on the various causes of clinical failure or complications after THA. Each cause or complication is listed according to time of occurrence, from the intraoperative period to the late stage post-surgery. For each specific condition requiring revision or further surgery, we summarize the important clinical information, including prevalence, diagnosis, risk factors, and treatment options.

Results

We focused on specific conditions that cause failure of THA, including periprosthetic joint infection, dislocation, malalignment/malposition, iliopsoas impingement, and other causes of pain after THA. We also discuss the prevalence, risk factors, diagnostic algorithm, and treatment options.

Conclusion

Identifying possible causes of THA failure at each stage after surgery is important. In addition, clinicians need to understand that patients may have an unsatisfactory outcome despite perfect surgical technique and/or postoperative radiographs.

目的材料和植入物设计的创新，以及针对各种并发症的程序和对策的改进，已经改善了全髋关节置换术（THA）患者的预后。然而，各种问题仍然存在。在这里，我们对THA临床失败的文献进行了全面的回顾，并讨论了具体问题的现状。方法对THA术后临床失败或并发症的各种原因进行叙述性综述。从术中到术后晚期，每种原因或并发症都根据发生时间列出。对于每种需要翻修或进一步手术的特定情况，我们总结了重要的临床信息，包括患病率、诊断、风险因素和治疗选择。结果我们重点研究了导致THA失败的具体情况，包括假体周围关节感染、脱位、对齐/错位、髂腰肌撞击以及THA后疼痛的其他原因。我们还讨论了患病率、危险因素、诊断算法和治疗方案。结论明确THA术后各阶段失败的可能原因非常重要。此外，临床医生需要了解，尽管手术技术和/或术后射线照片完美，但患者可能会出现不令人满意的结果。

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引用次数: 0

Optimizing femoral component rotation in TKA: The role of posterior condylar angle and condylar twist angle TKA中股骨组件旋转的优化：髁后角和髁扭转角的作用

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.09.003

Patricio Dumlao III , Hiroshi Fujii , Yutaka Suetomi , Atsunori Tokushige , Kiminori Yukata , Takashi Sakai

Purpose

Femoral component rotation (FCR) is crucial in total knee arthroplasty (TKA). Currently, the optimal method to select FCR is unknown due to patient anatomy variation. Addressing the variability of femoral component rotation is critical to optimizing TKA outcomes and patient satisfaction. In this study, we aimed to identify outlier frequency and evaluate malrotation risk reduction by setting anatomic limits for FCR selection.

Methods

One hundred patients with end-stage knee osteoarthritis requiring TKA were included and categorized as normal rotation, internal rotation outlier, and external rotation outlier based on their expected FCR calculated intraoperatively using the modified gap balancing technique with a tensioning device. The computed FCR was then referenced to their Posterior Condylar Angle (PCA) and Condylar Twist Angle (CTA). The postoperative FCR and 1, 2-, and 5-years functional scores were also measured.

Results

Seventy-one knees (71%) were within the limits of PCA and CTA. The combined outlier frequency is 29%. The mean computed FCRs are 4.4° (±1.5), −1° (±2.6), and 8.0° (±3.4) for the normal, internal rotation, and external rotation groups, respectively. Whereas after setting the limits, the postoperative FCRs are 3.1° (±1.5), 3.9° (±1.7), and 2.5° (±1.4) for the three groups, respectively. The relative risk reduction against malrotation was 65%. At 1, 2, and 5 years post-TKA, all groups showed significant functional improvement, with no significant differences in functional outcomes between the normal and outlier groups.

Conclusion

The use of lower and upper limits for selecting the FCR based on CTA and PCA can be a valuable approach to reducing malrotation risk and achieving satisfactory functional outcomes in TKA. Addressing the individual patient's anatomic limits contributes to improved TKA outcomes and patient-specific component alignment, thus enhancing the overall success of the procedure.

目的股骨组件旋转（FCR）是全膝关节置换术（TKA）的关键。目前，由于患者解剖结构的变化，选择FCR的最佳方法尚不清楚。解决股骨组件旋转的可变性对于优化TKA结果和患者满意度至关重要。在本研究中，我们旨在通过设置FCR选择的解剖极限来识别异常频率并评估旋转不良风险的降低。方法将100例需要TKA的终末期膝关节骨性关节炎患者纳入研究，并根据术中使用改良的带张力装置的间隙平衡技术计算的预期FCR，将其分为正常旋转、内旋转异常值和外旋转异常值。计算的FCR随后参考他们的后髁角（PCA）和髁扭转角（CTA）。还测量了术后FCR和1年、2年和5年的功能评分。结果71个膝关节（71%）在PCA和CTA范围内。组合异常频率为29%。正常、内旋和外旋组的平均计算FCR分别为4.4°（±1.5）、−1°（±2.6）和8.0°（±3.4）。设定界限后，三组术后FCR分别为3.1°（±1.5）、3.9°（±1.7）和2.5°（±1.4）。旋转不良的相对风险降低了65%。TKA术后1、2和5年，所有组均显示出显著的功能改善，正常组和异常组之间的功能结果没有显著差异。结论基于CTA和PCA选择FCR的下限和上限是降低TKA旋转不良风险和获得满意功能结果的一种有价值的方法。解决个别患者的解剖极限有助于改善TKA结果和患者特定组件的对齐，从而提高手术的整体成功率。

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引用次数: 0

Preoperative foot and ankle radiographic evaluation for total knee arthroplasty 全膝关节置换术前足踝关节影像学评价

Journal of Joint Surgery and Research

Pub Date : 2023-12-01 DOI: 10.1016/j.jjoisr.2023.08.003

Yoshihiro Wanezaki, Akemi Suzuki, Yuya Takakubo, Taku Nakajima, Shuji Toyono, Michiaki Takagi

Purpose

To radiographically evaluate the ankle and foot complications in preoperative patients for total knee arthroplasty (TKA) in Japan.

Methods

This study included 500 legs of 500 patients who planned to undergo primary TKA in affiliated hospitals of our university from August 2020 to November 2021. Hip to calcaneus view, anterior view of the ankle joint, and anterior and lateral views of the foot were taken within 1 month preoperatively. We measured hip-knee-ankle angle (HKA), mechanical ankle joint axis point (MAJAP), lateral distal tibial angle (LDTA), tibio-plafound inclination (TPI), talar inclination (TI), ankle joint line convergence angle (A-JLCA), talo-first metatarsal angle (TMA), calcaneal pitch angle (CPA), hallux valgus angle (HVA), first-second intermetatarsal angle (M1M2A), first fifth intermetatarsal angle (M1M5A), talonavicular coverage angle (TNCA), and percentage of Takakura Tanaka classification.

Results

Mean measured values were as follows: HKA: 11.0°; MAJAP, 39.6%; LDTA: 92.2°; TPI: 6.9°; TI: 7.2°; A-JLCA: 0.3°; TMA:−4.3° (<−4° in 247 feet, 49.4%); CPA: 15.9°(<20° in 366 feet, 73.2%); HVA: 16.8° (mild in 70 feet, 14.0%; moderate in 42 feet, 8.4%; severe in 23 feet, 4.6%); M1M2A: 11.1°(>9° in 373 feet, 74.6%); M1M5A: 31.1°(≥30° in 321 feet, 64.2%); TNCA: 10.6° (≥7° in 375 feet, 75.0%); Takakura Tanaka classification Stage ≥ IIIa in 108 feet, 21.6%.

Conclusions

Mild-to-severe hallux valgus was noted in 26.5% of patients and Stage IIIa or higher ankle osteoarthritis in 21.6%, and abnormal alignment—including flat feet—was indicated in some patients. Patient's knee, foot, and ankle symptoms should be considered before TKA.

目的对日本全膝关节置换术（TKA）术前患者的踝关节和足部并发症进行影像学评估。方法本研究纳入了计划于2020年8月至2021年11月在我校附属医院接受原发性TKA的500名患者的500条腿。术前1个月内拍摄髋关节至跟骨、踝关节前视图以及足部前视图和侧视图。我们测量了髋-膝-踝关节角（HKA）、机械踝关节轴点（MAJAP）、胫骨远端外侧角（LDTA）、胫骨平台倾斜度（TPI）、距骨倾斜度（TI）、踝关节线会聚角（A-JLCA）、距第一跖骨角（TMA）、跟骨倾角（CPA）、拇外翻角（HVA）、第一-第二跖骨间角（M1M2A）、，距舟骨覆盖角（TNCA）和Takakura Tanaka分类的百分比。结果平均测量值如下：HKA:11.0°；MAJAP为39.6%；LDTA：92.2°；TPI:6.9°；TI:7.2°；A-JLCA:0.3°；TMA:−4.3°（247英尺时＜−4°，49.4%）；CPA：15.9°（366英尺＜20°，73.2%）；HVA:16.8°（轻度70英尺，14.0%；中度42英尺，8.4%；重度23英尺，4.6%）；M1M2A:11.1°（373英尺内>；9°，74.6%）；M1M5A:31.1°（321英尺内≥30°，64.2%）；TNCA:10.6°（375英尺≥7°，75.0%）；高仓田中分类阶段≥结论26.5%的患者出现中度至重度拇外翻，21.6%的患者发现IIIa期或以上踝关节骨性关节炎，一些患者出现异常排列，包括扁平足。TKA前应考虑患者的膝盖、脚和脚踝症状。

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