Samuel Yan Jin Fang MBBS (HK) , Kwong Yuen Chiu MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Wai Kiu Thomas Liu MBBS (HK) , Amy Cheung MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Ping Keung Chan MBBS, MRCSEd, FHKCOS, FHKAM, FRCSEd (Orth) , Henry Fu MBBS (HK), MMedSc (HK), FRCSEd (Orth), FHKCOS, FHKAM
{"title":"影响机器人辅助全膝关节置换术成功实现术前严重外翻患者限制性运动对位的因素","authors":"Samuel Yan Jin Fang MBBS (HK) , Kwong Yuen Chiu MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Wai Kiu Thomas Liu MBBS (HK) , Amy Cheung MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Ping Keung Chan MBBS, MRCSEd, FHKCOS, FHKAM, FRCSEd (Orth) , Henry Fu MBBS (HK), MMedSc (HK), FRCSEd (Orth), FHKCOS, FHKAM","doi":"10.1016/j.artd.2024.101490","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) remains challenging in severe varus knees. We evaluated the impact of hip-knee-ankle varus deformity and osteophyte size on achieving restricted kinematic alignment (rKA) in robotic-arm-assisted TKA.</div></div><div><h3>Methods</h3><div>This retrospective study included 244 knees (194 patients) that underwent robotic-arm-assisted TKA for varus primary knee osteoarthritis at an academic institution. Intraoperative hip-knee-ankle angle (HKA) and soft tissue balance were monitored to assess the success of rKA with osteophyte resection alone. For those that failed, medial collateral ligament needle pie-crusting was performed.</div></div><div><h3>Results</h3><div>Mean age was 65.3 years (range, 48-83). Mean preoperative HKA was 11.9° varus (range, 1.0°-32.0°), and HKA after osteophyte resection was 5.1° varus (range, 0°-19.0°). Mean HKA correction was 6.8° (range, 0°-18.0°). rKA was achieved in 36.9% at a boundary of ≤3° varus and up to 72.1% at ≤6° varus. Preoperative varus HKA was lower in successful cases across all target alignments (<em>P</em> < .05). Medial tibial osteophyte size was 6.1% ± 2.9% and was smaller in all groups that achieved rKA (<em>P</em> < .05). Both were positively correlated with degree of deformity correction, <em>r</em> = 0.718 (<em>P</em> < .01) and <em>r</em> = 0.281 (<em>P</em> < .01), respectively.</div></div><div><h3>Conclusions</h3><div>This study highlighted the importance of varus deformity and medial tibial osteophytes when adopting rKA. They were associated with increased failure to achieve rKA. rKA was reliably achieved in minimal varus deformities (HKA ≤ 5°), we recommend an expanded protocol of HKA ≤ 6° varus for mild deformities (HKA 6°-10°), and consider medial soft tissue release for moderate (HKA 11°-15°) and severe deformities (HKA ≥ 16°).</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101490"},"PeriodicalIF":1.5000,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Affecting Successful Restricted Kinematic Alignment With Robotic Assisted Total Knee Arthroplasty in Patients With Severe Varus Preoperative Alignment\",\"authors\":\"Samuel Yan Jin Fang MBBS (HK) , Kwong Yuen Chiu MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Wai Kiu Thomas Liu MBBS (HK) , Amy Cheung MBBS (HK), FRCSEd (Orth), FHKCOS, FHKAM , Ping Keung Chan MBBS, MRCSEd, FHKCOS, FHKAM, FRCSEd (Orth) , Henry Fu MBBS (HK), MMedSc (HK), FRCSEd (Orth), FHKCOS, FHKAM\",\"doi\":\"10.1016/j.artd.2024.101490\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) remains challenging in severe varus knees. We evaluated the impact of hip-knee-ankle varus deformity and osteophyte size on achieving restricted kinematic alignment (rKA) in robotic-arm-assisted TKA.</div></div><div><h3>Methods</h3><div>This retrospective study included 244 knees (194 patients) that underwent robotic-arm-assisted TKA for varus primary knee osteoarthritis at an academic institution. Intraoperative hip-knee-ankle angle (HKA) and soft tissue balance were monitored to assess the success of rKA with osteophyte resection alone. For those that failed, medial collateral ligament needle pie-crusting was performed.</div></div><div><h3>Results</h3><div>Mean age was 65.3 years (range, 48-83). Mean preoperative HKA was 11.9° varus (range, 1.0°-32.0°), and HKA after osteophyte resection was 5.1° varus (range, 0°-19.0°). Mean HKA correction was 6.8° (range, 0°-18.0°). rKA was achieved in 36.9% at a boundary of ≤3° varus and up to 72.1% at ≤6° varus. Preoperative varus HKA was lower in successful cases across all target alignments (<em>P</em> < .05). Medial tibial osteophyte size was 6.1% ± 2.9% and was smaller in all groups that achieved rKA (<em>P</em> < .05). Both were positively correlated with degree of deformity correction, <em>r</em> = 0.718 (<em>P</em> < .01) and <em>r</em> = 0.281 (<em>P</em> < .01), respectively.</div></div><div><h3>Conclusions</h3><div>This study highlighted the importance of varus deformity and medial tibial osteophytes when adopting rKA. They were associated with increased failure to achieve rKA. rKA was reliably achieved in minimal varus deformities (HKA ≤ 5°), we recommend an expanded protocol of HKA ≤ 6° varus for mild deformities (HKA 6°-10°), and consider medial soft tissue release for moderate (HKA 11°-15°) and severe deformities (HKA ≥ 16°).</div></div>\",\"PeriodicalId\":37940,\"journal\":{\"name\":\"Arthroplasty Today\",\"volume\":\"30 \",\"pages\":\"Article 101490\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-10-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroplasty Today\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352344124001754\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344124001754","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Factors Affecting Successful Restricted Kinematic Alignment With Robotic Assisted Total Knee Arthroplasty in Patients With Severe Varus Preoperative Alignment
Background
Total knee arthroplasty (TKA) remains challenging in severe varus knees. We evaluated the impact of hip-knee-ankle varus deformity and osteophyte size on achieving restricted kinematic alignment (rKA) in robotic-arm-assisted TKA.
Methods
This retrospective study included 244 knees (194 patients) that underwent robotic-arm-assisted TKA for varus primary knee osteoarthritis at an academic institution. Intraoperative hip-knee-ankle angle (HKA) and soft tissue balance were monitored to assess the success of rKA with osteophyte resection alone. For those that failed, medial collateral ligament needle pie-crusting was performed.
Results
Mean age was 65.3 years (range, 48-83). Mean preoperative HKA was 11.9° varus (range, 1.0°-32.0°), and HKA after osteophyte resection was 5.1° varus (range, 0°-19.0°). Mean HKA correction was 6.8° (range, 0°-18.0°). rKA was achieved in 36.9% at a boundary of ≤3° varus and up to 72.1% at ≤6° varus. Preoperative varus HKA was lower in successful cases across all target alignments (P < .05). Medial tibial osteophyte size was 6.1% ± 2.9% and was smaller in all groups that achieved rKA (P < .05). Both were positively correlated with degree of deformity correction, r = 0.718 (P < .01) and r = 0.281 (P < .01), respectively.
Conclusions
This study highlighted the importance of varus deformity and medial tibial osteophytes when adopting rKA. They were associated with increased failure to achieve rKA. rKA was reliably achieved in minimal varus deformities (HKA ≤ 5°), we recommend an expanded protocol of HKA ≤ 6° varus for mild deformities (HKA 6°-10°), and consider medial soft tissue release for moderate (HKA 11°-15°) and severe deformities (HKA ≥ 16°).
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.