在全膝关节置换术患者中，使用冠状面膝关节排列分类法无法有效评估膝关节三维形态的变异性。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-26 DOI:10.1002/jeo2.70039

Ishaan Jagota, Joshua Twiggs, Brad Miles, Jonathan V. Baré

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引用次数: 0

摘要

目的：全膝关节置换术（TKA）中原生三维（3D）对位的最佳再现会影响手术效果；然而，现代 TKA 对位研究，如膝关节冠状面对位（CPAK），大多只关注冠状面对位。我们评估了胫骨、股骨和胫股骨在轴向和矢状面上的测量值与算术髋-膝-踝角度（aHKA）和关节线倾斜度（JLO）之间的关系。这些三维解剖测量结果也在不同的 CPAK 组别中进行了评估：方法：对 360 Med Care 计算机断层扫描（CT）数据库进行回顾性分析。对患者的 CT 扫描进行了分割和标记。线性回归分析比较了 12 个轴向和矢状面测量值（代表胫骨、股骨和胫股骨旋转、胫骨斜度和股骨屈曲）与 aHKA 和 JLO。非参数检验评估了不同 CPAK 组的这些解剖测量结果，而 Cohen's delta (d) 则确定了效应大小：结果：在 7450 个骨关节炎膝关节样本中，有显著但微弱的关系（r d > 0.80）。然而，效应大小（d）微不足道：CPAK表型虽然有助于描述膝关节冠状解剖，但无法区分胫骨、股骨和胫股骨旋转、胫骨斜度或股骨屈曲，而这些都是三维手术规划的关键方面。因此，需要更全面的膝关节表型解决方案来指导个性化的TKA对位策略：证据等级：二级

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Variability of three-dimensional knee morphology cannot be effectively assessed using a coronal plane knee alignment classification in total knee arthroplasty patients

Purpose

Optimal reproduction of the native three-dimensional (3D) alignment in total knee arthroplasty (TKA) influences outcomes; however, much of the modern TKA alignment research, such as the coronal plane alignment of the knee (CPAK), focuses only on coronal alignment. Tibial, femoral and tibiofemoral measurements on the axial and sagittal planes were evaluated for their relationship to the arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO). These 3D anatomical measurements are also evaluated across CPAK groups.

Methods

A retrospective analysis of the 360 Med Care computed tomography (CT) database was performed. Patient CT scans were segmented and landmarked. Linear regression analysis compared 12 axial and sagittal plane measurements (representing tibial, femoral and tibiofemoral rotation, tibial slope and femoral flexion) with both aHKA and JLO. Nonparametric tests assessed these anatomical measurements across the different CPAK groups, while Cohen's delta (d) determined the effect size.

Results

With a sample size of 7450 osteoarthritic knees, significant but weak relationships (r < 0.30) were observed between all 12 anatomical measurements and both aHKA and JLO. Tibiofemoral rotations between Insall's axis and both the posterior condylar and the surgical transepicondylar axes demonstrated large effect sizes (d > 0.80). However, trivial to small effect sizes (d < 0.50) were broadly observed across the 12 axial and sagittal measurements, underscoring their limited clinical significance.

Conclusions

While useful for describing coronal knee anatomy, CPAK phenotypes fail to differentiate tibial, femoral and tibiofemoral rotation, tibial slope or femoral flexion—crucial aspects of 3D surgical planning. Therefore, more comprehensive knee phenotyping solutions are required to guide individualised TKA alignment strategies.