立位侧位片上的术前胫股关节接触点可预测全膝关节置换术的膝关节前后运动学特性

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-11-14 DOI:10.1002/jeo2.70093

Yusuke Tominaga, Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Yusuke Horita, Masaki Takao

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引用次数: 0

摘要

目的本研究调查了膝关节骨性关节炎患者站立侧位片上的胫股关节接触点（CP），并评估了CP与全膝关节置换术（TKA）术前和术后膝关节运动学之间的关系。方法对使用导航系统进行双叉稳定 TKA 手术的 46 个膝关节外翻畸形患者的术中膝关节状态进行了调查。在最大伸展角度、15°、30°、45°、60°和90°时，术中股骨相对于胫骨的前后（AP）位置由导航系统在 TKA 手术前后进行评估。CP 定义为股骨和胫骨之间的 CP，在 TKA 手术前和手术后 1 年，通过膝关节最大伸展时的立位侧位片进行评估。CP以胫骨平台距离的比率表示，0表示股骨相对于胫骨的最前位置，1表示股骨相对于胫骨的最前位置。结果 TKA前后立位侧位片上的平均CP分别为0.54 ± 0.12和0.46 ± 0.08。术后 CP 明显比术前 CP 更前（p = 0.0002）。在 TKA 手术前后，股骨相对于胫骨的平均 AP 位置在膝关节早期屈曲时均向前方移动，代表非解剖 AP 移动。与术前CP前组（CP <0.54）相比，术前CP后组（CP >0.54）在TKA前后的15°至60°之间表现出更多的非解剖性AP移动。结论在站立位时，术前股骨相对于胫骨的后方偏差是膝关节非解剖AP运动学的一个预测因素。有必要对术后膝关节进行生物力学分析；然而，外科医生应关注术前站立位侧位片上的胫股骨CP，以预测膝关节运动学。证据等级Ⅲ级。

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Preoperative tibiofemoral contact point on standing lateral radiograph predicts anteroposterior knee kinematics in total knee arthroplasty

Purpose

This study investigated the tibiofemoral contact point (CP) on standing lateral radiographs in knee osteoarthritis and assessed the relationship between CP and pre- and postoperative knee kinematics in total knee arthroplasty (TKA).

Methods

The intraoperative knee status of 46 knees with varus deformity that underwent bicruciate stabilized TKA using a navigation system was investigated. The intraoperative anteroposterior (AP) position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60° and 90° was evaluated by the navigation system before and after TKA. The CP, defined as the CP between the femur and tibia, was assessed on standing lateral radiographs at the maximum extension of the knee before and 1 year after TKA. CP was expressed as the ratio of tibial plateau distance on a scale of 0–1, with 0 indicating the most anterior position of the femur relative to the tibia.

Results

The mean CP on standing lateral radiographs was 0.54 ± 0.12 and 0.46 ± 0.08 before and after TKA, respectively. The postoperative CP was significantly more anterior than the preoperative CP (p = 0.0002). The mean AP position of the femur relative to the tibia moved anteriorly during early knee flexion both before and after TKA, representing nonanatomical AP movement. The preoperative posterior CP group (CP > 0.54) showed more nonanatomical AP movement from 15° to 60° before and after TKA compared with the preoperative anterior CP group (CP < 0.54).

Conclusion

Preoperative posterior deviation of the femur relative to the tibia in the standing position was a predictive factor for nonanatomical AP knee kinematics. Biomechanical analysis of postoperative knees will be necessary; however, surgeons should focus on preoperative tibiofemoral CP on standing lateral radiographs to predict knee kinematics.