软骨厚度可以在全膝关节置换术中精确测量：在钳形运动学对齐的进一步。

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-01-26 DOI:10.1002/jeo2.70155

Giancarlo Giurazza, Stefano Campi, Michael T. Hirschmann, Edoardo Franceschetti, Andrea Tanzilli, Pietro Gregori, Michele Paciotti, Biagio Zampogna, Rocco Papalia

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引用次数: 0

摘要

简介：全膝关节置换术（TKA）中的运动学对齐（KA）是一种纯粹的股骨表面置换手术，旨在恢复个体关节炎前的解剖结构。然而，当在磨损侧系统地使用2mm补偿时，未磨损腔室中软骨厚度的变化可能会改变技术的准确性。本研究旨在通过将两种术中股骨软骨厚度测量技术与通过对骨切割图像进行像素分析来测量软骨厚度的摄影方法进行比较，从而验证两种术中股骨软骨厚度测量技术的有效性。该研究假设两种术中方法在照相法0.5 mm范围内具有可比性和相似的准确性。方法：前瞻性收集70例终末期膝关节骨性关节炎患者70例软骨厚度测量数据。对两种术中技术进行评价：分别在股骨远端切除术前后采用电针尖法（方法A）和尺子法（方法B）。术后摄影分析（方法C）作为参考方法。为了保持一致性，测量结果四舍五入到最接近的0.5毫米。采用Kruskal-Wallis检验、Wilcoxon秩和检验、Spearman秩相关、一致性百分比和类内相关系数（ICCs）对数据进行分析。结果：A法与B法测量股骨软骨厚度无显著差异。方法B与方法C的一致性为100%，方法A与方法C的一致性为85%。在15%的不一致病例中，方法A比方法C高估了0.5 mm，两种方法之间的相关系数很高（ρ = 0.88-1.0）。所有方法的观察者内部和观察者之间的信度都很高（ICCs 0.91-0.95）。讨论：两种术中方法都是可靠的，当四舍五入到最接近的0.5 mm时，与摄影法相当，两者之间没有显著差异。电灼法的另一个优点是在进行骨切割之前测量软骨厚度。证据等级：四级。

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Cartilage thickness can be accurately measured intraoperatively in total knee arthroplasty: A step further in calipered kinematic alignment

Introduction

Kinematic alignment (KA) in total knee arthroplasty (TKA) is by definition a pure femoral resurfacing procedure aiming to restore the individual prearthritic anatomy. However, when a 2 mm compensation is systematically used on the worn side, the variability in cartilage thickness in the unworn compartment might alter the accuracy of the technique. This study aimed to validate two intraoperative femoral cartilage thickness measurement techniques by comparing them to the photographic method, which measures cartilage thickness through pixel analysis of bone-cut images. The study hypothesized that the two intraoperative methods are comparable and similarly accurate within 0.5 mm of the photographic method.

Methods

Seventy cartilage thickness measurements from seventy patients with end-stage knee osteoarthritis were prospectively collected. Two intraoperative techniques were evaluated: the electrocautery tip method (Method A) and the ruler method (Method B), performed before and after distal femoral bone resections, respectively. The postoperative photographic analysis (Method C) served as the reference method. Measurements were rounded to the nearest 0.5 mm for consistency. Data were analyzed using Kruskal–Wallis test, Wilcoxon rank-sum tests, Spearman's rank correlation, percentage of agreement and intraclass correlation coefficients (ICCs).

Results

No significant differences were observed between Method A and Method B in measuring femoral cartilage thickness. Agreement with Method C was 100% for Method B and 85% for Method A. In the 15% of discordant cases, Method A overestimated the measurements by one category of 0.5 mm compared to Method C. Correlation coefficients between the methods were high (ρ = 0.88−1.0). Intra- and interobserver reliability was high for all methods (ICCs 0.91–0.95).

Discussion

Both intraoperative methods are reliable and comparable to the photographic method when rounded to the closest 0.5 mm, with no significant differences among them. The electrocautery method has the added advantage of measuring cartilage thickness before bone cuts are performed.