A bone graft from the tibial resection or patella that rectified a tibial over-resection reliably healed and improved clinical outcome scores: A retrospective study of kinematically aligned TKA

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-09-09 DOI:10.1002/ksa.12457

Alexander J. Nedopil, Daniel Razick, Stephen M. Howell, Maury L. Hull

{"title":"A bone graft from the tibial resection or patella that rectified a tibial over-resection reliably healed and improved clinical outcome scores: A retrospective study of kinematically aligned TKA","authors":"Alexander J. Nedopil, Daniel Razick, Stephen M. Howell, Maury L. Hull","doi":"10.1002/ksa.12457","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>During kinematically aligned (KA) total knee arthroplasty (TKA), the surgeon may need to rectify an over-resection of the medial, lateral or posterior tibia. This study tested the hypothesis that a bone graft taken from the tibial resection or patella and impacted beneath a tibial baseplate would heal, regardless of whether the tibial component and knee were in outlier ranges according to mechanical alignment (MA) criteria. The study also tested the hypothesis that the Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) would improve beyond the substantial clinical benefit and that the source and thickness of the bone graft would not influence their improvement.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study radiographically assessed the healing of a bone graft from the tibial resection (<i>n</i> = 19) or patella (<i>n</i> = 10) in 29 KA TKAs (18 females, mean age 65 years). The tibial component and knee alignment were categorized as in-range or outliers based on reported MA criteria for bone graft healing and implant survival. The one-sample <i>t</i> test identified differences in the improvement of the OKS and KOOS JR from their reported substantial clinical benefit of 16 and 20 points, respectively.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>At an average follow-up of 37 months, all bone grafts healed even though ≥55% of tibial components and 34% of knees were varus outliers according to MA criteria for bone healing and implant survival. Amongst the 29 patients, the mean OKS and KOOS JR improvements of 25 ± 11 and 47 ± 21 points, respectively, surpassed the threshold of their respective substantial clinical benefit (<i>p</i> < 0.01) and were not influenced by the bone graft's source and thickness (<i>p</i> ≥ 0.51).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>During cemented KA TKA, the surgeon can use a bone graft from the tibial resection or patella to rectify a tibial over-resection. This technique led to consistent bone healing and improved outcome scores.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level IV.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 3","pages":"956-966"},"PeriodicalIF":3.3000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ksa.12457","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

During kinematically aligned (KA) total knee arthroplasty (TKA), the surgeon may need to rectify an over-resection of the medial, lateral or posterior tibia. This study tested the hypothesis that a bone graft taken from the tibial resection or patella and impacted beneath a tibial baseplate would heal, regardless of whether the tibial component and knee were in outlier ranges according to mechanical alignment (MA) criteria. The study also tested the hypothesis that the Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) would improve beyond the substantial clinical benefit and that the source and thickness of the bone graft would not influence their improvement.

Methods

This retrospective study radiographically assessed the healing of a bone graft from the tibial resection (n = 19) or patella (n = 10) in 29 KA TKAs (18 females, mean age 65 years). The tibial component and knee alignment were categorized as in-range or outliers based on reported MA criteria for bone graft healing and implant survival. The one-sample t test identified differences in the improvement of the OKS and KOOS JR from their reported substantial clinical benefit of 16 and 20 points, respectively.

Results

At an average follow-up of 37 months, all bone grafts healed even though ≥55% of tibial components and 34% of knees were varus outliers according to MA criteria for bone healing and implant survival. Amongst the 29 patients, the mean OKS and KOOS JR improvements of 25 ± 11 and 47 ± 21 points, respectively, surpassed the threshold of their respective substantial clinical benefit (p < 0.01) and were not influenced by the bone graft's source and thickness (p ≥ 0.51).

Conclusions

During cemented KA TKA, the surgeon can use a bone graft from the tibial resection or patella to rectify a tibial over-resection. This technique led to consistent bone healing and improved outcome scores.

Level of Evidence

Level IV.

查看原文本刊更多论文

从胫骨切除处或髌骨处进行骨移植，可矫正胫骨过度切除，从而可靠地愈合并改善临床结果评分：运动学配位 TKA 的回顾性研究。

目的：在运动学配准（KA）全膝关节置换术（TKA）中，外科医生可能需要纠正胫骨内侧、外侧或后侧的过度切除。本研究对以下假设进行了测试：无论胫骨组件和膝关节是否根据机械对位（MA）标准处于离群范围，从胫骨切除处或髌骨取下并撞击胫骨底板下方的植骨都会愈合。该研究还测试了一个假设，即牛津膝关节评分（OKS）和关节置换术膝关节损伤和骨关节炎结果评分（KOOS JR）的改善程度将超过实质性临床获益，而骨移植的来源和厚度不会影响其改善程度：这项回顾性研究对 29 例 KA TKA（18 名女性，平均年龄 65 岁）中胫骨切除（19 例）或髌骨（10 例）移植骨的愈合情况进行了放射学评估。根据报告的 MA 骨移植愈合和植入物存活率标准，胫骨组件和膝关节对齐情况被分为范围内和范围外。通过单样本 t 检验确定了 OKS 和 KOOS JR 的改善程度与所报告的实质性临床获益（分别为 16 分和 20 分）之间的差异：结果：在平均 37 个月的随访中，尽管根据骨愈合和植入物存活率的 MA 标准，≥55% 的胫骨组件和 34% 的膝关节曲度离群，但所有植骨均已愈合。在 29 名患者中，OKS 和 KOOS JR 的平均改善幅度分别为 25 ± 11 分和 47 ± 21 分，超过了各自的实质性临床获益临界值（p 结论）：在骨水泥 KA TKA 中，外科医生可以使用胫骨切除处或髌骨的骨移植来纠正胫骨过度切除。这种技术可使骨愈合一致，并提高疗效评分：证据等级：IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).