Factors Affecting Successful Restricted Kinematic Alignment With Robotic Assisted Total Knee Arthroplasty in Patients With Severe Varus Preoperative Alignment

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2024-10-11 DOI:10.1016/j.artd.2024.101490

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

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引用次数: 0

Abstract

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°).

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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

背景全膝关节置换术（TKA）对于严重屈曲的膝关节仍然具有挑战性。我们评估了髋-膝-踝关节屈曲畸形和骨赘大小对机器人手臂辅助全膝关节置换术（TKA）中实现受限运动学对位（rKA）的影响。对术中髋-膝-踝角度（HKA）和软组织平衡进行监测，以评估单纯骨质增生切除术（rKA）的成功率。结果平均年龄为 65.3 岁（48-83 岁）。术前 HKA 平均曲度为 11.9°（范围为 1.0°-32.0°），骨质增生切除术后 HKA 平均曲度为 5.1°（范围为 0°-19.0°）。36.9%的患者在髋关节屈曲≤3°时获得了rKA，72.1%的患者在髋关节屈曲≤6°时获得了rKA。在所有目标对齐的成功病例中，术前曲度 HKA 均较低（P < .05）。胫骨内侧骨质增生的大小为 6.1% ± 2.9%，在所有达到 rKA 的组别中均较小（P < .05）。两者与畸形矫正程度呈正相关，分别为 r = 0.718 (P < .01) 和 r = 0.281 (P < .01)。我们建议对轻度畸形（HKA 6°-10°）采用HKA≤6°的扩大方案，对中度畸形（HKA 11°-15°）和重度畸形（HKA≥16°）考虑内侧软组织松解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

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.