Maamoun Alsalloum, Assil-Ramin Alimy, Jan Hubert, Tim Rolvien, Bernd Fink
{"title":"外侧入路与内侧入路相比，外翻性骨关节炎患者全膝关节置换术的临床和放射学效果相似。","authors":"Maamoun Alsalloum, Assil-Ramin Alimy, Jan Hubert, Tim Rolvien, Bernd Fink","doi":"10.1002/ksa.12526","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>In total knee arthroplasty (TKA), valgus deformities require special approaches to achieve precise mechanical axis correction and joint stability. This study aimed to determine whether the lateral approach without tibial tubercle osteotomy allows mechanical axis correction in valgus knee osteoarthritis (OA), which is at least as effective as the medial approach, while also assessing whether it provides clinically comparable results and complications.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A total of 204 patients undergoing TKA for valgus knee OA were included in this retrospective comparative study, with 131 patients in the lateral approach group and 73 patients in the medial approach group. The surgical goal was to achieve stability with a neutral axis based on mechanical alignment. Detailed pre- and postoperative clinical and radiographic data were obtained, including measurements of the hip–knee–ankle angle (HKAA) and patella tilt angle. Functional status was determined based on the Oxford Knee Score (OKS). Age, body mass index, sex and preoperative HKAA were adjusted between both groups using propensity score matching (<i>n</i> = 45 per group).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In the propensity score-matched cohort, the postoperative HKAA did not show differences when comparing the lateral and the medial approach at a mean follow-up of 19.7 months (<i>p</i> = 0.385). The achieved correction of the patella tilt angle was higher in the lateral approach group in the overall (<i>p</i> < 0.001) and matched cohort (<i>p</i> < 0.001). No differences were detected regarding the postoperative OKS and complications. However, wound healing disorders showed a tendency to be more prevalent in patients who underwent the lateral approach in the overall cohort (6.1%, <i>n</i> = 8 vs. 0.0%, <i>n</i> = 0, <i>p</i> = 0.053) but not in the propensity score-matched cohort (<i>p</i> = 0.494).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This study demonstrated that for pronounced valgus OA, the lateral approach achieves favourable results in HKAA correction, patellar tilt and complications comparable to the medial approach. However, the risk of wound healing disorders appears higher with severe valgus deformity.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III, therapeutic study.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 4","pages":"1378-1386"},"PeriodicalIF":3.3000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The lateral approach for total knee arthroplasty in valgus osteoarthritis provides similar clinical and radiological results compared with the medial approach\",\"authors\":\"Maamoun Alsalloum, Assil-Ramin Alimy, Jan Hubert, Tim Rolvien, Bernd Fink\",\"doi\":\"10.1002/ksa.12526\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>In total knee arthroplasty (TKA), valgus deformities require special approaches to achieve precise mechanical axis correction and joint stability. This study aimed to determine whether the lateral approach without tibial tubercle osteotomy allows mechanical axis correction in valgus knee osteoarthritis (OA), which is at least as effective as the medial approach, while also assessing whether it provides clinically comparable results and complications.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A total of 204 patients undergoing TKA for valgus knee OA were included in this retrospective comparative study, with 131 patients in the lateral approach group and 73 patients in the medial approach group. The surgical goal was to achieve stability with a neutral axis based on mechanical alignment. Detailed pre- and postoperative clinical and radiographic data were obtained, including measurements of the hip–knee–ankle angle (HKAA) and patella tilt angle. Functional status was determined based on the Oxford Knee Score (OKS). Age, body mass index, sex and preoperative HKAA were adjusted between both groups using propensity score matching (<i>n</i> = 45 per group).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>In the propensity score-matched cohort, the postoperative HKAA did not show differences when comparing the lateral and the medial approach at a mean follow-up of 19.7 months (<i>p</i> = 0.385). The achieved correction of the patella tilt angle was higher in the lateral approach group in the overall (<i>p</i> < 0.001) and matched cohort (<i>p</i> < 0.001). No differences were detected regarding the postoperative OKS and complications. 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The lateral approach for total knee arthroplasty in valgus osteoarthritis provides similar clinical and radiological results compared with the medial approach
Purpose
In total knee arthroplasty (TKA), valgus deformities require special approaches to achieve precise mechanical axis correction and joint stability. This study aimed to determine whether the lateral approach without tibial tubercle osteotomy allows mechanical axis correction in valgus knee osteoarthritis (OA), which is at least as effective as the medial approach, while also assessing whether it provides clinically comparable results and complications.
Methods
A total of 204 patients undergoing TKA for valgus knee OA were included in this retrospective comparative study, with 131 patients in the lateral approach group and 73 patients in the medial approach group. The surgical goal was to achieve stability with a neutral axis based on mechanical alignment. Detailed pre- and postoperative clinical and radiographic data were obtained, including measurements of the hip–knee–ankle angle (HKAA) and patella tilt angle. Functional status was determined based on the Oxford Knee Score (OKS). Age, body mass index, sex and preoperative HKAA were adjusted between both groups using propensity score matching (n = 45 per group).
Results
In the propensity score-matched cohort, the postoperative HKAA did not show differences when comparing the lateral and the medial approach at a mean follow-up of 19.7 months (p = 0.385). The achieved correction of the patella tilt angle was higher in the lateral approach group in the overall (p < 0.001) and matched cohort (p < 0.001). No differences were detected regarding the postoperative OKS and complications. However, wound healing disorders showed a tendency to be more prevalent in patients who underwent the lateral approach in the overall cohort (6.1%, n = 8 vs. 0.0%, n = 0, p = 0.053) but not in the propensity score-matched cohort (p = 0.494).
Conclusion
This study demonstrated that for pronounced valgus OA, the lateral approach achieves favourable results in HKAA correction, patellar tilt and complications comparable to the medial approach. However, the risk of wound healing disorders appears higher with severe valgus deformity.
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).
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