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IF 3.4 2区医学 Q1 ORTHOPEDICS

Journal of Arthroplasty Pub Date : 2025-02-27 DOI:10.1016/j.arth.2025.02.065

Simon W Young, Mei Lin Tay, Kohei Kawaguchi, Rupert van Rooyen, Matthew L Walker, William J Farrington, Ali Bayan

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引用次数: 0

摘要

导言：机械对位（MA）全膝关节置换术（TKA）被视为黄金标准；然而，一些患者在术后表示不满意。功能性对齐（FA）是一种潜在的替代方法，它将运动学对齐（KA）原理与截骨前的骨平衡整合在确定的边界内。使用功能性对齐的目的是通过恢复原始关节线和优化软组织平衡来改善疗效。然而，比较证据有限：这项前瞻性随机对照试验比较了机器人辅助 TKA 中的 MA（n = 121）和 FA（n = 123）。对于 MA，组件的定位垂直于肢体机械轴，并通过软组织松解达到平衡。对于FA，初始虚拟组件定位用于匹配本地膝关节解剖（KA），在切骨前调整软组织平衡。主要结果是被遗忘的关节评分（FJS）。结果采用混合模型方差分析进行比较：结果：在两年的随访中，平均 FJS 相当（MA：64.4 ± 30.1 对 FA：70.1 ± 25.6，P = 0.10）。MA病例的软组织松解率高于FA（65%对16%，P < 0.001）。与 MA 患者相比，FA 患者的膝关节损伤和骨关节炎结果 (KOOS) 症状评分（86.6 ± 12.9 对 82.5 ± 14.0，P = 0.01）和 KOOS 生活质量 (QOL) 评分（76.1 ± 20.3 对 70.7 ± 22.7，P = 0.03）更高。更多的 FA 患者 "愿意推荐 "该手术（94% 对 82%，P < 0.01）。对于术前膝关节冠状面对齐（CPAK）I型的患者，FA的FJS（71.3 ± 24.8对56.8 ± 31.6，P = 0.02）和KOOS-QOL（76.4 ± 21.7对64.2 ± 19.2，P = 0.02）均高于MA。在患者报告结果（牛津膝关节评分、KOOS、EuroQol-5维度、疼痛视觉模拟量表）、临床结果（住院时间、功能理疗测试）、再手术或植入物存活率（FA：1对MA：0次翻修）方面未见其他差异：结论：与机械式对位相比，功能性对位所需的软组织松解次数较少，但两年后患者报告的结果和临床结果相似。根据患者术前的对位情况，使用功能性对位可改善特定亚组患者的治疗效果。

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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The John N. Insall Award: Functional Versus Mechanical Alignment in Total Knee Arthroplasty: A Randomized Controlled Trial.

Background: Mechanical alignment (MA) in total knee arthroplasty is regarded as a gold standard; however, some patients report dissatisfaction postsurgery. Functional alignment (FA) is a potential alternative, integrating kinematic alignment (KA) principles with preresection bone balancing within defined boundaries. The use of FA aims to improve outcomes by restoring native joint lines and optimizing soft-tissue balance. However, comparative evidence is limited.

Methods: This prospective, randomized controlled trial compared MA (n = 121) and FA (n = 123) in robotic-assisted total knee arthroplasty. For MA, components were positioned perpendicular to the limb mechanical axis, with soft-tissue releases to achieve balance. For FA, initial virtual component positioning was used to match native knee anatomy, with adjustments for soft-tissue balance before bone cuts. The primary outcome was the forgotten joint score (FJS). Outcomes were compared with a mixed-model analysis of variance.

Results: At the 2-year follow-up, the mean FJS was comparable (MA: 64.4 ± 30.1 versus FA: 70.1 ± 25.6, P = 0.10). The MA cases had more soft-tissue releases than FA (65 versus 16%, P < 0.001). Compared to MA patients, FA patients had higher Knee Injury and Osteoarthritis Outcome (KOOS) Symptoms (86.6 ± 12.9 versus 82.5 ± 14.0, P = 0.01) and KOOS-Quality of Life scores (76.1 ± 20.3 versus 70.7 ± 22.7, P = 0.03). More FA patients "would recommend" the procedure (94 versus 82%, P < 0.01). For patients who had preoperative Coronal Plane Alignment of the Knee Type I, FA had higher FJS (71.3 ± 24.8 versus 56.8 ± 31.6, P = 0.02) and KOOS-Quality of Life (76.4 ± 21.7 versus 64.2 ± 19.2, P = 0.02) than MA. No other differences were seen in patient-reported outcomes (Oxford Knee Score, KOOS, EuroQol-5 Dimensions, Pain Visual Analog Scale), clinical outcomes (length of stay, functional physio tests), reoperations, or implant survivorship (FA: 1 versus MA: 0 revisions).

Conclusions: While FA required fewer soft-tissue releases compared to mechanical alignment, at 2 years patient-reported and clinical outcomes were similar. The use of FA may provide improved outcomes for a specific subgroup of patients based on their preoperative alignment.

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来源期刊

Journal of Arthroplasty 医学-整形外科

CiteScore

7.00

自引率

20.00%

发文量

734

审稿时长

48 days

期刊介绍： The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.