全膝关节置换术后胫骨后坡不具有可重复性和一致性

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-03-04 DOI:10.1016/j.knee.2025.01.006

Ekin Barış Demir, Fatih Barça, Mert Uçak, Halis Atıl Atilla, Mutlu Akdoğan, Yalım Ateş

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引用次数: 0

摘要

背景：我们的目的是比较全膝关节置换术（TKA）中采用髓内（IM）和髓外（EM）方法放置胫骨假体的胫骨后斜率（PTS）值、分布、与制造商推荐值的偏差以及该值的恢复情况，并分析影响这些值的因素。方法回顾性分析2022年至2024年期间，采用齐默尔- biomet NexGen®LPS固定轴承膝关节TKA手术的151例膝关节。膝关节按胫骨假体放置法（IM或EM）分组。比较两组术前描述性资料、术后PTS、PTS的散度、术前与术后PTS的差异、与制造商声称的7°偏差、异常值率。分析影响EM组术后PTS的因素。结果EM组分析膝关节95例（62.9%），IM组分析膝关节56例（37.1%）。平均PTS从8.8±3.5°降至6.7±2.7°(P <；EM组从10±4.1°到4.9±2.6°(P <；0.001)。IM组术后PTS明显低于对照组(P <；0.001)。EM组与制造商声称的7°的平均偏差为2.4±1.4°，IM组为2.8±1.8°（P = 0.14）。151例患者中15例（9.9%）术后PTS大于10°。线性回归分析显示，EM组术前PTS和体重的影响中等。结论虽然没有统计学意义，但EM方法更接近制造商推荐的矢状位对齐方法。然而，两组的PTS范围较广，异常值较多。两种方法在PTS重现性和一致性方面都不可靠。

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Posterior tibial slope after total knee arthroplasty is not reproducible or consistent

Background

Our aim was to compare posterior tibial slope (PTS) values, distribution, deviation from manufacturer’s recommended value and restoration of this value in total knee arthroplasty (TKA) with tibial component placement using intramedullary (IM) and extramedullary (EM) methods, and to analyze factors affecting these values.

Methods

A total of 151 knees operated with Zimmer-Biomet NexGen® LPS Fixed Bearing Knee TKA between 2022 and 2024 were retrospectively investigated. Knees were grouped by method of tibial component placement (IM or EM). Pre-operative descriptive data, postoperative PTS, scatteredness of PTS, difference between pre-operative and postoperative PTS, deviation from 7° which was claimed by the manufacturer and rate of outliers were compared between groups. Factors that might affect postoperative PTS in the EM group were analyzed.

Results

Ninety-five knees (62.9%) in the EM group and 56 knees (37.1%) in the IM group were analyzed. Mean PTS decreased from 8.8 ± 3.5° to 6.7 ± 2.7° (P < 0.001) in the EM group, and from 10 ± 4.1° to 4.9 ± 2.6° (P < 0.001) in the IM group. Postoperative PTS was significantly lower in the IM group (P < 0.001). Mean deviation from 7° claimed by the manufacturer was 2.4 ± 1.4° for the EM group and 2.8 ± 1.8° for the IM group (P = 0.14). In 15 of 151 patients (9.9%), postoperative PTS was above 10°. Linear regression analysis revealed a moderate effect of pre-operative PTS and weight in the EM group.

Conclusions

Although not statistically significant, the EM method is closer to the manufacturer’s recommendation for sagittal alignment. However, both groups had a wide range of PTS and a large number of outliers. Both methods are not reliable in terms of PTS reproducibility and consistency.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.