术前外翻畸形全膝关节置换术后残留外翻导致患者报告的预后较差

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2025-03-13 DOI:10.1016/j.artd.2025.101660

Anastasia A. Hunt MD, Ian Hollyer MD, Nicole S. Pham MPH, William J. Maloney MD, James I. Huddleston III MD

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引用次数: 0

摘要

背景：对于术前外翻畸形的全膝关节置换术（TKA）后最佳冠状位排列尚不清楚。本研究旨在评估外翻畸形TKA术后冠状位对齐对临床结果的影响。方法回顾性分析2010 ~ 2020年间术前外翻行原发性TKA的患者，随访时间至少1年。术前和术后通过髋关节-膝关节-踝关节角度的长腿x线片评估机械对齐。术后对准分为外翻（2°外翻）、中性（机械轴2°内翻）和内翻（2°内翻）。收集患者人口统计资料、术前和术后结局评分以及并发症。结果106例患者符合入选标准，术前外翻畸形平均为11°（标准差±6.1）。术后18例为内翻对准，58例为中性，30例为外翻对准。在2年的随访中，多变量分析显示，术后中性或内翻对齐的患者与残留外翻的患者相比，具有更好的退伍军人RAND 12项健康调查物理和膝关节损伤以及骨关节炎结局评分疼痛评分。膝内翻与膝外翻相比，膝关节社会评分功能评分有明显改善。在最后的随访中，膝关节损伤和骨关节炎结局评分：膝内翻患者的疼痛评分明显更好。与外翻膝关节相比，内翻患者实现VR-12物理评分最小临床重要差异的可能性是外翻患者的7.79倍，而中性患者实现膝关节社会评分功能最小临床重要差异的可能性是外翻患者的3.26倍。结论：与残留外翻相比，术前纠正外翻冠状位对准中性或内翻可改善患者报告的结果。

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Residual Postoperative Valgus After Total Knee Arthroplasty for Preoperative Valgus Deformity Results in Inferior Patient-Reported Outcomes

Background

The optimal postoperative coronal alignment after total knee arthroplasty (TKA) for preoperative valgus deformity is unknown. This study aims to evaluate the impact of postoperative coronal alignment on clinical outcomes following TKA for valgus deformities.

Methods

Patients in preoperative valgus undergoing primary TKA between 2010 and 2020 with at least 1 year of follow-up were retrospectively reviewed. Preoperative and postoperative mechanical alignment was assessed on long-leg radiographs via the hip-knee-ankle angle. Postoperative alignment was categorized into valgus (>2° valgus), neutral (within 2° of the mechanical axis), or varus (>2° varus). Patient demographics, preoperative and postoperative outcome scores, and complications were collected.

Results

106 patients met inclusion criteria, with a mean preoperative valgus deformity of 11° (standard deviation ± 6.1). Postoperatively, 18 patients were in varus alignment, 58 were neutral, and 30 remained in valgus. At 2-year follow-up, multivariate analyses showed that patients in neutral or varus alignment postoperatively had superior Veterans RAND 12-Item Health Survey Physical and Knee injury and Osteoarthritis Outcome Score Pain scores compared to those in residual valgus. Varus knees showed significantly greater improvement in Knee Society Score Function scores compared to valgus knees. At final follow-up, Knee injury and Osteoarthritis Outcome Score Pain scores were significantly better in varus knees. Patients in varus were 7.79 times more likely to achieve the minimal clinically important difference VR-12 Physical score, while patients in neutral were 3.26 times more likely to achieve the minimal clinically important difference for Knee Society Score Function when compared to valgus knees.

Conclusions

Correcting preoperative valgus coronal alignment to neutral or varus yields improved patient-reported outcomes when compared to residual valgus.

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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.