在功能对齐的TKA中，股骨外旋转2度与股骨周围填充率最低有关。

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-28 DOI:10.1002/ksa.12662

Alexander Maslaris, Eustathios Kenanidis, Nikolaos Mylonakis, Zakareya Gamie, Abtin Alvand, William F Jackson, Andrew J Price, Eleftherios Tsiridis

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The same caliper-measurements were performed on the femoral components used to calculate bone-implant differences and analyse possible patterns of postoperative trochlear anatomy-modifications (TAM) and condylar anatomy-modifications (CAM). Over- or understuffing analysis for different FRs and regression analysis were conducted to assess the effect of FR on CAM and TAM.Results: TAM results were Lat-AT -3.2 mm ([95% confidence interval [CI]: -3.71 to -2.63], p < 0.001), Ctr-AT 0.7 mm ([95%CI: 0.22-1.32], p = 0.02), and Ctr-OT -1.7 mm ([95%CI: -1.85 to -0.93], p < 0.001) with stuffing > 2 mm in 60.9%, 39.1%, and 39.1%, respectively. CAM results were Med-DC -3.6 mm ([95%CI: -4.14 to -3.05], p < 0.001) and Lat-PC 3.0 mm ([95%CI: 2.48-3.38], p > 0.001) with stuffing > 2 mm in 78.3% and 63.8%. FR (3.8 ± 2.6°, range: -1.6° to 8.5°) affected mostly the anterior (r = -0.40, p < 0.001) and posterior (r = 0.71, p < 0.001) aspects of the knee but hardly the OT plane (r = 0.06, p = 0.624) and the trochlear groove to its full range of flexion (r = 0.21, p = 0.17). External FR 2° was associated with the lowest incidence of femoral stuffing > 2 mm and ≥ 4 mm.Conclusions: FA-typical modification-pattern was a TAM with lateral facet understuffing, and CAM with medial distal understuffing and lateral posterior overstuffing. Trochlear groove height was non-significantly affected by FR. 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引用次数: 0

摘要

目的：全膝关节置换术（TKA）后股骨形态的改变有可能导致韧带不平衡和髌骨畸形。本研究的主要目的是量化tka诱导的股骨周围填充物，其次评估股骨旋转（FR）对滑车和髁解剖变化的影响。方法：对69例机器人辅助tka采用胫骨功能对齐（FA）的膝关节解剖修饰进行量化。在以下切除平面的内侧（Med）、中央（Ctr）和外侧（Lat）进行卡尺测量：前滑车（AT）、斜滑车（OT）、远端髁（DC）、后髁（PC）和胫骨（TIB）。对股骨假体进行相同的卡尺测量，用于计算骨-种植体差异，并分析术后滑车解剖修饰（TAM）和髁解剖修饰（CAM）的可能模式。对不同的FR进行过填充或下填充分析和回归分析，以评估FR对CAM和TAM的影响。结果：TAM结果为latat -3.2 mm([95%可信区间[CI]: -3.71 ~ -2.63]， p 2 mm分别为60.9%、39.1%和39.1%。CAM结果为Med-DC -3.6 mm ([95%CI: -4.14 ~ -3.05], p 0.001)，填充bbb2.0 mm分别为78.3%和63.8%。FR(3.8±2.6°,范围:-1.6°到8.5°)受影响的主要是前(r = -0.40, p 2毫米和≥4毫米。结论：fa典型的改良模式为TAM伴外侧关节突内填充，CAM伴内侧远端内填充和外侧后侧内填充。FR对滑车槽高度无显著影响。当股骨外旋2°时，FA与目前现成的假体的填充率最低。证据等级：二级。

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External femoral rotation of 2 degrees is associated with the lowest stuffing rates around the femur in functionally aligned TKA.

Purpose: Modifying femoral morphology after total knee arthroplasty (TKA) poses a potential risk for ligament-imbalances and patella mal-tracking. The purpose of this study was primarily to quantify TKA-induced stuffing around the femur and secondarily assess the effect of femoral rotation (FR) on trochlear and condylar anatomy-changes.

Methods: Knee anatomy-modification was quantified in 69 robotic-assisted TKAs utilising tibia-based functional alignment (FA). Caliper-measurements were performed on the medial (Med), central (Ctr), and lateral (Lat) sides of the following resection planes: anterior trochlea (AT), oblique trochlea (OT), distal condyles (DC), posterior condyles (PC) and tibia (TIB). The same caliper-measurements were performed on the femoral components used to calculate bone-implant differences and analyse possible patterns of postoperative trochlear anatomy-modifications (TAM) and condylar anatomy-modifications (CAM). Over- or understuffing analysis for different FRs and regression analysis were conducted to assess the effect of FR on CAM and TAM.

Results: TAM results were Lat-AT -3.2 mm ([95% confidence interval [CI]: -3.71 to -2.63], p < 0.001), Ctr-AT 0.7 mm ([95%CI: 0.22-1.32], p = 0.02), and Ctr-OT -1.7 mm ([95%CI: -1.85 to -0.93], p < 0.001) with stuffing > 2 mm in 60.9%, 39.1%, and 39.1%, respectively. CAM results were Med-DC -3.6 mm ([95%CI: -4.14 to -3.05], p < 0.001) and Lat-PC 3.0 mm ([95%CI: 2.48-3.38], p > 0.001) with stuffing > 2 mm in 78.3% and 63.8%. FR (3.8 ± 2.6°, range: -1.6° to 8.5°) affected mostly the anterior (r = -0.40, p < 0.001) and posterior (r = 0.71, p < 0.001) aspects of the knee but hardly the OT plane (r = 0.06, p = 0.624) and the trochlear groove to its full range of flexion (r = 0.21, p = 0.17). External FR 2° was associated with the lowest incidence of femoral stuffing > 2 mm and ≥ 4 mm.

Conclusions: FA-typical modification-pattern was a TAM with lateral facet understuffing, and CAM with medial distal understuffing and lateral posterior overstuffing. Trochlear groove height was non-significantly affected by FR. FA with the current off-the-shelf implant induces the lowest stuffing rates when set in 2° external femoral rotation.

Level of evidence: Level II.

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

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).