股骨假体缩小对全膝关节置换术中膝关节伸展及伸展间隙的影响

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-19 DOI:10.1016/j.jcot.2025.103023

Anoop Jhurani, Piyush Agarwal, Gaurav Ardawatia, Hardik Sahni, Mudit Srivastava

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引用次数: 0

摘要

背景：在全髋关节置换术中，通常考虑缩小股骨的尺寸，以增加屈曲空间或减少股骨假体的中外侧悬垂。这导致弯曲空间明显开放2-3毫米。然而，股骨组件缩小对膝关节伸展和最终矢状面矫正的影响尚不清楚。这项基于CAS的前瞻性研究旨在通过计算机导航的客观数据发现股骨组件缩小导致的膝关节伸展变化。方法在2020年至2022年期间共进行了1811例CAS膝关节手术。152个膝关节需要缩小，其中112个膝关节在应用排除标准后被纳入。患者平均BMI为28.2±4.6 kg/m，平均年龄62.5±8岁。结果术前平均畸形为固定屈曲7.7±4.3(0.5 ~ 14)，内翻8.6±2.7（3 ~ 13）。大、缩股骨展伸矢状面畸形的平均差异为5.8°，差异有统计学意义（p = 0.001）。缩小后的膝关节得到更多的伸展，可能是由于关节囊和软组织包膜内金属体积的减少。由于撞击减少，内侧软组织包膜松弛，缩小时冠状面对齐有显著的纠正（1°）（p = 0.001）。结论：外科医生应注意，股骨缩小可能会使膝关节伸展增加5.8°，这可能是增加两个间隙的策略，特别是当股骨组成部分有明显的中外侧悬垂时。证据等级：IV类。

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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Influence of femoral component downsizing on knee extension and resultant extension gap in TKA

Background

Downsizing of femur is often considered during TKA to increase the flexion space or to reduce the mediolateral overhang of the femoral component. This leads to an obvious opening up of flexion space by 2–3 mm. However, the effect of downsizing of the femur component on knee extension and final sagittal correction are unknown. This CAS based prospective study aims to find out change in knee extension caused as a result of downsizing the femur component through objective data from computer navigation.

Methods

Out of a total 1811 CAS knees operated between 2020 and 2022. 152 knees required downsizing of which 112 knees were included after applying exclusion criteria. The patients had average BMI of 28.2 ± 4.6 kg/m and average age of 62.5 ± 8 years.

Results

The average preoperative deformity was fixed flexion of 7.7 ± 4.3 (0.5–14) and varus of 8.6 ± 2.7 (3–13). The average difference of deformity in sagittal plane in extension between larger and downsized femur trial was 5.8° which was statistically significant (p = 0.001). Knee achieves more extension after downsizing possibly because of decrease in metallic volume in the joint capsule and soft tissue envelope. There was significant correction in coronal plane alignment (1°) on downsizing as the soft tissue envelope on the medial side relaxed due to decreased impingement (p = 0.001).

Conclusion

Surgeons should be aware that downsizing of the femur may increase the knee extension by 5.8° and this can be a strategy to increase both gaps specially when there is significant mediolateral overhang of the femoral component.

Level of evidence

Type IV.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.