CR和PS TKA中期随访时关节意识和种植体存活率的比较：一项基于解剖表型的倾向评分匹配分析

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-19 DOI:10.1002/jeo2.70242

Lars-Rene Tuecking, Tobias Welzel, Max Ettinger, Henning Windhagen, Peter Savov

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引用次数: 0

摘要

目的最近的研究强调了关节意识的作用以及术前解剖对全膝关节置换术（TKA）中十字架保留（CR）与后稳定（PS）植入物疗效的影响。目前缺乏在调整重要解剖参数和大群体解剖表型的情况下比较CR和PS假体的研究。方法本回顾性单中心研究分析了2008年至2014年使用Triathlon®CR或PS种植体系统进行原发性TKA的患者，随访时间至少为6.5年。采用基于人口统计学（年龄、性别和体重指数）、术前解剖角度参数（股骨外侧远端角[LDFA]、胫骨内侧近端角、髋关节-膝关节-踝关节角[HKA]、算术HKA和关节线倾角）和膝关节冠状面对齐（CPAK）类型的倾向评分对患者进行匹配。结果数据包括患者报告的结果（PROMs：遗忘关节评分、牛津膝关节评分、膝关节社会评分、西安大略和麦克马斯特大学骨关节炎指数、视觉模拟量表和加州大学洛杉矶分校）、人口统计数据、术后临床过程数据。采用R进行统计学分析，p <； 0.05为显著性。结果共纳入728例患者（513例CR， 215例PS），倾向评分匹配后分析519例患者（346例CR， 173例PS）。关节意识和进一步的临床评分显示CR和PS植入物无差异（p > 0.05）。两种种植体的5年和10年生存率相似（log-rank检验：p = 0.164和p = 0.163），尽管CR种植体的总体生存率较低。外翻CPAK III型和VI型的成活率最低，尤其是CR种植体。回归分析显示，患者年龄较小显著影响CR种植体的生存，而外翻LDFA增加则降低PS种植体的生存。结论在术前解剖控制的情况下，CR和PS假体的关节意识在中长期随访中无明显差异。同样，种植体存活率也没有明显变化。在这两种系统中，外翻CPAK表型的修正率明显更高。高外翻LDFA角度被认为是PS系统翻修的危险因素。证据等级三级。

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Comparable joint awareness and implant survival at midterm follow-up between CR and PS TKA: An anatomic phenotype-based propensity score-matched analysis

Purpose

Recent studies highlight the role of joint awareness and the influence of preoperative anatomy on outcomes of cruciate-retaining (CR) versus posterior-stabilized (PS) implants in total knee arthroplasty (TKA). There is currently a lack of studies comparing CR and PS prostheses while adjusting for important anatomical parameters and anatomical phenotypes with large group sizes.

Methods

This retrospective single-centre study analyzed patients who underwent primary TKA with the Triathlon® CR or PS implant system from 2008 to 2014 with a minimum follow-up of 6.5 years. Patients were matched using propensity scores based on demographics (age, gender and body mass index) and preoperative anatomic angle parameters (lateral distal femoral angle [LDFA], medial proximal tibia angle, hip–knee–ankle angle [HKA], arithmetic HKA and joint line obliquity) and Coronal Plane Alignment of the Knee (CPAK) types. Outcome data included patient-reported outcomes (PROMs: Forgotten Joint Score, Oxford Knee Score, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, visual analogue scale and University of California at Los Angeles), demographic data, post-operative clinical course data. Statistical analysis was conducted using R, with significance set at p < 0.05.

Results

A total of 728 patients (513 CR and 215 PS) were included, leaving 519 patients (346 CR and 173 PS) being analyzed after propensity score matching. Joint awareness and further clinical scores showed no differences between CR and PS implants (p > 0.05). Implant survival at 5 and 10 years was similar for both types (log-rank test: p = 0.164 and p = 0.163), though CR implants had lower survival rates overall. Valgus CPAK types III and VI showed the lowest survival rates, especially for CR implants. Regression analysis revealed younger patient age significantly affected CR implant survival, while increasing valgus LDFA decreased PS implant survival.

Conclusion

No differences were found in the joint awareness of CR and PS prostheses in the medium to long-term follow-up, while controlling for preoperative anatomy. Similarly, there were no significant variations in implant survival. Noticeably higher revision rates in the valgus CPAK phenotypes were found for both systems. A high valgus LDFA angle was identified as a risk factor for revisions in PS systems.