解剖和部件旋转不匹配对全膝关节置换术后的预后有负面影响

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-09 DOI:10.1002/jeo2.70415

Kohei Kawaguchi, Ryota Yamagami, Kenichi Kono, Junfeng Zhang, Shuji Taketomi, Hiroshi Inui, Sakae Tanaka

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引用次数: 0

摘要

目的解剖旋转失配（ARM）是指全膝关节置换术（TKA）中股骨与胫骨之间的术后旋转不良，部件旋转失配（CRM）是指全膝关节置换术中股骨与胫骨部件之间的旋转不良。本研究旨在量化ARM和CRM，并评估其单独和联合对术后预后的影响。方法对224例膝关节行原发性全膝关节置换术进行回顾性分析。术后使用计算机断层扫描测量股骨和胫骨组件之间的轴向旋转角（组件旋转角[CRA]）和股骨和胫骨之间的轴向旋转角（解剖旋转角[ARA]）。胫骨内部或胫骨组件相对于股骨或股骨组件的旋转被赋予正值。旋转失配定义为CRA和ARA超过±10°。临床结果采用术后1年膝关节损伤和骨关节炎预后评分（oos）进行评估。分层聚类分析将膝关节根据CRA和ARA分为两组（1组和2组）。结果术后ARA平均±标准差（SD）为5.2°±5.3°，16.1%（36个膝关节）存在ARM。膝关节有ARM的患者在KOOS疼痛亚量表上的改善明显差于无ARM的患者（p = 0.02）。术后CRA为1.5°±4.5°，有2.7%的病例（6个膝关节）有CRM，但单独使用CRM对术后结果没有显著影响。聚类分析确定了两组（组1:185个膝关节；组2:39个膝关节），与组1相比，组2表现出更大的CRAs和ARAs （p < 0.01）。2组的KOOS疼痛和日常生活活动改善程度也明显低于1组（p < 0.01, 0.04）。结论TKA术后CRM和ARM均有观察。ARM对术后预后有负面影响，CRM和ARM的联合存在进一步恶化了临床结果。证据等级四级。

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Anatomical and component rotational mismatches negatively affect postoperative outcomes in total knee arthroplasty

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Anatomical and component rotational mismatches negatively affect postoperative outcomes in total knee arthroplasty

Purpose

Anatomical rotational mismatch (ARM) refers to postoperative malrotation between the femur and tibia, and component rotational mismatch (CRM) refers to malrotation between the femoral and tibial components in total knee arthroplasty (TKA). This study aimed to quantify ARM and CRM and assess their individual and combined effects on postoperative outcomes.

Methods

This retrospective study analysed 224 knees that underwent primary TKA. Postoperative axial rotational angles between the femoral and tibial components (component rotational angle [CRA]) and between the femur and tibia (anatomical rotational angle [ARA]) were measured using computed tomography. Internal tibial or tibial component rotation relative to the femur or femoral component was assigned a positive value. Rotational mismatch was defined as CRA and ARA over ±10°. Clinical outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) 1 year postoperatively. Hierarchical cluster analysis categorised knees into two groups based on CRA and ARA (Groups 1 and 2).

Results

The mean ± standard deviation (SD) postoperative ARA was 5.2° ± 5.3°, with ARM present in 16.1% of cases (36 knees). Knees with ARM showed significantly worse improvement in the KOOS pain subscale than those without ARM (p = 0.02). Postoperative CRA was 1.5° ± 4.5°, with CRM observed in 2.7% of cases (6 knees), but CRM alone did not significantly affect postoperative outcomes. Cluster analysis identified two groups (Group 1: 185 knees; Group 2: 39 knees), with Group 2 exhibiting greater CRAs and ARAs compared to Group 1 (both p < 0.01). Group 2 also had significantly worse KOOS pain and activities of daily living improvement relative to Group 1 (p < 0.01, 0.04).

Conclusions

Both CRM and ARM were observed following TKA. ARM negatively impacted postoperative outcomes, and the combined presence of CRM and ARM further worsened clinical results.