全膝关节置换术后股骨前后移位起始角和内侧枢轴模式与活动范围相关

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-09 DOI:10.1002/jeo2.70435

Ryota Takase, Shogo Hashimoto, Takashi Ohsawa, Hibiki Kakiage, Akira Honda, Hirotaka Chikuda

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引用次数: 0

摘要

目的全膝关节置换术（TKA）术后膝关节活动范围（ROM）是改善临床评分和症状的重要因素。本研究旨在探讨术后稳定TKA （PSTKA）中使用导航系统观察到的术中因素与术前和术后参数之间的关系，包括股骨的前后移位、伸屈间隙。方法采用PSTKA治疗膝关节骨性关节炎21例。在术前和术后一年测量ROM和临床结果，包括特殊外科医院膝关节评分（HSS评分），并使用无图像导航系统测量术中运动学因素。我们根据术后屈曲挛缩的存在与否将受试者进一步分为两组（定义为术后一年内屈曲角度≤-5°）。无挛缩组12膝，挛缩组9膝。结果术后伸展角与股骨前后平移起始角相关（r = -0.60; p < 0.01），与术后HSS评分相关（r = 0.46; p = 0.04）。术后屈曲角度与外侧-内侧前后位平移比相关（r = 0.47; p = 0.03），表明内侧枢轴模式。与挛缩组相比，无挛缩组股骨前后平移起始角度明显小于挛缩组（无挛缩，30.6°±17.0°；无挛缩，48.4°±16.7°；p = 0.02），术后HSS评分明显高于无挛缩组（90.8±7.0；无挛缩，81.1±11.8;p < 0.05）。结论经PSTKA后屈曲挛缩的膝关节术中前后平移起始角度明显增大，术中内侧支点模式有利于术后屈曲角度的调整。证据等级三级。

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The anteroposterior femoral translation starting angle and the medial pivot pattern are correlated with the range of motion after total knee arthroplasty

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The anteroposterior femoral translation starting angle and the medial pivot pattern are correlated with the range of motion after total knee arthroplasty

Purpose

Postoperative range of motion (ROM) of the knee is an important factor for improving clinical scores and symptoms in total knee arthroplasty (TKA). This study aimed to investigate the relationship between intraoperative factors, including anteroposterior translation of the femur, and extension and flexion gaps, observed during posterior-stabilized TKA (PSTKA) using a navigation system, and preoperative and postoperative parameters.

Methods

Twenty-one knees with osteoarthritis that were treated by PSTKA were included. ROM and clinical outcomes, including the Hospital for Special Surgery Knee Score (HSS score), were measured before and one year after surgery, and intraoperative kinematic factors were measured using an image-less navigation system. We further divided the subjects into two groups based on the presence or absence of postoperative flexion contracture (defined as an extension angle ≤ –5°at one year after surgery). The no contracture group comprised 12 knees, and the contracture group comprised 9 knees.

Results

The postoperative extension angle correlated with the starting angle of the anteroposterior translation of the femur (r = –0.60; p < 0.01) and the postoperative HSS score (r = 0.46; p = 0.04). The postoperative flexion angle correlated with the lateral-to-medial anteroposterior translation ratio (r = 0.47; p = 0.03), indicating a medial pivot pattern. In comparison to the contracture group, the no contracture group had a significantly smaller starting angle of the anteroposterior translation of the femur in comparison to the contracture group (no contracture, 30.6° ± 17.0°; contracture, 48.4° ± 16.7°; p = 0.02) and a significantly higher postoperative HSS score (no contracture, 90.8 ± 7.0; contracture, 81.1 ± 11.8; p < 0.05).

Conclusions

This study revealed that knee joints with flexion contracture after PSTKA had a significantly larger starting angle of anteroposterior translation during surgery and that an intraoperative medial pivot pattern was beneficial for postoperative flexion angles.