A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee
A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee
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DOI：
10.1055/s-0038-1675421
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发表时间：
2019-10-01
影响因子：
1.7
通讯作者：
Hull, Maury L.
中科院分区：
文献类型：
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作者：
Shelton, Trevor J.;Howell, Stephen M.;Hull, Maury L.
我们假设，术中胫骨力大于自体膝关节胫骨力的全膝关节置换术（TKA）具有僵硬迹象，通过伸展和屈曲损失以及胫骨前向平移进行测量。对71例采用卡尺运动学对线TKA治疗的患者，在被动运动过程中测量胫骨内侧和外侧间室的术中力。测量最大伸展、屈曲和屈曲90 °时胫骨相对于股骨远端的前后位置。更换为2 mm厚的衬垫后重复测量。0、45和90度屈曲时内侧和外侧间室力的平均值之和代表通过90度运动弧的胫骨力。对于植入的衬垫，胫骨力平均值为28 +/- 17 lb，与报告的自体膝关节的20 +/- 7 lb相当。在6个月时，患者报告平均40分的牛津膝关节评分和15分的西安大略和麦克马斯特大学骨关节炎（WOMAC）评分。对于2 mm厚的胫骨垫片，胫骨力平均为50 +/- 28 lb。大于自体的30 lb胫骨力导致3度伸展损失、3度屈曲损失和3 mm胫骨前向平移。由于胫骨力大于自体的TKA具有僵硬迹象，因此降低该风险的策略是在平衡TKA时匹配自体膝关节的胫骨力，因为这恢复了高功能。
We hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior-posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 +/- 17 lb, which is comparable to the 20 +/- 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 +/- 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.