Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system
Joint gap kinematics in posterior-stabilized total knee arthroplasty measured by a new tensor with the navigation system
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DOI：
10.1115/1.2354201
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发表时间：
2006-12-01
影响因子：
1.7
通讯作者：
Kurosaka, Masahiro
中科院分区：
文献类型：
--
作者：
Matsumoto, Tomoyuki;Muratsu, Hirotsugu;Kurosaka, Masahiro
背景：手术期间软组织平衡的管理对于全膝关节置换术（TKA）的成功至关重要，但仍然很困难，这很大程度上取决于外科医生的感觉。先前对软组织平衡的评估是在非生理关节条件下进行的，即髌骨外翻并且仅在伸展和屈曲 90 度时不使用假体。因此，我们为 TKA 手术开发了一种新的张量，能够在整个运动范围内进行软组织平衡评估，同时再现术后关节对齐情况，其中髌股 (PF) 关节缩小，胫股关节对齐。我们本研究的目的是通过无 CT 计算机辅助导航系统使用张量来阐明关节间隙运动学。方法：对 30 名骨关节炎患者使用导航系统进行 30 次连续的初次后稳定 (PS) TKA 期间评估关节间隙运动学（定义为膝关节运动过程中的关节间隙变化）。使用新开发的张量进行测量，该张量能够测量整个运动范围内的关节间隙，包括 PF 关节复位和试验股骨假体就位后 TKA 后的相关关节状况。在完全伸展、5度、10度、15度、30度、45度、60度、90度和135度屈曲（髌骨外翻和复位）时通过张量评估关节间隙。导航系统用于获得植入的准确性，并在术中关节间隙测量期间测量膝关节的准确屈曲角度。结果：结果显示，关节间隙根据膝关节弯曲角度而变化。在膝关节完全伸展期间，关节间隙显示出加速减小。随着 PF 关节外翻，关节间隙在膝关节屈曲过程中增大。相反，与PF关节的关节间隙随着膝关节屈曲而减小，但在屈曲60度后减小。结论：我们阐明了在生理和可重复的关节条件下 PS TKA 中关节间隙运动学的特征。我们的研究结果可以为假肢设计和选择提供有用的信息，并允许在整个膝关节运动范围内评估手术技术，这可能导致 TKA 后获得一致的临床结果。
Background: The management of soft tissue balance during surgery is essential for the success of total knee arthroplasty (TKA) but remains difficult, leaving it much to the surgeon's feel. Previous assessments for soft tissue balance have been performed under unphysiological joint conditions, with patellar eversion and without the prosthesis only at extension and 90 deg of flexion. We therefore developed a new tensor for TKA procedures, enabling soft tissue balance assessment throughout the range of motion while reproducing postoperative joint alignment with the patellofemoral (PF) joint reduced and the tibiofemoral joint aligned. Our purpose in the present study was to clarify joint gap kinematics using the tensor with the CT-free computer assisted navigation system. Method of Approach: Joint gap kinematics, defined as joint gap change during knee motion, was evaluated during 30 consecutive, primary posterior-stabilized (PS) TKA with the navigation system in 30 osteoarthritic patients. Measurements were performed using a newly developed tensor, which enabled the measurement of the joint gap throughout the range of motion, including the joint conditions relevant after TKA with PF joint reduced and trial femoral component in place. Joint gap was assessed by the tensor at full extension, 5 deg, 10 deg, 15 deg, 30 deg, 45 deg, 60 deg, 90 deg, and 135 deg of flexion with the patella both everted and reduced. The navigation system was used to obtain the accuracy of implantations and to measure an accurate flexion angle of the knee during the intraoperative joint gap measurement. Results: Results showed that the joint gap varied depending on the knee flexion angle. Joint gap showed an accelerated decrease during full knee extension. With the PF joint everted, the joint gap increased throughout knee flexion. In contrast, the joint gap with the PF joint reduced increased with knee flexion but decreased after 60 deg of flexion. Conclusions: We clarified the characteristics of joint gap kinematics in PS TKA under physiological and reproducible joint conditions. Our findings can provide useful information for prosthetic design and selection and allow evaluation of surgical technique throughout the range of knee motion that may lead to consistent clinical outcomes after TKA.