Spondylolisthesis and mismatch deformity affect outcomes after total knee arthroplasty.
Spondylolisthesis and mismatch deformity affect outcomes after total knee arthroplasty.
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DOI：
10.1186/s13018-023-03605-y
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发表时间：
2023-03-02
影响因子：
2.6
通讯作者：
Park, Don Y. Y.
中科院分区：
文献类型：
--
作者：
Sheppard, William L. L.;Chiou, Daniel;Upfill-Brown, Alexander;Shah, Akash;Edogun, Eghosa;Sassoon, Adam;Park, Don Y. Y.
目前几乎没有关于全膝关节置换术（TKA）后脊柱滑脱、不匹配畸形和临床结局之间潜在关系的已发表数据。我们假设，预先存在的脊椎前移将导致TKA术后功能结局下降。在2017年1月至2020年期间对933例TKA进行了回顾性队列比较。如果TKA不是针对原发性骨关节炎（OA）进行的，或者如果术前腰椎X线片不可用/不足以测量脊椎滑脱程度，则将其排除。随后纳入了95例TKA，并将其分为两组：有脊椎滑脱的TKA和无脊椎滑脱的TKA。在脊椎前移队列中，通过侧位X线片计算骨盆发生率（PI）和腰椎前凸（LL），以确定差异（PI-LL）。PI-LL > 10°的X线片被归类为不匹配畸形（MD）。比较了两组之间的以下临床结局：麻醉下操作（MUA）需求、MUA/翻修前或MUA/翻修后的术后总活动弧（AOM）、屈曲挛缩发生率和后期翻修需求。49例TKA符合脊椎前移标准，44例未发生脊椎前移。两组在性别、体重指数、术前膝关节活动度（ROM）、术前AOM或阿片类药物使用方面无显著差异。在未进行干预的情况下，伴有脊椎滑脱和MD的TKA更可能出现MUA（p = 0.016）、ROM < 0-120（p < 0.014）和AOM降低（p < 0.02）。先前存在的脊椎滑脱本身可能不会对TKA后的临床结果产生不良影响。然而，脊椎前移增加了发展MD的可能性。在同时存在脊椎滑脱和伴随不匹配畸形的患者中，患者术后ROM/AOM在统计学和临床上显著降低，MUA需求增加。外科医生应考虑对接受全关节置换术的慢性背痛患者进行临床/影像学评估。3级
Little published data currently exist regarding the potential relationships between spondylolisthesis, mismatch deformity, and clinical outcomes following total knee arthroplasty (TKA). We hypothesize that preexisting spondylolisthesis will result in decreased functional outcomes after TKA. This retrospective cohort comparison of 933 TKAs was performed between January 2017 and 2020. TKAs were excluded if they were not performed for primary osteoarthritis (OA) or if preoperative lumbar radiographs were unavailable/inadequate to measure the degree of spondylolisthesis. Ninety-five TKAs were subsequently available for inclusion and divided into two groups: those with spondylolisthesis and those without. Within the spondylolisthesis cohort, pelvic incidence (PI) and lumbar lordosis (LL) were calculated on lateral radiographs to determine the difference (PI–LL). Radiographs with PI–LL > 10° were then categorized as having mismatch deformity (MD). The following clinical outcomes were compared between the groups: need for manipulation under anesthesia (MUA), total postoperative arc of motion (AOM) both pre-MUA or post-MUA/revision, incidence of flexion contracture, and a need for later revision. Forty-nine TKAs met the spondylolisthesis criteria, while 44 did not have spondylolisthesis. There were no significant differences in gender, body mass index, preoperative knee range of motion (ROM), preoperative AOM, or opiate use between the groups. TKAs with spondylolisthesis and concomitant MD were more likely to have MUA (p = 0.016), ROM < 0–120 (p < 0.014), and a decreased AOM (p < 0.02) without interventions. Preexisting spondylolisthesis by itself may not have adverse effect clinical results following TKA. However, spondylolisthesis increases the likelihood of developing MD. In those with both spondylolisthesis and concomitant mismatch deformities, patients had statistically and clinically significantly decreased in postoperative ROM/AOM and increased need for MUA. Surgeons should consider clinical/radiographic assessments of patients with chronic back pain who present for total joint arthroplasty. Level 3.
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