Fixed-bearing medial unicompartmental knee arthroplasty restores neither the medial pivoting behavior nor the ligament forces of the intact knee in passive flexion
Fixed-bearing medial unicompartmental knee arthroplasty restores neither the medial pivoting behavior nor the ligament forces of the intact knee in passive flexion
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DOI：
10.1002/jor.23838
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发表时间：
2018-07-01
影响因子：
2.8
通讯作者：
Imhauser, Carl W.
中科院分区：
文献类型：
--
作者：
Kia, Mohammad;Warth, Lucian C.;Imhauser, Carl W.
内侧单间室膝关节置换术（UKA）是治疗孤立性内侧骨关节炎的公认治疗方法。然而，使用不适当厚度的胫骨假体可能会导致假体早期失效或未置换的侧间室疾病进展。关于插入物厚度对膝关节运动学和韧带力的影响知之甚少。因此，使用胫股关节的计算模型来确定非一致性固定轴承内侧 UKA 如何影响胫股运动学，以及膝关节被动屈曲期间内侧副韧带 (MCL) 和前十字韧带 (ACL) 的张力。固定轴承内侧 UKA 无法维持完整膝关节从 0 度到 30 度被动屈曲时发生的内侧旋转。股骨髁相对于胫骨的异常前后 (AP) 平移延迟了胫骨内旋转，这种情况发生在完整膝关节的 0 度至 30 度屈曲范围内，但在 UKA 后发生在 30 度至 90 度屈曲范围内。尽管调节了 MCL 和 ACL 力，但内侧 UKA 后增加或减少胫骨插入物厚度也未能恢复完整膝关节的内侧枢轴行为。相对于完整膝关节，不符合内侧 UKA 的 AP 约束减少会导致髁突平移异常，无论插入物厚度如何，即使十字韧带和副韧带完整。这一发现表明，由内侧半月板和关节形态驱动的内侧室的顺应性在被动屈曲期间控制完整胫股关节中的 AP 髁平移方面起着重要作用。 (c) 2017 年骨科研究学会。由 Wiley periodicals, Inc. 出版。J Orthop Res 36:1868-1875, 2018。
Medial unicompartmental knee arthroplasty (UKA) is an accepted treatment for isolated medial osteoarthritis. However, using an improper thickness for the tibial component may contribute to early failure of the prosthesis or disease progression in the unreplaced lateral compartment. Little is known of the effect of insert thickness on both knee kinematics and ligament forces. Therefore, a computational model of the tibiofemoral joint was used to determine how non-conforming, fixed bearing medial UKA affects tibiofemoral kinematics, and tension in the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) during passive knee flexion. Fixed bearing medial UKA could not maintain the medial pivoting that occurred in the intact knee from 0 degrees to 30 degrees of passive flexion. Abnormal anterior-posterior (AP) translations of the femoral condyles relative to the tibia delayed coupled internal tibial rotation, which occurred in the intact knee from 0 degrees to 30 degrees of flexion, but occurred from 30 degrees to 90 degrees of flexion following UKA. Increasing or decreasing tibial insert thickness following medial UKA also failed to restore the medial pivoting behavior of the intact knee despite modulating MCL and ACL forces. Reduced AP constraint in non-conforming medial UKA relative to the intact knee leads to abnormal condylar translations regardless of insert thickness even with intact cruciate and collateral ligaments. This finding suggests that the conformity of the medial compartment as driven by the medial meniscus and articular morphology plays an important role in controlling AP condylar translations in the intact tibiofemoral joint during passive flexion. (c) 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1868-1875, 2018.