Is There a Force Target That Predicts Early Patient-reported Outcomes After Kinematically Aligned TKA?
Is There a Force Target That Predicts Early Patient-reported Outcomes After Kinematically Aligned TKA?
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DOI：
10.1097/corr.0000000000000600
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发表时间：
2019-05-01
影响因子：
4.2
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.
背景四个机械对线力目标用于预测早期患者报告的结局和/或指示平衡的TKA。对于使用运动学对线的外科医生，没有报告力目标。到目前为止，这些机械对线力目标与运动学对线的有用性还没有报道，也没有一个具体的力目标的运动学alignment.Questions/purposes（1）是否击中四个机械对线力目标提出的Gustke，雅各布斯，米尔，和Menghini确定是否有一个运动学对准TKA患者有更好的患者报告的牛津膝关节和WOMAC评分在6个月？(2)是否可以为运动学对线确定一个新的力目标，以确定患者的牛津膝关节评分是否>= 34分（最好48分，最差0分）？方法2017年7月至2017年11月期间，我们进行了148例连续初次TKA，其中所有患者均使用10个卡尺测量和验证检查进行了运动学对线治疗。在研究期间进行的148例TKA中，共有68例（46%）在使用内固定胫骨垫片被动活动期间进行了内侧和外侧胫骨间室力的术中测量，并在本回顾性研究中进行了评价。由于外科医生和手术团队对显示间室力的显示器不知情，因此在平衡膝关节时没有尝试达到机械对线力目标。Oxford膝关节评分和WOMAC评分测量术后6个月时患者报告的结局。对于每个机械对合力目标，Wilcoxon秩和检验确定达到目标的患者的结局评分是否优于未达到目标的患者。曲线下面积（AUC）分析试图确定完全伸展和10 °、30 °、45 °、60 °、75 °和90 °屈曲时运动学对线的新力目标，预测患者的牛津膝关节评分是否良好/极佳，结果达到或未达到四个机械对线力目标的患者在6个月时的Oxford膝关节评分和WOMAC评分没有升高或降低。使用Gustke力目标作为代表性示例，31例达到目标的患者的牛津膝关节评分为41 6 6，WOMAC评分为13 6 11，与37例未达到目标的患者的牛津膝关节评分39 +/- 8（p = 0. 436）和WOMAC评分17 +/- 17（p = 0. 463）没有差异。观察到的AUC较低（从0.56到0.58），未能识别出与良好/极佳（>= 34）相关的新运动学对线力目标结论：胫骨间室力与自体膝关节的报告相当，牛津膝关节和WOMAC评分的灵敏度不足，这可能解释了为什么机械对线力目标没有用，未确定动力学对准的力目标。术中传感器可以允许外科医生在手术室中非常精确地测量力，但是在卡钳运动学对准的TKA之后不需要该精度水平来实现良好/优异的结果，并且因此其使用可能仅仅增加费用和时间，但是从患者的观点来看不会改善结果。证据等级III，治疗性研究。
Background Four mechanical alignment force targets are used to predict early patient-reported outcomes and/or to indicate a balanced TKA. For surgeons who use kinematic alignment, there are no reported force targets. To date the usefulness of these mechanical alignment force targets with kinematic alignment has not been reported nor has a specific force target for kinematic alignment been identified.Questions/purposes (1) Does hitting one of four mechanical alignment force targets proposed by Gustke, Jacobs, Meere, and Menghini determine whether a patient with a kinematically aligned TKA had better patient-reported Oxford Knee andWOMAC scores at 6 months? (2) Can a new force target be identified for kinematic alignment that determines whether the patient had a good/excellent Oxford Knee Score of >= 34 points (48 best, 0 worst)?Methods Between July 2017 and November 2017, we performed 148 consecutive primary TKAs of which all were treated with kinematic alignment using 10 caliper measurements and verification checks. A total of 68 of the 148 (46%) TKAs performed during the study period had intraoperative measurements of medial and lateral tibial compartment forces during passive motion with an instrumented tibial insert and were evaluated in this retrospective study. Because the surgeon and surgical team were blinded from the display showing the compartment forces, there was no attempt to hit a mechanical alignment force target when balancing the knee. The Oxford Knee Score and WOMAC score measured patient-reported outcomes at 6 months postoperatively. For each mechanical alignment force target, a Wilcoxon rank-sum test determined whether patients who hit the target had better outcome scores than those who missed. An area under the curve (AUC) analysis tried to identify a new force target for kinematic alignment at full extension and 10 degrees, 30 degrees, 45 degrees, 60 degrees, 75 degrees, and 90 degrees of flexion that predicted whether patients had a good/excellent Oxford Knee Score, defined as a score of >= 34 points.Results Patients who hit or missed each of the four mechanical alignment force targets did not have higher or lower Oxford Knee Scores and WOMAC scores at 6 months. Using the Gustke force target as a representative example, the Oxford Knee Score of 41 6 6 and WOMAC score of 13 6 11 for the 31 patients who hit the target were not different from the Oxford Knee Score of 39 +/- 8 (p = 0.436) and WOMAC score of 17 +/- 17 (p = 0.463) for the 37 patients who missed the target. The low observed AUCs (from 0.56 to 0.58) at each of these flexion angles failed to identify a new kinematic alignment force target associated with a good/excellent (>= 34) Oxford Knee Score.Conclusions Tibial compartment forces comparable to those reported for the native knee and insufficient sensitivity of the Oxford Knee and WOMAC scores might explain why mechanical alignment force targets were not useful and a force target was not identified for kinematic alignment. Intraoperative sensors may allow surgeons to measure forces very precisely in the operating room, but that level of precision is not called for to achieve a good/excellent result after calipered kinematically aligned TKA, and so its use may simply add expense and time but does not improve the results from the patient's viewpoint. Level of Evidence Level III, therapeutic study.