Unicompartmental knee arthroplasty cannot restore the functional flexion axis of a living knee to normal
Unicompartmental knee arthroplasty cannot restore the functional flexion axis of a living knee to normal
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DOI：
10.1007/s00167-014-3296-7
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发表时间：
2015-12-01
影响因子：
3.8
通讯作者：
Endo, Naoto
中科院分区：
文献类型：
--
作者：
Mochizuki, Tomoharu;Sato, Takashi;Endo, Naoto
本研究的目的是调查内侧单间室膝关节置换术可能使膝关节功能屈曲轴恢复正常的假设。可以通过跟踪解剖标志的垂直平移来间接识别屈曲轴，这些解剖标志基本上在膝盖运动期间围绕屈曲轴移动。如果单髁膝关节能帮助恢复正常的屈曲轴，则关节成形术后的解剖标志将显示与正常膝关节屈曲时相似的垂直平移，在进行下蹲运动时，测定17个膝关节内侧单髁关节成形术前后的运动学，以计算临床上髁轴的垂直平移，通过结合双平面静态放射线照相术的单平面荧光透视系统使用三维到二维配准技术。结果与正常数据进行比较，并进行包括双向重复测量方差分析的统计学分析。对于内侧端，从10 A度到100 A度，正常、骨关节炎和单髁膝关节的平均上级垂直平移为7.3 +/- A 4.2，4.3 +/- A 7.2，和2.4 +/- A 3.1 mm，在正常和单间室膝关节之间具有统计学显著性（p < 0.001）。垂直平移在置换后不能恢复正常，单髁膝关节不能再现正常的屈曲轴。至于临床相关性，可能需要改变植入物设计和外科手术，以获得正常屈曲轴，重现正常运动。
The purpose of this study was to investigate the hypothesis that a medial unicompartmental knee arthroplasty might restore the functional flexion axis of a knee to normal. The flexion axis can be indirectly identified by tracking the vertical translation of anatomic landmarks that basically move around the flexion axis during a knee motion. If a unicompartmental knee could help restore the normal flexion axis, the anatomic landmarks after the arthroplasty would show the vertical translation similar to those of normal knees during a knee flexion.While performing a squatting motion, the kinematics of 17 knees were determined before and after a medial unicompartmental arthroplasty to calculate the vertical translation of a clinical epicondylar axis, using a three- to two-dimensional registration technique through a single-plane fluoroscopic system incorporating a biplanar static radiography. The results were compared with a normal data, and a statistical analysis including a two-way repeated-measured analysis of variance was performed.For the medial end, from 10A degrees to 100A degrees knee flexion, normal, osteoarthritic, and unicompartmental knees had the average superior vertical translation of 7.3 +/- A 4.2, 4.3 +/- A 7.2, and 2.4 +/- A 3.1 mm, respectively, with statistical significance between normal and unicompartmental knees (p < 0.001). The vertical translation did not return to normal post-implantation.A unicompartmental knee could not reproduce the normal flexion axis. As for clinical relevance, the changes of the implant design and surgical procedure may be necessary to obtain the normal flexion axis reproducing a normal motion.IV.