Total knee arthroplasty reduces knee extension torque in-vitro and patellofemoral arthroplasty does not
Total knee arthroplasty reduces knee extension torque in-vitro and patellofemoral arthroplasty does not
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DOI：
10.1016/j.jbiomech.2020.109739
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发表时间：
2020-05-07
影响因子：
2.4
通讯作者：
Amis, Andrew A.
中科院分区：
文献类型：
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作者：
Joseph, Michelle N.;Carmont, Michael R.;Amis, Andrew A.
全膝关节置换术(TKA)后患者往往难以恢复膝关节伸展力量，这可能反映了包括几何和后退运动学在内的力学改变，因此本工作的目的是通过比较自然膝关节、TKA和髌股关节置换术(PFA)对股四头肌张力的响应来探讨这一问题。将8个新鲜冰冻的膝关节安装在膝关节伸展试验台上，进行股四头肌负荷和胫骨伸展扭矩测量。每个膝关节接受四种情况：自然膝关节、PFA、十字交叉保留(CR)和后路稳定(PS)TKA。KET测量范围为屈膝120度至0度。数据分析采用单因素方差分析和后组配对t检验。KET在终末伸展和屈曲70~100度时最低，在屈曲20~30度时最大。在屈曲30-40度时，PFA产生了最大的KET(p<；0.008)，与本地的CR-TKA和PS-TKA相比。CR-和PS-TKA在0-50度屈曲时KET较低(P<；0.001度在0-30度)，在完全伸展时下降到自然膝关节KET或PFA的25%。PFA在屈曲早期具有最高的KET，可能是由于滑车偏移量增加和/或保留了十字机构，所以在功能活动范围内PFA可能更有利。在深度屈曲中，PS-TKA相对于CR-TKA所声称的益处并未被检测到。CR-TKA和PS-TKA在0-50度屈膝时的KET均低于自然膝关节状态和PFA膝关节状态。这种力学效应可能有助于解释全膝关节置换术后膝关节伸展无力的临床表现。(C)2020作者。爱思唯尔有限公司出版。
Patients often have difficulty recovering knee extension strength post total knee arthroplasty (TKA), and that may reflect alteration of the mechanics including geometry and rollback kinematics, so the purpose of this work was to explore this by comparing the knee extension torque (KET) of the native knee, TKA and patellofemoral arthroplasty (PFA) in response to quadriceps tension. Eight fresh-frozen knees were mounted in a knee extension rig with quadriceps loading and tibial extension torque measurement. Each knee was subject to four conditions: native knee, PFA, cruciate-retaining (CR) and posterior-stabilized (PS) TKA. The KET was measured from 120 degrees to 0 degrees knee flexion. Data were analyzed using one-way ANOVA and post-hoc paired t-tests. The native KET was lowest in terminal extension and 70-100 degrees flexion, and maximal at 20-30 degrees flexion. PFA produced the greatest KET (p < 0.008) compared with native, CR- and PS-TKA, at 30-40 degrees flexion. CR- and PS-TKA had lower KET across 0-50 degrees flexion (p < 0.001 across 0-30 degrees), falling to 25% of the native knee KET or the PFA at full extension. PFA had the highest KET in early flexion possibly due to increased trochlear offset and/or preservation of the cruciate mechanism, so PFA may be more beneficial during the functional range of motion. The claimed benefits of PS- over CR-TKA in deep flexion were not detected. Both CR- and PS-TKAs led to lower KET than the native and PFA knee states across 0-50 degrees flexion. This mechanical effect may help to explain clinical findings of knee extension weakness post-TKA. (C) 2020 The Authors. Published by Elsevier Ltd.