Mismatch between trochlear coronal alignment of arthritic knees and currently available prosthesis: a morphological analysis of 4116 knees and 45 implant designs.
Mismatch between trochlear coronal alignment of arthritic knees and currently available prosthesis: a morphological analysis of 4116 knees and 45 implant designs.
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DOI：
10.1007/s00167-022-07251-5
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发表时间：
2023-08
影响因子：
3.8
通讯作者：
Wilkinson, Matthew P. R.
中科院分区：
文献类型：
--
作者：
Rosa, Sergio Barroso;Hazratwala, Kaushik;Wilkinson, Matthew P. R.
在高达五分之一的全膝关节置换术（TKR）中，外科医生无法获得良好的临床和功能结果。尽管进行了全面的诊断检查，但在这些患者中并不总能确定根本原因。本研究的目的是比较自体和假体股骨柄解剖结构，以评价形态不匹配的潜在来源，并从理论上评估临床结局较差的原因。对关节炎术前TKR患者的360膝关节系统数据库中4116个膝关节CT的自体股骨颈角进行了评价。进行了半自动三维分析，以确定冠状面（NTA）中的原生转子角以及其他142个参数。进行主动检索以识别当前可用的TKR型号;从制造商提供的技术数据中提取冠状面（PTA）中的假体转子定位。平均自体股骨转子间角（NTA）为1.6° ± 6.6°（外翻），范围为− 23.8°（内翻）至30.3°（外翻）。60.6%的膝关节存在外翻NTA，39.4%的膝关节存在内翻NTA。识别了89个TKR模型;其中45个模型的股骨转子详细信息可用，其中93%的假体股骨转子角（PTA）设计为外翻方向，6.9%显示为中性（0°）PTA。PTA的内翻对线在任何系统中均不存在。34个型号的PTA角度数值可用;这些数值范围为0°至15°外翻，中值为6.18°（SD ± 2.88°）。本研究显示，自体和假体股骨转子间角之间存在显著不匹配。相关比例的研究膝关节（41.45%）超出了当前可用植入物的股骨转子角范围;代表了生物力学失衡的潜在来源。虽然有必要进行进一步研究以充分了解本研究的临床意义，但制造商可能需要在未来的植入物设计中考虑这些发现。III级，回顾性队列研究。
In up to a fifth of total knee replacements (TKR), surgeons are not capable of achieving good clinical and functional results. Despite comprehensive diagnostic workup, an underlying cause is not always identified in these patients. The purpose of this study is to compare native and prosthetic trochlear anatomies, to evaluate a potential source of morphologic mismatch and theoretically, of poor clinical outcomes. Native trochlear angles of 4116 knee CTs from 360 Knee Systems database of arthritic pre-operative TKR patients were evaluated. A semi-automated tridimensional analysis was performed to define the native trochlear angle in the coronal plane (NTA) among other 142 parameters. An active search was conducted to identify currently available TKR models; prosthetic trochlear orientation in the coronal plane (PTA) was extracted from the technical data provided by manufacturers. The mean native trochlear angle (NTA) was 1.6° ± 6.6° (valgus) with a range from − 23.8° (varus) to 30.3°(valgus). A valgus NTA was present in 60.6% of the knees and 39.4% of them had a varus NTA. 89 TKR models were identified; trochlear details were available for 45 of them, of which 93% were designed with a valgus orientation of the prosthetic trochlear angle (PTA) and 6.9% showed a neutral (0°) PTA. Varus alignment of PTA was not present in any system. Angular numeric values for PTA were available for 34 models; these ranged from 0° to 15° of valgus, with a median value of 6.18° (SD ± 2.88°). This study shows a significant mismatch between native and prosthetic trochlear angles. A relevant proportion of the studied knees (41.45%) fall out of the trochlear angle range of currently available implants; representing a potential source for biomechanical imbalance. While further research is warranted to fully understand the clinical implications of the present study, manufacturers may need to take these findings into account for future implant designs. Level III, retrospective cohort study.
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