Comparative study of lower-limb alignment imaging parameters between kinematic and mechanical alignment in patients with primary total knee replacement
Zhao Xiaoxiong, Wen Liang, Wang Zhiwei, Zhou Lei, Ma Desi, Pan Jiang
Department of Orthopaedic, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China
Abstract:Objective This study aimed to explore the changes in lower-limb alignment imaging parameters before and after kinematic alignment(KA)-total knee replacement (TKA) and mechanical alignment(MA)-TKA, as well as to analyze the causes of postoperative residual varus. Methods A retrospective cohort study was conducted on 36 patients who underwent TKA from June 2020 to January 2021 in the Department of Orthopedics, Beijing Chaoyang Hospital Affiliated to Capital Medical University. The patients included 17 males and 19 females aged 58-82 years old. During TKA, 18 patients subjected to KA technique were included in the KA group, and 18 patients subjected to MA technique were included in the MA group. The baseline data of the patients including age, gender, body mass index, operative time, and lateral ratio were compared between the two groups. Hip-knee-ankle angle(HKA), medial proximal tibial angle(MPTA), medial lateral distal femoral angle(mLDFA), and the degree of correction were compared between the two groups pre- and post-operatively. Correlation and regression analyses were conducted on HKA, MPTA, and mLDFA in each group. Results No statistical significance was found in the comparison of baseline data between the two groups (all P values > 0.05). Preoperative HKA (172.2° ± 5.3° vs. 172.8° ± 4.6°), mLDFA (88.9° ± 2.7° vs. 90.4° ± 3.1°), MPTA (84.8° ± 1.7° vs. 84.4° ± 3.7°), and postoperative HKA (175.8° ± 2.6° vs. 176.3° ± 2.0°), and mLDFA (89.4° ± 2.7° vs. 90.9° ± 2.4°) in the KA and MA groups had no statistically significant difference (t=0.35, 1.58, 0.37, 0.68, 1.76, all P values > 0.05). Postoperative HKA in both groups was higher than that before surgery, and postoperative MPTA in the MA group was higher than that before surgery; the differences were statistically significant (all P values < 0.05). MPTA in the KA group was lower than that in the MA group (85.3° ± 1.8° vs. 87.4° ± 2.1°), and the difference was statistically significant (t=3.33, P = 0.002). MPTA correction degree in the MA group (4.3° ± 2.8°) was higher than that in the KA group (1.9° ± 1.5°), and the difference was statistically significant (t=3.25, P = 0.003). Additionally, a high correlation existed between post- and pre-operative mLDFA in the KA group (R2 = 0.79, P < 0.001). Conclusion KA-TKA with traditional instruments can restore the preoperative anatomical morphology of the joint line of the distal femur and proximal tibia. The joint line of the proximal tibia is more inclined, and the joint line of the distal femur is more evaginated, thereby making the knee joint line more parallel to the ground than MA-TKA. MA-TKA femoral prosthesis placement is more prone to varus. Therefore, for TKA with mild residual varus after surgery, the reasons for the residual varus differed between KA-TKA and MA-TKA, and KA is not MA with residual varus.
赵潇雄, 温亮, 王志为, 周磊, 马德思, 潘江. 运动学对线与机械学对线对初次全膝关节置换术患者下肢对线参数的影响[J]. 中华解剖与临床杂志, 2022, 27(3): 156-162.
Zhao Xiaoxiong, Wen Liang, Wang Zhiwei, Zhou Lei, Ma Desi, Pan Jiang. Comparative study of lower-limb alignment imaging parameters between kinematic and mechanical alignment in patients with primary total knee replacement. Chinese Journal of Anatomy and Clinics, 2022, 27(3): 156-162.
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