Correlation study between anatomical matching of trochlear resection and alignment parameters of lower extremities in kinematically aligned total knee arthroplasty
Wang Zhiwei1, Wen Liang1, Song Dayong2, Ma Desi1, Wang Xiaohong2, Qu Tiebing3
1Department of Orthopaedic Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China; 2Beijing Naton Medical Technology Innovation Center Co., Ltd, Beijing 100038, China; 3Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Center, Beijing 100068, China
Abstract：Objective This study aimed to explore the correlation between the insufficient coverage of lateral trochlear bone resection and the various alignment parameters of the lower extremities in kinematically aligned total knee arthroplasty(KA-TKA). Methods Forty-eight patients (54 knees) who underwent KA-TKA surgery at Beijing Chaoyang Hospital from May 2018 to July 2020 were retrospectively investigated. The patients comprised 12 males and 36 females who were aged 69±6.7 years (range: 57-85 years). Twenty-three patients (23 knees) underwent surgery using patient-specific instruments, and conventional instruments with caliper and other special tools were used in 25 patients (31 knees). The hip-knee-ankle (HKA) angle, the mechanical distal femoral lateral angle (mLDFA), the joint line convergence angle (JLCA), the medial proximal tibial angle (MPTA), and the transepicondylar axis angle (TEAA) were obtained through full-length weight-bearing X-ray, CT, or intraoperative measurement and used as independent variables. The exposed resection bone surface data at the middle (MIDcover) and inferior (INFcover) levels of the patients' lateral femoral trochlear were recorded through CT or intraoperative caliper measurements and used as dependent variables. Spearman correlation and linear regression analyses were conducted. Results Among the 54 knees, 37 (87%) had varying degrees of lateral trochlear resection coverage insufficiency, with MIDcover and INFcover being 2.8 mm (2.6 mm) and 2.3 mm (2.5 mm) [M(QR)], respectively. MIDcover and INFcover had a significant negative correlation with mLDFA, and the correlation coefficients were -0.839 and -0.691 (all P values＜0.05), respectively; they were also significantly negatively correlated with HKA, and the correlation coefficients were -0.574 and -0.585 (all P values＜0.05), respectively. The insufficient coverages were not significantly correlated to TEAA and MPTA. Linear regression analysis showed that MPTA had a great impact on MIDcover and INFcover, with regression coefficients of -0.703 (R2=0.708) and -0.473 (R2=0.489), respectively. Conclusions When performing KA-TKA using conventional prostheses, insufficient coverage of the lateral trochlear resection surface is common. The greater the valgus of the distal femoral joint line is, the more insufficient the coverage of the lateral trochlear bone resection is.
王志为, 温亮, 宋大勇, 马德思, 王晓红, 曲铁兵. 运动学对线全膝关节置换股骨滑车截骨面解剖适配与下肢对线参数的相关性研究[J]. 中华解剖与临床杂志, 2021, 26(2): 155-161.
Wang Zhiwei, Wen Liang, Song Dayong, Ma Desi, Wang Xiaohong, Qu Tiebing. Correlation study between anatomical matching of trochlear resection and alignment parameters of lower extremities in kinematically aligned total knee arthroplasty. Chinese Journal of Anatomy and Clinics, 2021, 26(2): 155-161.
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2021, Vol. 26 
