胫骨假体的不同后倾角度对内侧间室单髁置换术后膝关节功能的影响

doi:10.19723/j.issn.1671-167X.2021.05.011

Abstract

Abstract:

Objective: To evaluate the relationship between postoperative knee function and the sagittal position of tibial component in unicompartmental knee arthroplasty (UKA). Methods: We retrospectively enrolled the patients who underwent UKA from January 2016 to May 2020. They were assigned into 2 groups according to postoperative posterior tibial slope (PTS): the normal PTS group (PTS≥3° and PTS<8°) and the abnormal PTS group (PTS<3° or ≥8°). The patients were followed up for at least 12 months. The postoperative Knee Society Clinical Score (KSS-C), Knee Society Functional Score (KSS-F) and knee range of motion (ROM) were compared between the two groups. Results: A total of 72 patients (82 knees) were included with 51 patients (58 knees) in PTS normal group and 21 patients (24 knees) in PTS abnormal group. All the patients were followed up with median of 23.6 months. There was no significant difference in the general data [gender, age, body mass index (BMI)], pre-operative knee range of motion, preoperative KSS-C score and KSS-F score (P > 0.01). The KSS-C score, KSS-F score, and knee range of motion significantly improved after surgery (P<0.01) for all the patients. The postoperative KSS-C score in normal PTS group (88.76±2.79) was significantly higher than the KSS-C score in abnormal PTS group (84.42±3.35, P<0.01), but no significant difference between the 2 groups was observed in postoperative KSS-F score and knee range of motion (P > 0.01). In addition, there was no correlation between the change of PTS and postoperative KSS-C score (r=-0.034, 95%CI: -0.247 to 0.186, P = 0.759), KSS-F score (r = -0.014, 95%CI: -0.238 to 0.198, P = 0.901) and knee range of motion (r= 0.045, 95%CI: -0.214 to 0.302, P = 0.686). Conclusion: The posterior tibial slope between 3° and <8° can be recommended to improve knee joint function in mobile UKA, and excessive or insufficient PTS should be avoided.

Key words: Knee osteoarthritis, Unicompartmental knee arthroplasty, Posterior tibial slope, Postoperative knee joint function

CLC Number:

R684.1

Hao WU,Li-ping PAN,Heng LIU,Hong-bin WANG,Tai-guo NING,Yong-ping CAO. Effect of posterior tibial slope on the short-term outcome in mobile-bearing unicompartmental knee arthroplasty[J].Journal of Peking University (Health Sciences), 2021, 53(5): 877-882.

Figures/Tables 4

Figure 1

Table 1

Details of the patients in the study"

Items	PTS≥3° and <8° (n=58)	PTS<3° or ≥8° (n=24)	PTS≥8°(n=22)	P₁	P₂
Age/years, $x ?$ ±s	65.78±8.69	63.91±5.54	63.27±5.32	0.336	0.211
BMI/ (kg/m²), $x ?$ ±s	26.58±3.56	26.45±3.23	26.59±3.34	0.870	0.994
Gender, n				0.080	0.198
Male	18	3	3
Femal	40	21	19
Preoperative knee ROM /(°), $x ?$ ±s	105.08±17.86	107.29±17.38	107.72±17.30	0.610	0.553
Preoperative KSS-C score, $x ?$ ±s	57.31±6.74	58.12±6.99	58.36±7.18	0.624	0.542
Preoperative KSS-F score, $x ?$ ±s	54.13±12.64	54.37±12.01	54.54±11.94	0.938	0.896
Preoperative PTS/ (°), $x ?$ ±s	7.27±2.43	8.17±2.74	8.80±0.64	0.144	0.149

Table 1

Table 2

The comparison between preoperative and postoperative results"

Items	Preoperation	Postoperation	P
PTS /(°), $x ?$ ±s	7.54±2.54	6.54±1.83	0.002
Knee ROM /(°), $x ?$ ±s	105.73±17.64	121.04±12.04	<0.001
KSS-C Score, $x ?$ ±s	57.55±6.78	87.49±3.56	<0.001
KSS-F Score, $x ?$ ±s	54.21±12.38	81.22±10.05	<0.001

Table 2

Table 3

The comparison of clinical results in each group"

Items	PTS≥3° and <8° (n=58)	PTS<3° or ≥8° (n=24)	PTS≥8°(n=22)	P₁	P₂
Postoperative PTS/ (°), $x ?$ ±s	5.84±1.18	8.23±2.04	8.80±0.64	<0.001	<0.001
Change of PTS/ (°), $x ?$ ±s	2.13±1.67	2.83±1.84	2.54±1.64	0.099	0.324
Postoperative knee ROM/ (°), $x ?$ ±s	121.12±12.67	120.83±10.60	120.91±11.09	0.922	0.945
Postoperative KSS-C score, $x ?$ ±s	88.76±2.79	84.42±3.35	84.41±3.33	<0.001	<0.001
Postoperative KSS-F score, $x ?$ ±s	81.55±9.79	80.42±10.83	80.45±10.90	0.645	0.666

Table 3

References 24

[1]	Burn E, Sanchez-Santos MT, Pandit HG, et al. Ten-year patient-reported outcomes following total and minimally invasive unicom-partmental knee arthroplasty: A propensity score-matched cohort analysis [J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5):1455-1464. doi: 10.1007/s00167-016-4404-7
[2]	Bottomley N, Jones LD, Rout R, et al. A survival analysis of 1084 knees of the Oxford unicompartmental knee arthroplasty: A comparison between consultant and trainee surgeons [J]. Bone Joint J, 2016, 98(Supple 10):22-27.
[3]	Hamilton TW, Pandit HG, Inabathula A, et al. Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss: A medium-term follow-up [J]. Bone Joint J, 2017, 99(4):475-482.
[4]	Gulati A, Pandit H, Jenkins C, et al. The effect of leg alignment on the outcome of unicompartmental knee replacement [J]. J Bone Joint Surg Br, 2009, 91(4):469-474. doi: 10.1302/0301-620X.91B4.22105 pmid: 19336806
[5]	Rivière C, Harman C, Leong A, et al. Kinematic alignment technique for medial OXFORD UKA: An in-silico study [J]. Orthop Traumatol Surg Res, 2019, 105(1):63-70. doi: 10.1016/j.otsr.2018.11.005
[6]	Pandit H, Hamilton TW, Jenkins C, et al. The clinical outcome of minimally invasive phase 3 Oxford unicompartmental knee arthroplasty: A 15-year follow-up of 1 000 UKAs [J]. Bone Joint J, 2015, 97(11):1493-1500.
[7]	Yoo JH, Chang CB, Shin KS, et al. Anatomical references to assess the posterior tibial slope in total knee arthroplasty: a comparison of 5 anatomical axes [J]. J Arthroplasty, 2008, 23(4):586-592. doi: 10.1016/j.arth.2007.05.006
[8]	Price AJ, Svard U. A second decade lifetable survival analysis of the Oxford unicompartmental knee arthroplasty [J]. Clin Orthop Relat Res, 2011, 469(1):174-179. doi: 10.1007/s11999-010-1506-2
[9]	Murray DW, Goodfellow JW, O'Connor JJ. The Oxford medial unicompartmental arthroplasty: A ten-year survival study [J]. J Bone Joint Surg Br, 1998, 80(6):983-989. pmid: 9853489
[10]	Slaven SE, Cody JP, Sershon RA, et al. The impact of coronal alignment on revision in medial fixed-bearing unicompartmental knee arthroplasty [J]. J Arthroplasty, 2020, 35(2):353-357. doi: S0883-5403(19)30921-0 pmid: 31668526
[11]	Zhu GD, Guo WS, Zhang QD, et al. Finite element analysis of mobile-bearing unicompartmental knee arthroplasty: The influence of tibial component coronal alignment [J]. Chin Med J (Engl), 2015, 128(21):2873-2878.
[12]	马路遥, 郭万首, 张启栋. 胫骨假体后倾对Oxford单髁关节置换术后短期临床结果的影响 [J]. 中华外科杂志, 2017, 55(6):430-434.
[13]	马广文, 黄斐, 吴云峰, 等. 胫骨后倾截骨对活动平台单髁关节置换术疗效的影响 [J]. 中华骨与关节外科杂志, 2017, 10(4):302-304.
[14]	Hernigou P, Deschamps G. Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty [J]. J Bone Joint Surg Am, 2004, 86(3):506-511. doi: 10.2106/00004623-200403000-00007
[15]	Chatellard R, Sauleau V, Colmar M, et al. Medial unicompartmental knee arthroplasty: Does tibial component position influence clinical outcomes and arthroplasty survival? [J]. Orthop Traumatol Surg Res, 2013, 99(Suppl 4):219-225.
[16]	Sekiguchi K, Nakamura S, Kuriyama S, et al. Effect of tibial component alignment on knee kinematics and ligament tension in medial unicompartmental knee arthroplasty [J]. Bone Joint Res, 2019, 8(3):126-135. doi: 10.1302/2046-3758.83.BJR-2018-0208.R2 pmid: 30997038
[17]	Sawatari T, Tsumura H, Iesaka K, et al. Three-dimensional finite element analysis of unicompartmental knee arthroplasty: The influence of tibial component inclination [J]. J Orthop Res, 2005, 23(3):549-554. pmid: 15885474
[18]	Inoue S, Akagi M, Asada S, et al. The valgus inclination of the tibial component increases the risk of medial tibial condylar fractures in unicompartmental knee arthroplasty [J]. J Arthroplasty, 2016, 31(9):2025-2030. doi: 10.1016/j.arth.2016.02.043
[19]	Hanada M, Hotta K, Matsuyama Y. Dependence of knee range of motion on the alignment of femoral and tibial components after medial unicompartmental knee arthroplasty [J]. Eur J Orthop Surg Traumatol, 2021, 31(2):291-298. doi: 10.1007/s00590-020-02770-8
[20]	Weber P, Schröder C, Schmidutz F, et al. Increase of tibial slope reduces backside wear in medial mobile bearing unicompartmental knee arthroplasty [J]. Clin Biomech (Bristol, Avon), 2013, 28(8):904-909. doi: 10.1016/j.clinbiomech.2013.08.006
[21]	Nunley RM, Nam D, Johnson SR, et al. Extreme variability in posterior slope of the proximal tibia: Measurements on 2 395 CT scans of patients undergoing UKA? [J]. J Arthroplasty, 2014, 29(8):1677-1680. doi: 10.1016/j.arth.2014.03.024 pmid: 24768545
[22]	Lo Presti M, Raspugli GF, Reale D, et al. Early failure in medial unicondylar arthroplasty: Radiographic analysis on the importance of joint line restoration [J]. J Knee Surg, 2019, 32(9):860-865. doi: 10.1055/s-0038-1669448 pmid: 30212918
[23]	Weber P, Woiczinski M, Steinbrück A, et al. Increase in the tibial slope in unicondylar knee replacement: Analysis of the effect on the kinematics and ligaments in a weight-bearing finite element model [J]. Biomed Res Int, 2018, 2018:8743604.
[24]	Khow YZ, Liow MHL, Lee M, et al. Posterior condylar offset and posterior tibial slope targets to optimize knee flexion after unicom-partmental knee arthroplasty [J/OL]. Knee Surg Sports Traumatol Arthrosc, 2021, 1 (2021-01-29) [2021-04-15]. https://pubmed.ncbi.nlm.nih.gov/33512542 .

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Effect of posterior tibial slope on the short-term outcome in mobile-bearing unicompartmental knee arthroplasty

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