运动学对线技术对全膝关节置换术后关节活动度的效果

doi:10.3969/j.issn.1006-9771.2022.07.004

Abstract

Abstract:

Objective To explore the effect of kinematic alignment on postoperative knee function for patients after total knee arthroplasty (TKA).

Methods From June, 2020 to October, 2021, 200 patients undergoing primary TKA in Beijing Chaoyang Hospital were divided into mechanical alignment (MA) group (n = 100) and kinematic alignment (KA) group (n = 100). All the patients accepted comprehensive rehabilitation after operation. They were assessed with Keen Society Score (KSS) before and three months after operation, with Visual Analogue Scale for pain (VAS) before, and three days and three months after operation. The time of first standing, the time of first straight-leg raising more than 30°, and the active range of motion (AROM) of knee before, and one, two and three days, and one and three months after operation were recorded, as well as where to go after discharge.

Results A total of 96 patients in MA group and 98 in KA group finished the research. The AROM of knee improved more in the KA group than in the MA group after operation (F_group = 8.816, P = 0.017), and the incidence going to the rehabilitation institutes was less (χ²= 6.542, P = 0.011).

Conclusion KA may promote the rapid recovery of AROM of knee for patients after TKA, and reduce the needs of institute-based rehabilitation after discharge, to save medical costs.

Key words: total knee arthroplasty, kinematic alignment, rehabilitation

CLC Number:

R687.4

ZHANG Qi,LIANG Yuan,ZHANG Ran,WANG Zhiwei,JI Changgao. Effects of kinematic alignment on range of motion after total knee arthroplasty[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 764-769.

Figures/Tables 4

References 37

[1]	CARR A J, ROBERTSSON O, GRAVES S, et al. Knee replacement[J]. Lancet, 2012, 379(9823): 1331-1340. doi: 10.1016/S0140-6736(11)60752-6
[2]	BOURNE R B, CHESWORTH B M, DAVIS A M, et al. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?[J]. Clin Orthop Relat Res, 2010, 468(1): 57-63. doi: 10.1007/s11999-009-1119-9
[3]	NAM D, NUNLEY R M, BARRACK R L. Patient dissatisfaction following total knee replacement: a growing concern?[J]. Bone Joint J, 2014, 96-B(< W>11 Suppl A): 96-100. doi: 10.1302/0301-620X.96B11.34152
[4]	RIVIÈRE C, IRANPOUR F, AUVINET E, et al. Mechanical alignment technique for TKA: Are there intrinsic technical limitations?[J]. Orthop Traumatol Surg Res, 2017, 103(7): 1057-1067. doi: 10.1016/j.otsr.2017.06.017
[5]	DOSSETT H G, ESTRADA N A, SWARTZ G J, et al. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results[J]. Bone Joint J, 2014, 96-B(7): 907-913. doi: 10.1302/0301-620X.96B7.32812
[6]	BELLEMANS J, COLYN W, VANDENNEUCKER H, et al. The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus[J]. Clin Orthop Relat Res, 2012, 470(1): 45-53. doi: 10.1007/s11999-011-1936-5
[7]	HOWELL S, HULL M. Kinematic alignment in total knee arthroplasty. Definition, history, principle, surgical technique, and results of an alignment option for TKA[J]. Arthropaedia, 2014, 1: 44-53.
[8]	HOWELL S M, KUZNIK K, HULL M L, et al. Results of an initial experience with custom-fit positioning total knee arthroplasty in a series of 48 patients[J]. Orthopedics, 2008, 31(9): 857-863.
[9]	HOWELL S M, NEDOPIL A J, HULL M L. Negligible effect of surgeon experience on the accuracy and time to perform unrestricted caliper verified kinematically aligned TKA with manual instruments[J]. [ahead of print]. Knee Surg Sports Traumatol Arthrosc, 2022. doi: 10.1007/s00167-022-06939-y. doi: 10.1007/s00167-022-06939-y
[10]	MCEWEN P J, DLASKA C E, JOVANOVIC I A, et al. Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery[J]. J Arthroplasty, 2020, 35(2): 443-450. doi: 10.1016/j.arth.2019.08.064
[11]	中华医学会骨科学分会. 骨关节炎诊治指南(2007年版)[J]. 中华骨科杂志, 2007, 27(10): 793-796.
	Chinese Orthopaedic Association. Chin J Orthop, 2007, 27(10): 793-796.
[12]	HOWELL S M, PAPADOPOULOS S, KUZNIK K T, et al. Accurate alignment and high function after kinematically aligned TKA performed with generic instruments[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(10): 2271-2280. doi: 10.1007/s00167-013-2621-x
[13]	王志为, 温亮, 宋大勇, 等. 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 Z W, WEN L, SONG D Y, et al. Correlation study between anatomical matching of trochlear resection and alignment parameters of lower extremities in kinematically aligned total knee arthroplasty[J]. Chin J Anatomy Clin, 2021, 26(2): 155-161.
[14]	李冉, 杜巨豹, 曹光磊, 等. 骨科康复一体化模式对全膝关节置换术患者运动功能的效果[J]. 中国康复理论与实践, 2022, 28(2): 144-149.
	LI R, DU J B, CAO G L, et al. Effects of integrated orthopedic rehabilitation pathway on motor function after total knee arthroplasty[J]. Chin J Rehabil Theory Pract, 2022, 28(2): 144-149.
[15]	LIM H A, SONG E K, SEON J K, et al. Causes of aseptic persistent pain after total knee arthroplasty[J]. Clin Orthop Surg, 2017, 9(1): 50-56. doi: 10.4055/cios.2017.9.1.50
[16]	NIKI Y, NAGURA T, KOBAYASHI S, et al. Who will benefit from kinematically aligned total knee arthroplasty? Perspectives on patient-reported outcome measures[J]. J Arthroplasty, 2019, 35(2): 438-442, e2. doi: 10.1016/j.arth.2019.09.035
[17]	WYLDE V, DENNIS J, GOOBERMAN-HILL R, et al. Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials[J]. BMJ Open, 2018, 8(2): e020368. doi: 10.1136/bmjopen-2017-020368
[18]	RAO L, TAYLOR W R, HORN N, et al. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review[J]. Knee, 2022, 34: 62-75. doi: 10.1016/j.knee.2021.11.002
[19]	AN V V G, TWIGGS J, LEIE M, et al. Kinematic alignment is bone and soft tissue preserving compared to mechanical alignment in total knee arthroplasty[J]. Knee, 2019, 26(2): 466-476. doi: 10.1016/j.knee.2019.01.002
[20]	ROTH J D, HOWELL S M, HULL M L. Kinematically aligned total knee arthroplasty limits high tibial forces, differences in tibial forces between compartments, and abnormal tibial contact kinematics during passive flexion[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1589-1601. doi: 10.1007/s00167-017-4670-z
[21]	HALDER A, KUTZNER I, GRAICHEN F, et al. Influence of limb alignment on mediolateral loading in total knee replacement: in vivo measurements in five patients[J]. J Bone Joint Surg Am, 2012, 94(11): 1023-1029. doi: 10.2106/JBJS.K.00927
[22]	NIKI Y, NAGURA T, NAGAI K, et al. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1629-1635. doi: 10.1007/s00167-017-4788-z
[23]	TANIKAWA H, TADA M, HARATO K, et al. Influence of total knee arthroplasty on patellar kinematics and patellofemoral pressure[J]. J Arthroplasty, 2017, 32(1): 280-285. doi: 10.1016/j.arth.2016.06.044
[24]	MATZ J, HOWARD J L, MORDEN D J, et al. Do changes in patellofemoral joint offset lead to adverse outcomes in total knee arthroplasty with patellar resurfacing? A radiographic review[J]. J Arthroplasty, 2017, 32(3): 783-787, e781. doi: 10.1016/j.arth.2016.08.032
[25]	LOZANO R, CAMPANELLI V, HOWELL S, et al. Kinematic alignment more closely restores the groove location and the sulcus angle of the native trochlea than mechanical alignment: implications for prosthetic design[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5): 1504-1513. doi: 10.1007/s00167-018-5220-z
[26]	KOH I J, PARK I J, LIN C C, et al. Kinematically aligned total knee arthroplasty reproduces native patellofemoral biomechanics during deep knee flexion[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5): 1520-1528. doi: 10.1007/s00167-018-5270-2
[27]	KESHMIRI A, MADERBACHER G, BAIER C, et al. Kinematic alignment in total knee arthroplasty leads to a better restoration of patellar kinematics compared to mechanic alignment[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(5): 1529-1534. doi: 10.1007/s00167-018-5284-9
[28]	FORTIER L M, ROCKOV Z A, CHEN A F, et al. Activity recommendations after total hip and total knee arthroplasty[J]. J Bone Joint Surg Am, 2021, 103(5): 446-455. doi: 10.2106/JBJS.20.00983
[29]	HENDERSON K G, WALLIS J A, SNOWDON D A. Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis[J]. Physiotherapy, 2018, 104(1): 25-35. doi: 10.1016/j.physio.2017.01.002
[30]	WAINWRIGHT T W, GILL M, MCDONALD D A, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations[J]. Acta Orthop, 2020, 91(1): 3-19. doi: 10.1080/17453674.2019.1683790
[31]	JETTE D U, HUNTER S J, BURKETT L, et al. Physical therapist management of total knee arthroplasty[J]. Phys Ther, 2020, 100(9): 1603-1631. doi: 10.1093/ptj/pzaa099
[32]	BAKAA N, CHEN L H, CARLESSO L, et al. Reporting of post-operative rehabilitation interventions for total knee arthroplasty: a scoping review[J]. BMC Musculoskelet Disord, 2021, 22(1): 602. doi: 10.1186/s12891-021-04460-w
[33]	DOMINGUEZ-NAVARRO F, IGUAL-CAMACHO C, SILVESTRE-MUNOZ A, et al. Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: a systematic review and meta-analysis[J]. Gait Posture, 2018, 62: 68-74. doi: 10.1016/j.gaitpost.2018.03.003
[34]	BUTTON K, IQBAL A S, LETCHFORD R H, et al. Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model[J]. Physiotherapy, 2012, 98(4): 288-299.
[35]	KURU COLAK T, KAVLAK B, AYDOGDU O, et al. The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises[J]. Rheumatol Int, 2017, 37(3): 399-407. doi: 10.1007/s00296-016-3646-5
[36]	CHEN H, ZHENG X, HUANG H, et al. The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis: a quasi-experimental study[J]. BMC Musculoskelet Disord, 2019, 20(1): 160. doi: 10.1186/s12891-019-2521-4
[37]	FATOYE F, YEOWELL G, WRIGHT J M, et al. Clinical and cost-effectiveness of physiotherapy interventions following total knee replacement: a systematic review and meta-analysis[J]. Arch Orthop Trauma Surg, 2021, 141(10): 1761-1778. doi: 10.1007/s00402-021-03784-5

项目	MA组(n = 96)	KA组(n = 98)	χ²/t值	P值
性别(男/女)/n	45/51	42/56	0.317	0.574
年龄/岁	65.2±2.6	64.0±1.7	0.154	0.730
侧别(左/右)/n	46/50	50/48	0.187	0.666
身高/cm	160±4.5	161±5.4	1.890	0.365
体质量指数/kg·m^-2	29.9±2.8	28.5±3.5	1.562	0.445
术前VAS(行走)	6.7±2.8	6.4±2.2	0.024	0.876
术前KSS	67.2±7.0	65.8±8.2	0.188	0.702
术前ROM/°	109±5.4	112±7.0	0.775	0.360

组别	n	术后3 d	术后3个月
MA组	96	5.7±2.1	1.7±0.51
KA组	98	5.4±2.8	1.6±0.63
t值		0.632	0.164
P值		0.211	0.787

组别	n	首次下地时间/h	首次直腿抬高> 30°时间/h	出院去向(家庭/机构)/n	术后3个月KSS
MA组	96	32(18)	25(4)	69/27	87.8±3.9
KA组	98	28(14)	23(3)	85/13	89.0±2.8
Z/χ²/t值		-1.699	-1.022	6.542	0.265
P值		0.089	0.228	0.011	0.554

组别	n	术后1 d	术后2 d	术后3 d	术后1个月	术后3个月
MA组	96	62.5±7.2	80.9±9.4	87.2±10.9	107±8.2	109±7.9
KA组	98	80.1±6.7	96.4±5.2	99.0±5.0	109±5.6	110±4.9

Effects of kinematic alignment on range of motion after total knee arthroplasty

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