Impact of preoperative knee varus deformity on total knee arthroplasty
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[目的]探讨膝内翻畸形程度对全膝关节置换术(total knee arthroplasty,TKA)疗效的影响.[方法]回顾性分析2020年4月-2022年4月86例在本院行TKA的膝骨关节炎患者的临床资料.根据术前髋-膝-踝角(hip-knee-ankle angle,HKAA),54例为轻度内翻(≤10°),32例为中度内翻畸形(10°～20°).分析下肢力线与临床评分的相关性.[结果]两组均顺利手术,无严重并发症,两组间围手术期指标的差异均无统计学意义(P＞0.05).随时间推移,两组术后VAS评分、WOMAC评分、膝伸-屈ROM及HSS评分均显著改善(P＜0.05).术前及术后3个月轻度组VAS、HSS、WOMAC及膝伸-屈ROM均显著优于中度组(P＜0.05).影像方面,轻度组术前股胫角(femorotibial angle,FTA)[(190.4±5.6)° vs(196.3±6.1)°,P＜0.001]、胫骨近端内侧角(medial proximal tibial angle,MPTA)[(73.4±3.8)°vs(67.2±3.1)°,P＜0.001]、胫骨平台后倾角(posterior tibial slope,PTS)[(8.5±1.9)° vs(7.2±1.6)°,P=0.002]、机械轴偏移(mechanical axis deviation,MAD)[(38.4±1.5)mm vs(40.6±2.1)mm,P=0.002]均显著优于中度组.末次随访时,轻度组的 FTA[(174.3±4.1)°vs(180.7±5.3)°,P＜0.001]、MPTA[(87.6±5.3)° vs(79.3±4.5)°,P＜0.001]显著优于中度组(P＜0.05),但两组间PTS、MAD的差异无统计学意义(P＞0.05).Pearson相关性分析显示,术前FTA与VAS评分(r=0.416,P=0.014)、WOMAC 评分(r=0.545,P＜0.001)呈显著正相关,与 ROM 呈显著负相关(r=-0.545,P＜0.001);术前 MPTA与 VAS 评分(r=-0.452,P=0.008)、WOMAC 评分(r=-0.578,P＜0.001)呈显著负相关,与 ROM 呈显著正相关(r=0.614,P＜0.001).末次随访FTA、MPTA与VAS评分、WOMAC评分、ROM均无显著相关性(P＞0.05).[结论]术前膝内翻畸形程度对TKA术后下肢力线影响显著,但对膝关节活动度、膝关节功能的影响较小.
[Objective]To investigate the effect of preoperative knee varus deformity on the outcomes of total knee arthroplasty(TKA).[Methods]A retrospective study was conducted on 86 patients who received TKA for knee osteoarthritis in our hospital from April 2020 to April 2022.According to the preoperative hip-knee-ankle angle(HKAA),54 patients had mild knee varus(≤10°),while the remaining 32 pa-tients had moderate knee varus deformity(10°～20°).The correlation between lower limb alignment and clinical score was analyzed.[Results]All patients in both groups had TKA performed successfully without serious complications,and with no significant differences regarding peri-operative data between the two groups(P＞0.05).The VAS,WOMAC and HSS scores,as well as knee extension-flexion ROM significantly im-proved in both groups over time postoperatively(P＜0.05).The mild group proved significantly better than the moderate group in terms VAS,WOMAC and HSS scores,as well as knee extension-flexion ROM before operation and 3 months postoperatively(P＜0.05).Radiographically,the mild group proved significantly superior to the moderate group in terms of femorotibial angle(FTA)[(190.4±5.6)° vs(196.3±6.1)°,P＜0.001],medial proximal tibial angle(MPTA)[(73.4±3.8)° vs(67.2±3.1)°,P＜0.001],posterior tibial slope(PTS)[(8.5±1.9)° vs(7.2±1.6)°,P=0.002],mechanical axis deviation(MAD)[(38.4±1.5)mm vs(40.6±2.1)mm,P=0.002]before TKA;additionally FTA[(174.3±4.1)° vs(180.7± 5.3)°,P＜0.001],MPTA[(87.6±5.3)° vs(79.3±4.5)°,P＜0.001]regardless of that there was no significant difference in PTS and MAD between the two groups(P＞0.05)postoperatively.As results of Pearson correlation analysis,preoperative FTA was significantly positively correlated to VAS scores(r=0.416,P=0.014)and WOMAC scores(r=0.545,P＜0.001),whereas negatively correlated with ROM(r=-0.545,P＜0.001).In addition,the preoperative MPTA was significantly negatively correlated to VAS scores(r=-0.452,P=0.008)and WOMAC scores(r=-0.578,P＜0.001),whereas significantly positively correlated to ROM(r=0.614,P＜0.001).However,there were no correlation between FTA,or MPTA with VAS,WOMAC score and ROM at the last follow-up(P＞0.05).[Conclusion]The extent of knee varus deformity before surgery has con-siderable effect on the lower limb alignment after TKA,but has little effect on knee joint motion and knee function.
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