Total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the treatment of knee osteoarthritis with knee valgus deformity

doi:10.12307/2022.172

Abstract

Abstract: BACKGROUND: Studies have shown that the use of posterior cruciate ligament retaining prosthesis in total knee arthroplasty can retain more proprioception, reduce the stress of patellofemoral joint, enhance the function of quadriceps femoris through the rolling of femoral rear wheel, increase the range of motion of knee joint, make the gait of patients more normal, and improve the satisfaction of patients.
OBJECTIVE: To explore the clinical efficacy of total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the treatment of knee osteoarthritis with knee valgus deformity.
METHODS: From November 2018 to December 2020, data of 30 patients (all single knee arthroplasty) with knee osteoarthritis and genu valgus deformity who underwent primary total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the Department of Joint Surgery of the Affiliated Ganzhou Hospital of Nanchang University were retrospectively analyzed. The knee valgus angle and range of motion of 30 patients were measured before operation and 2 weeks and 3 months after operation, and the knee function was evaluated by HSS. The study has been approved by the Ethics Committee of the Affiliated Ganzhou Hospital of Nanchang University (approval No. TY-ZKY2021-009-01).
RESULTS AND CONCLUSION: (1) The knee valgus angle of 30 patients at 2 weeks and 3 months after operation was less than that before operation (P < 0.05), and there was no significant difference in knee valgus angle between 3 weeks and 3 months after operation (P > 0.05). (2) The range of motion of knee joint in 30 patients at 2 weeks and 3 months after operation was higher than that before operation (P < 0.05). There was no significant difference in range of motion of knee joint between 3 weeks and 3 months after operation (P > 0.05). (3) The overall HSS scores of 30 patients at 2 weeks and 3 months after operation were higher than those before operation (P < 0.05), and there was no significant difference in overall HSS scores between 3 weeks and 3 months after operation (P > 0.05). (4) The results showed that total knee arthroplasty with posterior cruciate ligament retaining prosthesis can effectively correct the deformity of knee joint, reduce the pain of knee joint, improve the muscle strength of affected limb, and significantly improve the range of motion and function of knee joint, showing significant clinical effect.

Key words: posterior cruciate ligament, artificial knee prosthesis, total knee arthroplasty, osteoarthritis, knee valgus, knee joint pain, range of motion of knee joint, clinical effect

CLC Number:

Zhou Jianguo, Liu Shiwei, Yuan Changhong, Bi Shengrong, Yang Guoping, Hu Weiquan, Liu Hui, Qian Rui. Total knee arthroplasty with posterior cruciate ligament retaining prosthesis in the treatment of knee osteoarthritis with knee valgus deformity[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(6): 892-897.

Figures/Tables 5

30例患者全膝关节置换后2周、3个月的疼痛评分大于术前(P < 0.05)，全膝关节置换后2周与3个月的疼痛评分比较差异无显著性意义(P > 0.05)，表明后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形能够明显减轻患者疼痛；全膝关节置换后2周、3个月的功能评分大于术前(P < 0.05)，全膝关节置换后2周与3个月的功能评分比较差异无显著性意义(P > 0.05)，提示后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形，能够明显提高患者的膝关节功能；全膝关节置换后2周、3个月的关节活动度评分大于术前(P < 0.05)，全膝关节置换后2周与术后3个月的活动度评分比较差异无显著性意义(P > 0.05)，提示后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形，能够显著改善患者的关节活动度；全膝关节置换后2周、3个月的稳定性评分大于术前(P < 0.05)，全膝关节置换后2周与3个月的稳定性评分比较差异无显著性意义(P > 0.05)，提示后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形，能够提升患者的膝关节稳定性；全膝关节置换后2周、3个月的屈曲畸形评分大于术前(P < 0.05)，全膝关节置换后2周与3个月的屈曲畸形评分比较差异无显著性意义(P > 0.05)，提示后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形，能够矫正患者的膝关节屈曲畸形；全膝关节置换后2周、3个月的肌力评分大于术前(P < 0.05)，全膝关节置换后2周与3个月的肌力评分比较差异无显著性意义(P > 0.05)，提示后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形，能够明显提高患肢肌肉力量，见图2。"

所有患者全膝关节置换后在疼痛、功能、活动度、稳定性、屈曲畸形、肌力方面均得到了明显改善，且最终结果显示：优秀 27膝、良好3膝、及格0膝、差0膝。表明采用后交叉韧带保留型假体全膝关节置换治疗膝关节骨性关节炎合并膝外翻畸形患者，能够矫正膝关节畸形、减轻膝关节疼痛、提高患肢肌力、显著改善膝关节活动度及功能。 2.6 典型病例 59岁女性患者，主诉：右膝关节疼痛伴活动受限2年，加重半年；入院诊断：右膝关节骨性关节炎(Kellgren-Lawrence分级Ⅲ级)。查体：生命体征平稳，心、肺、腹未查及异常。专科查体：①视诊：右膝关节稍肿胀，右膝关节外翻畸形，脊柱生理弯曲存在，无明显侧弯及后凸畸形，四肢皮肤未见异常；②触诊：右膝关节周围压痛，浮髌试验(±)，右侧麦氏征(+)，内侧应力试验(-)，外侧应力试验(±)，研磨试验(+)，前后抽屉试验(-)，双下肢直腿抬高试验及加强试验(-)，其余四肢各关节未触及明显异常，双下肢皮肤感觉血运正常；③动诊：右膝关节伸直0°，屈曲80°，脊柱活动基本正常，余肢体未见明显活动异常；④量诊：双上肢等粗等长，双下肢等粗等长，无短缩畸形。影像学检查：全膝关节置换前膝关节正侧位显示：中等量骨赘增生，膝关节间隙明显狭窄，见图3A；全膝关节置换前膝关节MRI显示后交叉韧带信号粗细形态正常、连续性完好，见图3B；双下肢全长正位X射线片测量术前膝外翻角为 16.79°，见图3C。采用后交叉韧带保留型假体全膝关节置换手术治疗，复查双下肢全长正位X射线片测量术后膝外翻角为6.83°，全膝关节置换后显著矫正膝关节外翻畸形，见图3D；全膝关节置换后复查膝关节正侧位片显示：膝关节假体位置良好，无假体松动断裂、膝关节脱位和假体周围骨折等并发症，见图3E。"

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