Relationship of lower limb alignment and component alignment with outcomes and implant loosening rate after total knee arthroplasty

doi:10.3969/j.issn.2095-4344.1288

Abstract

Abstract:

BACKGROUND: There is still much controversy about the lower limb alignment after total knee arthroplasty. There are few studies on the relationship between lower limb alignment and clinical outcome in Chinese patients.

OBJECTIVE: To analyze the relationship of limb alignment (angle of femoral and tibial mechanical alignment), coronal alignment of the femoral component (distal medial angle of femoral prosthesis) and coronal alignment of the tibial component (proximal medial angle of tibial prosthesis) with clinical outcome and implant loosening rate after total knee arthroplasty in patients with knee osteoarthritis.

METHODS: Data of 118 patients (139 knees) with knee osteoarthritis after first total knee arthroplasty from March 2015 to December 2016 were retrospectively analyzed. All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. The long-leg weight-bearing radiographs were taken and the angle of femoral and tibial mechanical alignment (angle of femoral and tibial mechanical alignment), distal medial angle of femoral prosthesis (distal medial angle of femoral prosthesis), proximal medial angle of tibial prosthesis (proximal medial angle of tibial prosthesis) were measured before and after surgery. The postoperative follow-up of the knee range of motion and Hospital for Special Surgery scores were used to evaluate the clinical outcome after total knee arthroplasty. Standard radiographs were subsequently obtained at follow-up in order to look for signs of wear and or lucency using the EWALD classification. The relationship of limb alignment (angle of femoral and tibial mechanical alignment), femoral alignment (distal medial angle of femoral prosthesis), and tibial alignment (proximal medial angle of tibial prosthesis) with clinical outcome and implant loosening rate after total knee arthroplasty was analyzed.

RESULTS AND CONCLUSION: (1) All the 118 patients (139 knees) were followed up for 35.8 ± 6.2 months. No complications such as osteolysis, loosening of the prosthesis and prosthesis fracture were found. (2) For the limb alignment, there were significant differences in the Hospital for Special Surgery scores between the neutral group and the varus group and the valgus group (P < 0.05), and the neutral group score was highest. (3) As for femoral component alignment, the difference of the Hospital for Special Surgery scores was statistically significant between the neutral group and the valgus group (P < 0.05), and the score in the neutral group was higher. (4) As for tibial component alignment, there were no significant differences in postoperative Hospital for Special Surgery scores among the three groups (P > 0.05). (5) The traditional neutral alignment [angle of femoral and tibial mechanical alignment = (180±3)°] was still recommended for the recovery alignment after total knee arthroplasty. The residual postoperative varus and valgus alignment should be avoided as much as possible. In the short-term follow-up, the postoperative limb alignment had no effect on the loosening of the prosthesis.

Key words: total knee arthroplasty, knee osteoarthritis, coronal, lower limb alignment, knee motion range, Hospital for Special Surgery scores, angle of femoral and tibial mechanical alignment, distal medial angle of femoral prosthesis, proximal medial angle of tibial prosthesis

CLC Number:

R459.9

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R459.9

Yang Shuo, Feng Shuo, Xu Chongjun, Tang Jinlong, Pei Fang, Zha Guochun, Chen Xiangyang.

Relationship of lower limb alignment and component alignment with outcomes and implant loosening rate after total knee arthroplasty

[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(24): 3780-3785.

Figures/Tables 3

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