No Correlation Between Clinical Outcomes and Changes in the Tibia-Metaphyseal Angle Following Total Knee Arthroplasty: A Retrospective Study

BackgroundDespite numerous advances in the implant design and surgical technique, improvement in patient satisfaction following total knee arthroplasty (TKA) has plateaued. Various TKA alignment strategies have been introduced that impact the coronal positioning of the tibial component relative to the native joint line. This study aims to analyze if postoperative variance of the joint line from preoperative native alignment is correlated with changes in patient-reported outcomes following primary TKA.MethodsA retrospective review of an academic center’s patient population identified all primary TKAs between 2013 and 2021 with full-length, standing radiographs and patient-reported outcome measures (PROMs) data. These measures included the Knee injury and Osteoarthritis Outcome Score for Joint Replacement, Patient-Reported Outcome Measurement Information System, and Veterans RAND 12 scores. Preoperative and postoperative radiographic measurements for hip-knee angle, tibia-metaphyseal angle, tibial-axis orientation angle, and joint-line obliquity angle were recorded. Three-month, 1-year, and 2-year PROM scores were correlated with the change in degrees for each of the angles using a Spearman’s correlation. A Mann-Whitney U-test was used to compare angular changes with a change in PROM scores.ResultsOne hundred and ninety nine patients (204 knees) with a mean age of 67 years were included. Average follow-up was 23 months. Three-month, 1-year, and 2-year follow-up rates were 93%, 64%, and 34%, respectively. Improvements were seen across all PROMs regardless of an angular change.ConclusionThere were no clear correlations between PROMs and variation in joint line obliquity in the coronal plane. These data suggest that the magnitude of the variation in coronal tibial alignment from native alignment does not impact PROMs. Further study is indicated to correlate an angular change with functional measures.     

体质量指数对全髋关节置换后早期髋关节功能恢复影响的三维步态分析

文题释义：三维步态分析系统：通过对利用摄像机得到的人体运动图像进行图像处理，来进行步态分析的技术及装置。以获取人体在各体态和运动下的生理、病理的力学和数学参数，进行人体各部位和机能检测，所检测的数据经进一步分析计算后可获得人体各部位(特别是关节)的受力状态，以及机械功、代谢能量消耗的情况。 体质量指数：是一个计算值，当需要比较及分析一个人的体质量对于不同高度的人所带来的健康影响时，体质量指数值是一个中立而可靠的指标。 背景：肥胖对全髋关节置换的影响已有学者进行讨论，但目前尚缺乏对不同体质量指数患者使用三维步态分析技术进行随访的研究。 目的：通过三维步态分析系统定量分析体质量指数对全髋关节置换后早期髋关节功能恢复的影响。 方法：选择大连大学附属中山医院关节外科2017年1月至2018年6月收治的全髋关节置换患者60例，根据入院时体质量指数分为超重组(体质量指数≥25 kg/m²)与正常组(体质量指数< 25 kg/m²)，每组30例。所有患者对检测方案均知情同意，且得到医院伦理委员会批准。收集患者的手术部位、年龄、性别、身高、体质量、手术时间等临床基本资料；术后6个月时使用三维步态分析技术采集时间-距离参数(步幅、步频、平均步速)、动力学参数及运动学参数对髋关节功能进行评价。 结果与结论：①2组在手术部位、性别比例及年龄方面差异无显著性意义(P > 0.05)；但超重组手术时间明显长于正常组，差异有显著性意义(P=0.000)；②时间-距离参数方面，2组在步幅、步频及平均步速上差异虽无显著性意义，但超重组步幅(1.08±0.18) m小于正常组(1.35±1.45) m；③运动学参数中，超重组在髋关节各个面的活动范围均小于正常组，差异有显著性意义(P < 0.05)；④动力学参数方面，屈髋力矩峰值超重组小于正常组，差异有显著性意义(P=0.011)；伸髋力矩峰值2组差异无显著性意义(P=1.000)；⑤提示肥胖对全髋关节置换后早期功能恢复存在一定影响。 ORCID: 0000-0003-1824-687X(陈浩鹏) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

运动学对线应用于全膝关节置换术的研究进展

全膝关节置换术是目前治疗终末期膝关节骨性关节炎最有效的方法之一，全膝关节置换术后膝关节功能、术后膝关节疼痛与术后下肢力线有着密切的关系。目前膝关节置换术下肢对线方式主要采用机械力学对线方法，该方法可以改善膝关节功能，但是有部分患者也会产生术后膝关节的疼痛、活动受限等并发症，导致术后患者满意度较差。近些年越来越多的研究开始关注运动力学对线技术并应用于临床。运动学对线技术旨在重建患者的解剖结构，将膝关节假体运动轴与膝关节生理性运动轴保持一致，减少膝关节周围软组织和韧带的松解，实现膝关节生理性运动。该文就运动力学对线方法在全膝关节置换术中的应用进展作一综述。     

In Kinematically Aligned Total Knee Arthroplasty,Failure to Recreate Native Tibial Alignment Is Associated With Early Revision

BackgroundThe goal of kinematically aligned (KA) total knee arthroplasty (TKA) is to restore native knee anatomy. However, there are concerns about patellofemoral tracking problems with this technique that lead to early revision. We measured the differences between preoperative anatomic alignment and postoperative component alignment in a consecutive series of KA TKA and evaluated the association between alignment changes and the likelihood of early revision.MethodsThe charts of 219 patients who underwent 275 KA TKA procedures were reviewed. Preoperative anatomic alignment and postoperative tibial and femoral component alignment were measured radiographically. The difference in component alignment compared with preoperative anatomic alignment was compared between patients who underwent aseptic revision and those who did not at a minimum of 12 months of follow-up. Receiver operating characteristic curves were created for statistically significant variables, and the Youden index was used to determine optimal alignment thresholds with regard to likelihood of revision surgery.ResultsChange in tibial component alignment compared with native alignment was greater (P = .005) in the revision group (5.0° ± 3.7° of increased varus compared with preoperative anatomic tibial angle) than in the nonrevision group (1.3° ± 4.2° of increased varus). The Youden index indicated that increasing tibial varus by >2.2° or more is associated with increased likelihood of revision. Preoperative anatomic alignment and change in femoral alignment and overall joint alignment (ie, Q angle) were not associated with increased likelihood of revision.ConclusionSmall increases in tibial component varus compared with native alignment are associated with early aseptic revision in patients undergoing KA TKA.     

Anterior Tibial Post Impingement During Stair Climbing: A Kinematic Analysis and Clinical Outcomes

Background

Anterior tibial post impingement during gait and stair ambulation was reported in knees with posterior-stabilized prostheses. However, the link between anterior post impingement and knee kinematics and between anterior post impingement and the clinical outcome has not been well investigated. Therefore, the purpose of this study was to assess the anterior impingement to clarify the relevant kinematics and clinical results including patient-reported outcomes.

Influence of L2 proficiency on kinematic duration of single words: Real and novel word production by Bengali-English speakers

The study explored the influence of second language proficiency on the kinematic duration of single words. Participants produced real and novel words with variable stress targets (e.g., trochaic and iambic) embedded in first language (L1) and second language (L2) sentence frames. Participants were monolingual English speakers (n=10) and Bengali-English bilinguals with early exposure to English (n=10) and late exposure to English (n=10). Bengali was the L1 and English was the L2 for all 20 bilingual participants. Duration of lip movements for the target real and novel words was analysed. Results suggest that kinematic duration of single words was not influenced by speakers' L2 proficiency. However, L2 proficiency influenced foreign accent ratings for the real words, but not the novel words. Kinematic duration and perception of accent were not correlated, which might imply that accent reduction might not always be a direct consequence of shorter word duration.     

面向植入式医疗器械的人体运动学分析方法综述

随着植入式医疗器械的大量使用,其安全性受到广泛关注。植入式医疗器械出现故障,力学原因被认为是其失效的一个重要因素,日常活动中微小而反复的力学载荷会造成植入式医疗器械元件的疲劳损坏。获取并研究典型日常活动的人体重点解剖部位的运动信息,对植入式医疗器械的设计及手术方案的优化具有积极意义。本文概括了人体运动学研究的3种方法以及日常活动模拟动作的选取,介绍了该领域的最新进展及问题,并展望了有价值的研究方向。     

A kinematic analysis of relative stability of the lower extremities between subjects with and without chronic low back pain

Even though a number of studies have evaluated postural adjustments based on kinematic changes in subjects with low back pain (LBP), kinematic stability has not been examined for abnormal postural responses during the one leg standing test. The purpose of this study was to evaluate the relative kinematic stability of the lower extremities and standing duration in subjects with and without chronic LBP. In total, 54 subjects enrolled in the study, including 28 subjects without LBP and 26 subjects with LBP. The average age of the subjects was 37.8 ± 12.6 years and ranged from 19 to 63 years. The outcome measures included normalized holding duration and relative kinematic stability. All participants were asked to maintain the test position without visual input (standing on one leg with his/her eyes closed and with the contra lateral hip flexed 90°) for 25 s. The age variable was used as a covariate to control confounding effects for the data analyses. The control group demonstrated significantly longer holding duration times (T = −2.78, p = 0.007) than the LBP group (24.6 ± 4.2 s vs. 20.5 ± 6.7 s). For the relative kinematic stability, there was a difference in dominance side (F = 9.91, p = 0.003). There was a group interaction between side and lower extremities (F = 11.79, p = 0.001) as well as an interaction between age and dominance side (F = 7.91, p = 0.007). The relative kinematic stability had a moderate negative relationship with age (r = −0.60, p = 0.007) in subjects without LBP. Clinicians need to understand the effects of age and relative stability, which decreased significantly in the single leg holding test, in subjects with LBP in order to develop effective rehabilitation strategies.