Türk toplumunda medial tibial platonun morfometrisi ve unikondiler diz protezi tibial komponentleriyle olan ilişkisi

Öz

Amaç: Bu çalışmanın amacı Türk hastaların tibial rezeksiyon alanlarının ölçümünü yapmak ve bu ölçümleri günümüzde kullanılan tibial implantların boyutları ile karşılaştırmak idi.

Çalışma planı: İki yüz altmış hastanın MR görüntülerinde unikondilerdiz artroplastisinde (UDA)rezeksiyonu yapılan medial tibial platonun 7 farklı boyutunun ve Türkiye’de en fazla kullanılan UDA implantlarının ölçümü yapıldı. İstatistiksel analiz için SPSS yazılımı kullanılarak Student’s t-test, ANOVA, ki-kare ve Pearson korelasyon katsayısı testlerinden yararlanıldı.

Bulgular: Türk toplumunun dizlerindeki anteroposterior ve tibial platonun en geniş mediolateral boyutları Accuris ve Mitus implantlarına göre Oxford ve Zuk implantlarında nispeten daha yaklaşık bulundu (p<0.001). Merkez mediolateral boyut ile en geniş mediolateral boyut arasındaki mesafe erkeklerde 2.4 (dağılım: 0-6.3) mm, kadınlarda 2.6 (dağılım: 0-6.3) mm olarak bulundu. Bu ölçümler bize maksimum mediolateral boyutun, olgularımızın çoğunda (260 ölçümün 202’sinde) merkez mediolateral boyutun posteriorunda bulunduğunu gösterdi. Bu sonuçlar, rezeke edilen medial tibial kondilin anteroposterior ölçümlerinin asimetrik olduğuna işaret etmekteydi.

Çıkarımlar: Batı ve Asya toplumlarının antropometrik ölçümlerine göre tasarlanan tibial implantlar Türk toplumunun ihtiyaçlarını tam olarak karşılamamaktadır. En iyi uyum için farklı toplumlara yönelik farklı UDA implantlarının tasarlanması gerekmektedir.

Anahtar Kelimeler

• Protez; tibial implant; Türk toplumu; unikondiler diz artroplastisi.

Morphometry of the medial tibial plateau in Turkish knees: correlation to the current tibial components of unicompartmental knee arthroplasty

Abstract

Objective: The objective of this study was to measure the resected surfaces of the tibia in knees of Turkish patients and to compare these measurements with the dimensions of tibial implants in current use.

Methods: We made measurements of seven different dimensions of the medial tibial plateau at the virtual resection level for unicompartmental knee arthroplasty (UKA) on MRIs of 260 patients and the most commonly used four UKA implants in Turkey. Statistical analysis was performed by using Student’s t-test, analysis of variance (ANOVA), chi-square test and Pearson’s correlation coefficient by using SPSS software.

Results: The anteroposterior and widest mediolateral dimensions of the tibial plateau of Turkish knees were found relatively more approximate to the dimensions of Oxford and Zuk prostheses compared to that of Accuris and Mitus (p<0.001). The distance between the central mediolateral dimension and the widest mediolateral dimension was 2.4 (range: 0-6.3) mm in males and 2.6 (range: 0-6.2) mm in females. The maximum mediolateral dimension was found posterior to the central mediolateral dimension in the majority (202 out of 260) of cases. These findings point towards the asymmetry in the AP halves of the resected medial tibial condyle.

Conclusion: Tibial components designed according to anthropometric measurements based on both Western and Asian populations do not perfectly meet the requirements of Turkish population. Designing different UKA prostheses for different populations are required for best fit.

Keywords

• Prosthesis
• tibial implant
• Turkish population
• unicondylar knee arthroplasty

References

1. Berend ME, Small SR, Ritter MA, Buckley CA. The effects of bone resection depth and malalignment on strain in the proximal tibia after total knee arthroplasty. J Arthroplasty 2010;25:314-8.
2. Innocenti B, Truyens E, Labey L, Wong P, Victor J, Bellemans J. Can medio-lateral baseplate position and load sharing induce asymptomatic local bone resorption of the proximal tibia? A finite element study. J Orthop Surg Res 2009;4:26.
3. D’Lima DD, Patil S, Steklov N, Slamin JE, Colwell CW Jr. Tibial forces measured in vivo after total knee arthroplasty. J Arthroplasty 2006;21:255-62.
4. Chau R, Gulati A, Pandit H, Beard DJ, Price AJ, Dodd CA, et al. Tibial component overhang following unicompartmental knee replacement-does it matter? Knee 2009;16:310-3.
5. Nielsen PT, Hansen EB, Rechnagel K. Cementless total knee arthroplasty in unselected cases of osteoarthritis and rheumatoid arthritis. A 3-year follow-up study of 103 cases. J Arthroplasty 1992;7:137-43.
6. Cheng FB, Ji XF, Zheng WX, Lai Y, Cheng KL, Feng JC, Li YQ. Use of anthropometric data from the medial tibial and femoral condyles to design unicondylar knee prostheses in the Chinese population. Knee Surg Sports Traumatol Arthrosc 2010;18:352-8.
7. Surendran S, Kwak DS, Lee UY, Park SE, Gopinathan P, Han SH, et al. Anthropometry of the medial tibial condyle to design the tibial component for unicondylar knee arthroplasty for the Korean population. Knee Surg Sports Traumatol Arthrosc 2007;15:436-42.
8. Hitt K, Shurman JR 2nd, Greene K, McCarthy J, Moskal J, Hoeman T, et al. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems. J Bone Joint Surg Am 2003;85-A Suppl 4:115-22.

9. NIH Consensus Statement on total knee replacement. NIH Consens State Sci Statements 2003;20:1-34.
10. Choong PF, Dowsey MM. Update in surgery for osteoarthritis of the knee. Int J Rheum Dis 2011;14:167-74.
11. Walker PS, Yildirim G, Arno S, Heller Y. Future directions in knee replacement. Proc Inst Mech Eng H 2010;224:393-414.
12. Incavo SJ, Ronchetti PJ, Howe JG, Tranowski JP. Tibial plateau coverage in total knee arthroplasty. Clin Orthop Relat Res 1994;299:81-5.
13. Fitzpatrick C, FitzPatrick D, Lee J, Auger D. Statistical design of unicompartmental tibial implants and comparison with current devices. Knee 2007;14:138-44.
14. Güleç E, Akın G, Sagir M, Koca Özer B, Gültekin T, Bektaş Y. Anthropometric dimensions of Anatolian people: results of 2005 Turkish Anthropometric Survey. [Article in Turkish] Ankara Üniversitesi Dil ve TarihCoğrafya Fakültesi Dergisi 2009;49:187-201.
15. Fitzpatrick CK, FitzPatrick DP, Auger DD. Size and shape of the resection surface geometry of the osteoarthritic knee in relation to total knee replacement design. Proc Inst Mech Eng H 2008;222:923-32.