Total diz protezinde eklem hareket açıklığı ile femoral rollback arasındaki ilişki

Year 2014, Volume: 48 Issue: 1, 1 - 5, 14.03.2014

Lúcio Honório de Carvalho Jr Eduardo Frois Temponi Luiz Fernando Machado Soares Matheus Jacques Braga Gonçalves

Abstract

Amaç: Bu çalışmanın amacı bağ koruyan (BK) ve posterior stabilize (PS) total diz protezli (TDP) hastalarda femoral rollback ile eklem hareket açıklığı (EHA) arasındaki ilişkiyi karşılaştırmaktı.
Çalışma planı: Primer diz artrozu bulunan ve TDP ameliyatı geçirmiş 31 hastanın (26 kadın ve 5 erkek) 38 dizi çalışmaya alındı. PS grubundaki 24 dizde arka çapraz bağ (AÇB) feda edilirken, BK grubundaki 14 AÇB korundu. Hastaların ortalama takip süresi 30.6 ay idi. Hastaların EHA ile femoral rollback değerlendirmesi için lateral skopiden yararlanıldı.
Bulgular: Ortalama EHA’nın BK grubunda 106.43±9º, PS grubunda 105.43±11.7º olduğu saptandı (p=0.78). Ortalama femoral rollback 10.5±9.7 mm iken, BK grubundaki ölçümün (5.8±6.5 mm) PS grubuna (13.2±10.5 mm) göre anlamlı derecede düşük olduğu belirlendi (p=0.026615). BK protezlerin değerlendirilmesinde femoral rollback ile EHA arasında korelasyon bulunamazken (p=0.78 and r=0.8), PS protezlerde anlamlı korelasyon saptandı (p=0.01 and r=0.49). Regresyon analizinde her femoral rollback birimi için EHA’nın 0.545 derece arttığı belirlendi.
Çıkarımlar: Posterior stabilize TDP’de femoral rollback artmış ve EHA ile ilişkili olduğu halde, BK TDP ve PS TDP arasında EHA açısından bir fark bulunamamıştır.

Keywords

Eklem hareket açıklığı; femoral rollback; total diz protezi.

Relationship between range of motion and femoral rollback in total knee arthroplasty

Abstract

Objective: The aim of this study was to evaluate the relation between femoral rollback and range of motion (ROM) in patients with cruciate retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA).
Methods: The study included 38 knees of 31 patients (26 female and 5 male) with primary knee arthrosis who underwent TKA. The posterior cruciate ligament (PCL) was sacrificed in 24 knees in the PS group and preserved in 14 in the CR group. Mean follow-up was 30.6 months. Patients were submitted to fluoroscopic lateral evaluation for ROM and femoral rollback assessment.
Results: Average ROM of the CR group was 106.43±9º and 105.43±11.7º for the PS group (p=0.78). Average femoral rollback was 10.5±9.7 mm and was significantly lower in the CR group (5.8±6.5 mm) than the PS group (13.2±10.5 mm) (p=0.026615). While there was no correlation between the femoral rollback and ROM for CR prostheses (p=0.78 and r=0.8), there was a significant correlation for PR prostheses (p=0.01 and r=0.49) with regression pointing to an increase of 0.545 degrees ROM for each unit of femoral rollback.
Conclusion: Despite increase in femoral rollback and its relation with ROM in PS TKA, there were no differences in ROM between CR and PS TKA.

Keywords

Femoral rollback, range of motion, total knee arthroplasty

References

• Ritter MA, Campbell ED. Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty 1987;2:95-7.
• Aglietti P, Buzzi R, De Felice R, Giron F. The Insall-Burstein total knee replacement in osteoarthritis: a 10-year minimum follow-up. J Arthroplasty 1999;14:560-5.
• Anouchi YS, McShane M, Kelly F Jr, Elting J, Stiehl J. Range of motion in total knee replacement. Clin Orthop Relat Res 1996;331:87-92.
• Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, et al. In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 1998;356:47-57.
• Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13-4.
• Insall JN, Hood RW, Flawn LB, Sullivan DJ. The total condylar knee prosthesis in gonarthrosis. A five to nineyear follow-up of the first one hundred consecutive replacements. J Bone Joint Surg Am 1983;65:619-28.
• McAuley JP, Harrer MF, Ammeen D, Engh GA. Outcome of knee arthroplasty in patients with poor preoperative range of motion. Clin Orthop Relat Res 2002;404:203-7. Myles CM, Rowe PJ, Walker CR, Nutton RW. Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry. Gait Posture 2002;16:46-54.
• Tew M, Forster IW, Wallace WA. Effect of total knee arthroplasty on maximal flexion. Clin Orthop Relat Res 1989;247:168-74.
• Yamakado K, Kitaoka K, Yamada H, Hashiba K, Nakamura R, Tomita K. Influence of stability on range of motion after cruciate-retaining TKA. Arch Orthop Trauma Surg 2003;123:1-4. de Carvalho LH Jr, Castro CA, Gonçalves MB, Rodrigues LC, Cunha FV, Lopes FL. Range of motion after total knee arthroplasty. Acta Ortop Bras 2005;13:233-4.
• Walker PS, Garg A. Range of motion in total knee arthroplasty. A computer analysis. Clin Orthop Relat Res 1991;262:227-35.
• Hartford JM, Banit D, Hall K, Kaufer H. Radiographic analysis of low contact stress meniscal bearing total knee replacements. J Bone Joint Surg Am 2001;83-A:229-34.
• Andriacchi TP, Galante JO. Retention of the posterior cruciate in total knee arthroplasty. J Arthroplasty 1988;3 Suppl:13-9.
• Sorger JI, Federle D, Kirk PG, Grood E, Cochran J, Levy M. The posterior cruciate ligament in total knee arthroplasty. J Arthroplasty 1997;12:869-79.
• Clark CR, Rorabeck CH, MacDonald S, MacDonald D, Swafford J, Cleland D. Posterior-stabilized and cruciateretaining total knee replacement: a randomized study. Clin Orthop Relat Res 2001;392:208-12.
• Goodfellow J, O’Connor J. The mechanics of the knee and prosthesis design. J Bone Joint Surg Br 1978;60-B:358-69. Malkani AL, Rand JA, Bryan RS, Wallrichs SL. Total knee arthroplasty with the kinematic condylar prosthesis. A ten-year follow-up study. J Bone Joint Surg Am 1995;77:423-31.
• Pereira DS, Jaffe FF, Ortiguera C. Posterior cruciate ligament-sparing versus posterior cruciate ligament-sacrificing arthroplasty. Functional results using the same prosthesis. J Arthroplasty 1998;13:138-44.
• Fontanesi G, Rotini R, Pignedoli P, Giancecchi F. Retention of the posterior cruciate ligament in total knee arthroplasty. Ital J Orthop Traumatol 1991;17:65-71.
• Scott RD, Volatile TB. Twelve years’ experience with posterior cruciate-retaining total knee arthroplasty. Clin Orthop Relat Res 1986;205:100-7.
• Freeman MA, Railton GT. Should the posterior cruciate ligament be retained or resected in condylar nonmeniscal knee arthroplasty? The case for resection. J Arthroplasty 1988;3 Suppl:3-12.
• Lombardi AV Jr1, Berend KR. Posterior cruciate ligament-retaining, posterior stabilized, and varus/valgus posterior stabilized constrained articulations in total knee arthroplasty. Instr Course Lect 2006;55:419-27.
• Cates HE, Komistek RD, Mahfouz MR, Schmidt MA, Anderle M. In vivo comparison of knee kinematics for subjects having either a posterior stabilized or cruciate retaining high-flexion total knee arthroplasty. J Arthroplasty 2008;23:1057-67.
• Sasaki H, Kubo S, Matsumoto T, Muratsu H, Matsushita T, Ishida K, ET AL. The influence of patella height on intra-operative soft tissue balance in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012;20:2191-6.
• Chandran N, Amirouche F, Gonzalez MH, Hilton KM, Barmada R, Goldstein W. Optimisation of the posterior stabilised tibial post for greater femoral rollback after total knee arthroplasty--a finite element analysis. Int Orthop 2009;33:687-93.
• Conditt MA, Noble PC, Bertolusso R, Woody J, Parsley BS. The PCL significantly affects the functional outcome of total knee arthroplasty. J Arthroplasty 2004;19(7 Suppl 2):107-12.
• Dennis DA, Komistek RD, Stiehl JB, Walker SA, Dennis KN. Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions. J Arthroplasty 1998;13:748-52.
• Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res 2003;416:37-57.
• Komistek RD, Dennis DA, Mahfouz M. In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res 2003;410:69-81.
• Mahfouz MR, Komistek RD, Dennis DA, Hoff WA. In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 2004;86-A Suppl 2:56-61.
• Seon JK, Park JK, Jeong MS, Jung WB, Park KS, Yoon TR, et al. Correlation between preoperative and postoperative knee kinematics in total knee arthroplasty using cruciate retaining designs. Int Orthop 2011;35:515-20.
• Chaudhary R, Beaupré LA, Johnston DW. Knee range of motion during the first two years after use of posterior cruciate-stabilizing or posterior cruciate-retaining total knee prostheses. A randomized clinical trial. J Bone Joint Surg Am 2008;90:2579-86.
• Kim YH, Choi Y, Kwon OR, Kim JS. Functional outcome and range of motion of high-flexion posterior cruciateretaining and high-flexion posterior cruciate-substituting total knee prostheses. A prospective, randomized study. J Bone Joint Surg Am 2009;91:753-60.
• Misra AN, Hussain MR, Fiddian NJ, Newton G. The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 2003;85:389-92.
• Carvalho Jr LH, Soares LFM, Gonçalves MBJ, Costa LL, Costa LP, Lessa RR. Femoral roll back in total knee arthroplasty: comparison between prostheses that preserve and sacrifice the posterior cruciate ligament. Rev Bras Ortop 2011;46:417-9.
• Victor J, Banks S, Bellemans J. Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg Br 2005;87:646-55.
• Seon JK, Park JK, Shin YJ, Seo HY, Lee KB, Song EK. Comparisons of kinematics and range of motion in highflexion total knee arthroplasty: cruciate retaining vs. substituting designs. Comparisons of kinematics and range of motion in high-flexion total knee arthroplasty: cruciate retaining vs. substituting designs. Knee Surg Sports Traumatol Arthrosc 2011;19:2016-22.