No Difference in 10-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A Randomized Trial

医学 随机对照试验 骨关节炎 射线照相术 冠状面 生存曲线 沃马克 运动学 物理疗法 口腔正畸科 外科 放射科 内科学 癌症 物理 替代医学 病理 经典力学
作者
John Gibbons,Nina Zeng,Ali Bayan,Matthew L. Walker,Bill Farrington,Simon W. Young
出处
期刊:Clinical Orthopaedics and Related Research [Lippincott Williams & Wilkins]
被引量:4
标识
DOI:10.1097/corr.0000000000003193
摘要

Background There is continuing debate about the ideal philosophy for component alignment in TKA. However, there are limited long-term functional and radiographic data on randomized comparisons of kinematic alignment versus mechanical alignment. Questions/purposes We present the 10-year follow-up findings of a single-center, multisurgeon randomized controlled trial (RCT) comparing these two alignment philosophies in terms of the following questions: (1) Is there a difference in PROM scores? (2) Is there a difference in survivorship free from revision or reoperation for any cause? (3) Is there a difference in survivorship free from radiographic loosening? Methods Ninety-nine patients undergoing primary TKA for osteoarthritis were randomized to either the mechanical alignment (n = 50) or kinematic alignment (n = 49) group. Eligibility for the study was patients undergoing unilateral TKA for osteoarthritis who were suitable for a cruciate-retaining TKA and could undergo MRI. Patients who had previous osteotomy, coronal alignment > 15° from neutral, a fixed flexion deformity > 15°, or instability whereby constrained components were being considered were excluded. Computer navigation was used in the mechanical alignment group, and patient-specific cutting blocks were used in the kinematic alignment group. At 10 years, 86% (43) of the patients in the mechanical alignment group and 80% (39) in the kinematic alignment group were available for follow-up performed as a per-protocol analysis. The PROMs that we assessed included the Knee Society Score, Oxford Knee Score, WOMAC, Forgotten Joint Score, and EuroQol 5-Dimension score. Kaplan-Meier analysis was used to assess survivorship free from reoperation (any reason) and revision (change or addition of any component). A single blinded observer assessed radiographs for signs of aseptic loosening (as defined by the presence of progressive radiolucent lines in two or more zones), which was reported as survivorship free from loosening. Results At 10 years, there was no difference in any PROM score measured between the groups. Ten-year survivorship free from revision (components removed or added) likewise did not differ between the groups (96% [95% CI 91% to 99%] for the mechanical alignment group and 91% [95% CI 83% to 99%] for the kinematic alignment group; p = 0.38). There were two revisions in the mechanical alignment group (periprosthetic fracture, deep infection) and four in the kinematic alignment group (two secondary patella resurfacings, two deep infections). There was no statistically significant difference in reoperations for any cause between the two groups. There was no difference with regard to survivorship free from loosening on radiographic review (χ 2 = 1.3; p = 0.52) (progressive radiolucent lines seen at 10 years were 0% for mechanical alignment and 3% for kinematic alignment). Conclusion Like the 2-year and 5-year outcomes previously reported, 10-year follow-up for this RCT demonstrated no functional or radiographic difference in outcomes between mechanical alignment and kinematic alignment TKA. Anticipated functional benefits of kinematic alignment were not demonstrated, and revision-free survivorship at 10 years did not differ between the two groups. Given the unknown long-term impact of kinematic alignment with regard to implant position (especially tibial component varus), we must conclude that mechanical alignment remains the reference standard for TKA. We could not demonstrate any advantage to kinematic alignment at 10-year follow-up. Level of Evidence Level I, therapeutic study.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
Adel完成签到 ,获得积分10
刚刚
刚刚
2秒前
wss123456发布了新的文献求助10
2秒前
3秒前
4秒前
大个应助泡泡糖采纳,获得10
5秒前
思源应助DY采纳,获得10
5秒前
Rita发布了新的文献求助10
6秒前
猪猪hero应助麻辣烫小姐采纳,获得10
6秒前
蓝色的梦发布了新的文献求助10
6秒前
7秒前
wbj0722完成签到,获得积分10
7秒前
shinn发布了新的文献求助30
7秒前
量子星尘发布了新的文献求助10
8秒前
fivezcy发布了新的文献求助10
9秒前
萧水白应助liberty采纳,获得10
11秒前
12秒前
pipi发布了新的文献求助10
13秒前
14秒前
zhouz发布了新的文献求助10
15秒前
15秒前
小北完成签到,获得积分10
17秒前
17秒前
独特冰安发布了新的文献求助10
17秒前
一杯沧海完成签到 ,获得积分10
17秒前
19秒前
李健应助寡核苷酸小白采纳,获得10
19秒前
慕青应助shinn采纳,获得10
20秒前
LuckyJ_Jia发布了新的文献求助10
20秒前
20秒前
Ashley完成签到,获得积分10
20秒前
YifanWang应助wss123456采纳,获得20
21秒前
YifanWang应助wss123456采纳,获得20
21秒前
七堇发布了新的文献求助10
21秒前
23秒前
24秒前
刘子发布了新的文献求助10
24秒前
含蓄的金鱼完成签到,获得积分10
24秒前
所所应助直率谷蕊采纳,获得10
24秒前
高分求助中
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
Effective Learning and Mental Wellbeing 300
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3975339
求助须知:如何正确求助?哪些是违规求助? 3519670
关于积分的说明 11199199
捐赠科研通 3256002
什么是DOI,文献DOI怎么找? 1798043
邀请新用户注册赠送积分活动 877386
科研通“疑难数据库(出版商)”最低求助积分说明 806305