研究关键词total knee arthroplasty・kinematic alignment・knee arthroplasty outcomes・femoral head-neck morphology・orthopedic surgery
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近期论文 / 著作
Achieving a neutral hip-to-calcaneus axis in kinematically aligned total knee arthroplasty equalizes coronal hindfoot pressure balance at initial ground contact in the gait cycle.2019 · AIMS: Evaluating plantar pressure distribution and coronal lower limb alignment, including the hindfoot, using the hip-to-calcaneus axis, known as the ground mechanical axis (GA), is valuable in total knee arthroplasty (TKA). This study aimed to compare postoperative changes in plantar pressure distribution and lower limb alignment between mechanically aligned TKA (MA-TKA) and ground kinematically aligned TKA (gKA-TKA), targeting neutral GA. METHODS: After 1:1 propensity score matching, 35 pairs of patients with end-stage osteoarthritis of the knee, who underwent gKA-TKA and MA-TKA with similar preoperative disability between September 2019 and March 2022, were compared. Plantar pressure distribution during walking and unipedal stance was measured preoperatively and one year postoperatively using a pressure plate. The hip-knee-calcaneus angle (HKC) (positive values = valgus) and the percentage of the GA passing position at the knee joint (%GA; medial edge, 0%; lateral edge, 100%) were assessed on long-leg radiographs in unipedal stance. RESULTS: MA-TKA showed a medial loading pattern in the hindfoot. gKA-TKA exhibited a nearly equal pressure distribution in the coronal plane of the hindfoot. Postoperative centre-of-pressure path length during unipedal stance was significantly better for gKA-TKA than MA-TKA (p = 0.043). Furthermore, mean HKC angle and mean %GA of the MA-TKA were 2.0° (SD 2.4°) and 54.2% (SD 9.0%), respectively; those of the gKA-TKA were -0.2° (SD 1.0°) and 49.6% (SD 5.0%), respectively. Significant correlations were observed between the HKC angle (r = 0.391 (95% CI 0.172 to 0.573)) or %GA (r = 0.343 (95% CI 0.117 to 0.535)) and the hindfoot plantar pressure pattern in the coronal plane, indicating that postoperative lower limb valgus deformity in the hip-to-calcaneus axis results in a medial loading pattern. CONCLUSION: gKA-TKA can provide more neutral weightbearing in the GA, more equal coronal hindfoot pressure during walking, and improved stability in unipedal stance compared with MA-TKA.
Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt.2018 · This study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA). We retrospectively analyzed 115 patients who underwent robot-assisted THA between August 2018 and November 2019. Acetabular cup alignment and three-dimensional (3D) position were measured using pre- or postoperative computed tomography (CT) data. Absolute differences in cup inclination, anteversion, and 3D position were assessed, and their relation to preoperative factors was evaluated. The average measurement of the absolute differences was 1.8° ± 2.0° (inclination) and 1.9° ± 2.3° (anteversion). The average absolute difference in the 3D cup position was 1.1 ± 1.2 mm (coronal plane) and 0.9 ± 1.0 mm (axial plane). Multivariate analysis revealed that a posterior pelvic tilt [odds ratio (OR, 1.1; 95% confidence interval (CI), 1.00-1.23] and anterior surgical approach (OR, 5.1; 95% CI, 1.69-15.38) were predictive factors for inaccurate cup positioning with robot-assisted THA. This is the first study to demonstrate the predictive risk factors (posterior pelvic tilt and anterior surgical approach) for inaccurate cup position in robot-assisted THA.
Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip : a case control study.2018 · AIMS: This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS: The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured. RESULTS: The mean values of absolute differences (postoperative CT-preoperative plan) were 1.7° (standard deviation (SD) 2.0) (inclination) and 2.5° (SD 2.1°) (anteversion) in DDH patients, and no significant differences were found between non-DDH and DDH patients. The mean absolute differences for 3D cup position were 1.1 mm (SD 1.0) (coronal plane) and 1.2 mm (SD 2.1) (axial plane) in DDH patients, and no significant differences were found between two groups. No significant difference was found either in cup alignment between postoperative CT and navigation record after cup screws or in the severity of DDH. Excellent restoration of leg length and combined offset were achieved in both groups. CONCLUSION: We demonstrated that robotic-assisted THA may achieve precise cup positioning in DDH patients, and may be useful in those with severe DDH. Cite this article: Bone Joint Res 2021;10(10):629-638.
