| Objective: To observe the sectional anatomical changes of the knee in southern China and to find out the matching degree between knee and different knee prosthesis;to observe the clinical outcome of two kinds of knee prosthesis after total knee arthroplasty.Methods: 1.Analysis of the matching degree between sectional anatomical measurement and prosthesis of the knee.From February 2017 to February 2018,170 cases of knee joint CT scan were performed in the first affiliated Hospital of University of South China.Among them,124 cases were diagnosed as degenerative knee,including 48 males and 76 females,aged 59.4 ±3.2 years old.There were46 patients(21 males and 25 females,aged 34.2 ±10.9 years old)without degeneration of the knee.The patient’s knee CT scan data was imported into the three-dimensional reconstruction work platform(Carestream Image Suite,USA)to be three-dimensionally reconstructed and the TKA intraoperative osteotomy was simulated to measure the dimensions of mediolateral(ML)and anteroposterior(AP)of the proximal tibia and thedistal femur.The data of each group with different genders and with or without degenerative knee were statistically analyzed,then the measurement results and 7 kinds of knee prostheses that were commonly used clinically was compared,the prosthesis coverage rate was calculated using the 5mm tolerance range method.2.Clinical outcome analysis of two kinds of prosthesis after total knee arthroplasty.A retrospective study of 52 patients with a first-time unilateral or non-synchronous bilateral TKA from June 2016 to June 2017 were divided into two groups according to the type of prosthesis.Twenty-three of these patients were treated with Attune(Depuy Synthes,USA)knee prostheses and 29 cases of Sigma PFC(Depuy Synthes,USA)knee prostheses.The data of operation time,size of prosthesis,femoral rotation,incidence of patellar crepitus and anterior knee pain,knee range of motion,VAS score,KSS function and clinical score were collected.The data were statistically analyzed by SPSS 22.0 software.Results: 1.Analysis of the matching degree between sectional anatomical measurement and prosthesis of the knee.(1)In the patients with degenerative knee in the south of China,the male fML and fAP of the distal femur osteotomy were 74.6±3.0mm and59.6±3.7mm respectively,and the female fML and fAP were 65.8±3.6mm and 54.7±3.9mm,respectively.The t ML and tAP of the proximal tibia ofthe male knee were 74.1±2.7 mm and 50.6±2.9 mm,respectively,and the female t ML and t AP were 65.9±3.0 mm and 44.6±2.8 mm,respectively.In patients without degenerative knee disease,the male fML and fAP of the distal femur osteotomy were 76.0±2.9 mm and 60.5±3.5 mm,respectively.The female fML and fAP were 67.8±2.7 mm and 55.2±3.3mm,respectively.The male tML and t AP of the proximal tibial osteotomy were 74.9±2.6 mm and 52.0±5.2 mm,respectively.The female t ML and tAP were 66.9±2.9 mm and 45.7±2.6 mm,respectively.In the osteotomy of knee,the male was larger than the female,and there was significant difference between the two groups(P < 0.05).Compared with patients without degenerative changes only in female fML there was a statistical difference between the two groups(P<0.05),there was no statistically significant difference in the other line data(P>0.05).With the increase of AP,the ratio of ML/AP decreased gradually,and the distribution of ML/AP ratio in males was larger than that in females with the same AP.(2)Comparing the datas of patients with degenerative knee joints with the sizes of 7 different prostheses,the results showed that the coverage rates of the prostheses at the tibial was better than that of the femoral,the coverage of the 7 kinds of prostheses(Attune,Sigma,Scorpio,NexGen,Duracon,Uknee,Icon A3)in the tibial prosthesis were82.3%,71.8%,72.2%,67.7 %,63.8%,79.1%,and 66.1% respectively;the femur prosthesis coverage rates were 27.4%,15.3%,16.1%,21.8%,40.3%,29.0%,and 22.5%,respectively.2.Clinical outcome analysis of two kinds of prosthesis after total knee arthroplasty.52 patients were followed up with an average of 10.5 ±4.1 months.There were no loosening of prosthesis and infection complications.The KSS score and VAS score of the two groups were significantly improved compared with those before operation.There was no significant difference in the operation time between the two groups(P > 0.05).The ML and AP of the prosthesis in the Attune group were larger than those in the Sigma group(P <0.05).There was no significant difference in PCA between the two groups before operation(P > 0.05).The postoperative femoral rotation angle was examined and Attune group had external rotation of 1.26±0.43° and Sigma group had1.57±0.54°.There was no significant difference between the two groups(P>0.05).There was no significant difference in postoperative VAS score and KSS score between the two groups(P>0.05).There was no significant difference between the two groups in anterior knee pain and patellar crepitus after surgery(P>0.05).There was no significant difference between the two groups in the flexion and extension of knee before surgery(P>0.05).In the Attune group,the knee flexion was better than the Sigma group after surgery(P<0.05).There was no significant difference in the degree of knee extension after surgery(P>0.05).Conclusions:1.The bone morphology of the knees in the South China population has its own characteristics.Seven kinds of knee prostheses are relatively satisfactory at the tibial end,but the matching of the femoral ends is relatively low and there is still room for improvement.The dimensions of future knee prostheses should be designed to take into account differences in ethnicity and gender in order to achieve a satisfactory match.2.Two kinds of knee prostheses all have good short-term outcome on functional rehabilitation of patients after surgery and the long-term outcome still needs to be further followed up. |
