| Objective:To explore the correlation between blackburne-peel ratio(BPR)and modified insall-salvati ratio(mISR)and clinical prognosis after total knee arthroplasty(TKA).Methods:Prospectively collected in September 2017 to August 2018 on the west coast of the affiliated hospital of Qingdao university joint surgery in patients with primary total knee replacement of knee osteoarthritis,a total of 252 patients,statistics and analysis of the basic information(Include: Age,Sex and BMI),preoperative and postoperative knee range of motion(ROM)and mISR,BPR,joint line height and posterior tibial slope(PTS)inclination measured on knee x-rays,and WOMAC,FJS-12 scores at 1 year follow-up.Data measurement and statistical analysis were conducted by professionals who were not involved in the diagnosis and treatment of patients.The data were analyzed by SPSS 24.0statistical software.The measurement data was descriptioned by mean ± standard deviation,and independent sample t test was used.The measurement data with non-normal distribution were described by median(quartile spacing),and tested by mann-whitney U symbol rank-sum test.?2 test was used for counting data.If the theoretical frequency<1,the Fisher exact probability method is used for statistical analysis.Subsequently,variables with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to determine independent predictors.P<0.05(double tail)was considered as a statistically significant difference.Results:Of the 252 patients who met the inclusion criteria,225 eventually completed the follow-up study.The total ROM and extension of the patient were improved compared with the preoperative one(preoperative total ROM was 108°,postoperative 111° and extension was-5° before surgery,0° after surgery),and the difference was statistically significant(P<0.05),while the improvement of flexion was not significant(114° before surgery and 113° after surgery),and the difference was not statistically significant(P>0.05).The mean values of mISR(1.5)and BPR(0.8)both decreased(1.4 and 0.6)in the 1-year follow-up after the operation compared with those before the operation,and the mean joint line increased by about 2mm after the operation.The differences were statistically significant(P<0.05).During 1-year follow-up,BPR was correlated with flexion(P<0.001).Since BPR is a compound variable including patella height,joint line height and PTS,we conducted multiple regression analysis on it,and found that patella height and postoperative PTS are independent predictors of postoperative BPR(P<0.001),but joint line height is not.But when we used the equivalent regression formula to analyze the mISR,we found that only the preoperative mISR was correlated with the postoperative mISR(P<0.001).The mean score of FJS-12 and WOMAC was 78.4 points and 15.6 points at the 1-year follow-up.Multiple regression analysis showed that BPR was a positive independent predictor for FJS-12 1 year after surgery(P=0.015),while m ISR was not significant.WOMAC score was only correlated with patient age,and we found that patient age was also correlated with FJS-12 score(P<0.001).Conclusion:BPR can significantly predict the clinical prognosis of patients with primary TKA,while mISR was not.Continuous variables(BPR and mISR)were indeed better than dichotomous variables(whether patients had PB or PPB)to describe their clinical outcomes.Postoperative BPR values fell,the clinical outcomes in patients with often worse.Its clinical significance is to remind us that orthopedic surgeons should carry out personalized osteotomy design according to the preoperative measured BPR value in their daily work.During the operation,we should try our best to avoid the operation which may lead to the decrease of BPR(for example,too few tibial osteotomies,too many distal femoral osteotomies,and too much lateral collateral ligament release,etc.),as this may lead to poor clinical prognosis and reduce postoperative knee movement of patients. |
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