| Background: The joint cavity of hemophiliacs is prone to repeated bleeding,and the deposition of blood will lead to synovial hyperplasia,angiogenesis,hose destruction and other pathological changes in the joint cavity.The joint cavity of the body large joint is the most obvious target joint affected by the change,among which the lesion of the motile and weight-bearing large joint is the serious,such as the hip,knee,shoulder,ankle,and the knee joint is the most serious.For hemophilia patients who are difficult to maintain coagulation factor replacement therapy,the knee joint during development is in this pathological environment for a long time,which will lead to abnormal development of epiphyseal growth plate.Therefore,the local anatomical morphology of the mature knee joint generates change under this pathological environment,and the end-stage hemophilia arthritis(HA)accompanied by this anatomical change,whether it can place the prosthesis according to the reference standard of osteoarthritis(OA)has not been reported.Therefore,this study makes a morphological analysis of the knee prosthesis placement surface of HA patients with anatomical changes,to identify the morphological characteristics of the prosthesis placement surface of HA patients,and to verify the accuracy of the reference marks of commonly used prosthesis rotation alignment axis on the prosthesis installation plane of HA patients,and then to determine the best position of the prosthesis rotation alignment axis of HA patients.Methods: 40 patients with end-stage HA and OA who underwent total knee arthroplasty(TKA)in our hospital were selected,and their preoperative imaging data of lower limbs were obtained.The bone model was reconstructed by Mimics 21.0 software,and the three-dimensional solid bone model was imported into 3-Matics software to simulate the osteotomy in the process of knee arthroplasty.According to the 2mm cartilage thickness,under the 8mm lateral plateau was selected as the simulative installation plane of tibial prosthesis.The fitting ellipse of the largest profile and the fitting circle of the medial and lateral platform were established on the plane,and the center of the fitting ellipse was used as the posterior edge point of the alignment axis of the prosthesis.The 1/3 medial patellar tendon(1/3MPT)and the 1/3 medial tibial tubercle(1/3MTT)were selected as the anterior points of the rotation axis,and the 1/3MPT axis and 1/3MTT axis were established as the rotation alignment axis of the prosthesis.The angle between the 1/3MPT axis and the 0 °AP axis,the patellar tendon length(patellar tendon length,PTL),the width of the 1/3MPT axis through the medial patellar tendon(M1),and the medial percentage length(M1/PTL × 100%)were measured.The angle between 1/3MTT axis and 0 °AP axis,tibial tubercle length(TTL),1/3MTT axis through medial width of tibial tubercle(M2),percentage of medial length(M2/TTL×100%);medial platform anteroposterior diameter,lateral platform anteroposterior diameter on the osteotomy surface(MPAP,LPAP),geometric transverse length on osteotomy surface(GTL),the anteroposterior length of the osteotomy surface(APL),and calculate the ratio of APL/GTL.Result: For the morphology of osteotomy surface,MPAP,LPAP,APL,PTL,M1 and M2 of HA group were significantly lower than those of OA group,and there was significant difference between the two groups(p>0.05),but there was no significant difference for GTL and TTL,and TTL in HA group was higher than that in OA group.In the aspect of rotation alignment,both the 1/3MPT and 1/3MTT axes showed an obvious external rotation tendency,and there was a significant statistical difference between the two groups(p>0.05).The tendency of external rotation of 1/3MPT axis and 1/3MTT axis in HA group was more obvious than that in OA group.In terms of ratio,there were significant differences in APL/GTL,M1/PTL and M2/TTL between HA group and OA group,and the ratio of OA group was higher than that of HA group.In terms of rotation mismatch,the M1/PTL and M2/TTL in OA group were higher than those in HA group,and were closer to the medial edge of patellar tendon than 0 °AP axis in OA group.Conclusion: The overall development of the tibial platform of the knee joint in patients with HA is relatively smaller,and the morphological changes are mainly characterized by the shortening of the anteroposterior diameter.The morphological changes led to a change about the position of rotation alignment axis of the HA knee prosthesis.In patients with HA,the rotation alignment axis of the tibial prosthesis was 9.26 °to the medial edge of the patellar tendon(lateral 3.67 mm from the medial edge)to the medial edge of the patellar tendon or 13.02 °to the medial edge of the tibial tubercle(lateral 3.07 mm from medial edge).These two points are within 1/7 to 1/6 range and close to 1/7 point of the medial patellar tendon or within 1/9 to 1/8 and close to 1/8 point of the medial tibial tuberosity,respectively. |
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