Application of a new extramedullary reference technique with pre-osteotomy of anterior femoral condyle in total knee arthroplasty

doi:10.3877/cma.j.issn.1674-0785.2024.09.003

Abstract

Abstract:

Objective

To investigate the feasibility and safety of extramedullary reference with anterior femoral condyle pre-osteotomy technique in total knee arthroplasty （TKA）.

Methods

A total of 160 patients with advanced knee osteoarthritis （OA） who underwent primary TKA at Suqian Third Hospital from January 2022 to December 2022 were randomly divided into two groups： A and B. In group A， a new extramedullary reference technique was adopted while in group B， standard intramedullary femoral instruments were used. Excluding cases with a follow-up duration less than 12 months， there were 68 cases in group A and 67 cases in group B. Gender， age， body mass index （BMI）， affected side， preoperative Visual Analogue Scale （VAS） score， preoperative range of motion （ROM）， preoperative Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）， and preoperative Oxford Knee Score （OKS） were evaluated in the two groups. Operation time， postoperative drainage volume， incidence of notching of anterior femoral cortex， postoperative hip-knee-ankle （HKA）， tibiofemoral angle （TFA）， femoral flexion angle （FFA），posterior tibial slope （PTS）， and proximal tibia medial angle （MPTA）， and postoperative complication rate were compared between the two groups， and VAS score， knee ROM， and WOMAC and OKS at 1， 6， and 12 months after operation were analyzed.

Results

There were no significant differences in gender， age， BMI，sides， preoperative VAS score， preoperative ROM， and preoperative WOMAC and OKS between the two groups （P＞0.05）. The incidence of anterior femoral cortex notching in group A （5.9%） was significantly lower than that of group B （17.9%； P＜0.05）. The postoperative drainage volume of group A ［（248.9±49.8） ml］was significantly less than that of group B ［（378.9±43.7） ml； P＜0.05］. There were no significant differences in operation time， postoperative complication rate， HKA， TFA， FFA， PTS， and MPTA between the two groups （P＞0.05）. The VAS score， ROM， WOMAC， and OKS in group A were significantly better than those of group B at 1 month after operation （P＜0.05）. However， no significant differences were found between the two groups at 6 and 12 months of follow-up （P＞0.05）.

Conclusion

The new extramedullary reference technique with pre-osteotomy of anterior femoral condyle in TKA is safe and effective. Compared with the intramedullary alignment system， the new technique not only reduces postoperative drainage volume and the incidence of nothing of anterior femoral cortex， but it is also associated with more pain relief and better joint function and ROM within 1 month after operation.

Key words: Replacement, Arthroplasty, Femur, Extramedullary reference

Songlei Wang, Yiliang Zhang, Hao Meng, Wei Song, Linchen Bai, Xin Yuan, Hui Zhang. Application of a new extramedullary reference technique with pre-osteotomy of anterior femoral condyle in total knee arthroplasty[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(09): 811-819.

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Figures/Tables 5

临床特征	A组	B组	t/χ²值	P值
性别［例（%）］			0.20	1.00
男性	19（27.9）	18（26.9）
女性	49（72.1）	49（73.1）
年龄（岁， $\overset{ˉ}{x}$ ±s）	64.0±6.7	64.0±6.1	0.18	1.00
左/右	37/31	37/30	0.01	1.00
BMI（ $\overset{ˉ}{x}$ ±s）	23.6±3.2	23.4±3.4	0.28	0.78
VAS（ $\overset{ˉ}{x}$ ±s）	7.5±2.1	8.1±3.2	0.30	0.46
活动度（ $\overset{ˉ}{x}$ ±s）°	94.7±6.5	91.6±5.8	0.32	0.84
WOMAC（ $\overset{ˉ}{x}$ ±s）	129.4±5.4	130.4±6.5	0.29	0.79
OKS（ $\overset{ˉ}{x}$ ±s）	50.5±3.4	48.4±4.6	0.48	0.65

临床特征	A组	B组	t/χ²值	P值
性别［例（%）］			0.20	1.00
男性	19（27.9）	18（26.9）
女性	49（72.1）	49（73.1）
年龄（岁， $\overset{ˉ}{x}$ ±s）	64.0±6.7	64.0±6.1	0.18	1.00
左/右	37/31	37/30	0.01	1.00
BMI（ $\overset{ˉ}{x}$ ±s）	23.6±3.2	23.4±3.4	0.28	0.78
VAS（ $\overset{ˉ}{x}$ ±s）	7.5±2.1	8.1±3.2	0.30	0.46
活动度（ $\overset{ˉ}{x}$ ±s）°	94.7±6.5	91.6±5.8	0.32	0.84
WOMAC（ $\overset{ˉ}{x}$ ±s）	129.4±5.4	130.4±6.5	0.29	0.79
OKS（ $\overset{ˉ}{x}$ ±s）	50.5±3.4	48.4±4.6	0.48	0.65

临床特征	A组（n=68）	B组（n=67）	P值
手术时间（min， $\overset{ˉ}{x}$ ±s）	77.3±11.1	74.0±10.3	0.65
术后引流量（ml， $\overset{ˉ}{x}$ ±s）	248.9±49.8	378.9±43.7	＜0.01
术后并发症［例（%）］	2（2.9）	3（4.5）	0.68
术后1月（ $\overset{ˉ}{x}$ ±s）
膝关节活动度（度）	98.5±4.5	90.6±3.6	0.03
WOMAC评分（分）	75.2±7.3	84.6±5.9	0.02
VAS评分	3.1±1.2	5.6±2.3	0.04
OKS评分	35.3±3.2	40.4±3.4	0.04
术后6个月（ $\overset{ˉ}{x}$ ±s）
膝关节活动度（度）	105.3±5.2	104.4±3.5	0.57
WOMAC评分（分）	34.2±2.3	35.1±3.3	0.41
VAS评分	2.3±1.7	2.8±2.2	0.46
OKS评分	25.7±2.1	26.4±3.0	0.58
术后12个月（ $\overset{ˉ}{x}$ ±s）
膝关节活动度（度）	110.3±4.2	109.3±5.1	0.32
WOMAC评分（分）	15.2±1.4	17.1±2.1	0.39
VAS评分	1.4±1.1	1.5±0.9	0.64
OKS评分	18.4±1.9	16.9±4.3	0.76

临床特征	A组（n=68）	B组（n=67）	P值
手术时间（min， $\overset{ˉ}{x}$ ±s）	77.3±11.1	74.0±10.3	0.65
术后引流量（ml， $\overset{ˉ}{x}$ ±s）	248.9±49.8	378.9±43.7	＜0.01
术后并发症［例（%）］	2（2.9）	3（4.5）	0.68
术后1月（ $\overset{ˉ}{x}$ ±s）
膝关节活动度（度）	98.5±4.5	90.6±3.6	0.03
WOMAC评分（分）	75.2±7.3	84.6±5.9	0.02
VAS评分	3.1±1.2	5.6±2.3	0.04
OKS评分	35.3±3.2	40.4±3.4	0.04
术后6个月（ $\overset{ˉ}{x}$ ±s）
膝关节活动度（度）	105.3±5.2	104.4±3.5	0.57
WOMAC评分（分）	34.2±2.3	35.1±3.3	0.41
VAS评分	2.3±1.7	2.8±2.2	0.46
OKS评分	25.7±2.1	26.4±3.0	0.58
术后12个月（ $\overset{ˉ}{x}$ ±s）
膝关节活动度（度）	110.3±4.2	109.3±5.1	0.32
WOMAC评分（分）	15.2±1.4	17.1±2.1	0.39
VAS评分	1.4±1.1	1.5±0.9	0.64
OKS评分	18.4±1.9	16.9±4.3	0.76

组别	A组	B组	P值
HKA（°）	0.3±1.9	0.2±2.0	0.92
TFA（°）	4.2±1.6	4.4±1.8	0.58
MPTA（°）	87.5±2.0	87.1±1.44	0.23
FFA（°）	0.9±1.8	1.3±1.6	0.23
PTS（°）	3.4±2.0	3.9±2.3	0.27
皮质过度切割［例（%）］	4（5.9）	12（17.9）	0.04

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