人工膝関節置換術における異なる2形状の膝蓋骨コンポーネントに関する検討

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  • Comparison of Radiological Assessments and Clinical Outcome for Two Different Types of Patellar Component in Total Knee Arthroplasty
  • ジンコウ シツカンセツ チカンジュツ ニ オケル コトナル 2 ケイジョウ ノ シツガイコツ コンポーネント ニ カンスル ケントウ

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<p>Objective: The influence of the shape of the patellar component is still unknown in total knee arthroplasty (TKA). The purpose of this study was a comparative investigation of radiological assessments and clinical outcome in two different types of patellar component.</p><p>Methods: Thirty cases of primary TKA with varus knee osteoarthritis were enrolled in this study. We used the Attune knee system (DePuy Synthes Inc) ; in 15 knees we used a dome-type patellar component (D-type), whereas in the other 15 knees we used an anatomical-type (A-type). Examination items were as follows: 1) Pre- and postoperative patellar tilting angle by lateral and axial views of knee joint plain radiographs. The tilting angle of lateral view was defined as between the cutting surface of the patella and the anterior cortex of the femoral distal portion. 2) Postoperative Japanese Orthopaedic Association (JOA) score. 3) The presence of anterior knee pain. Statistical analysis was performed using the paired t-test, with a level of significance defined with a P value of<0.05.</p><p>Results: The mean preoperative tilting angle in the lateral view of light flexion was 28° (D-type) and 30° (A-type), respectively. The mean postoperative angle was 41° (D-type) and 39° (A-type), respectively. The mean preoperative tilting angle of the axial view was 3° (D-type) and 4° (A-type), respectively. The mean postoperative angle was 1° (D-type) and 1° (A-type), respectively. The mean postoparative JOA score was 84 (D-type) and 86 (A-type), respectively. No cases developed anterior knee pain.</p><p>Conclusion: The D-type component is designed with a central convexity. The lateral tilting angle tended to strongly tilt posteriorly compared to physiological patella positioning with this design. The A-type component had adequate thickness of its superior and inferior poles and medial and lateral sides. It had an adequate contact area to the femoral component. Therefore, we predicted that the A-type comes close to physiological patellar tilting. However, from the results of this study, there was no significant statistical difference. There was no difference in the postoperative outcome of both component types.</p>

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