Гиперкоррекция оси нижней конечности как исход одномыщелкового эндопротезирования коленного сустава

Введение. Одномыщелковое эндопротезирование коленного сустава (ОЭКС) является эффективным хирургическим вмешательством, применяемым у пациентов с гонартрозом, когда преимущественно поражён один из отделов коленного сустава. Одним из факторов неблагоприятного исхода частичной артропластики может быть недостаточная или избыточная коррекция оси нижней конечности.

Цель работы — оценить возможные пути профилактики недостаточной или избыточной коррекции оси нижней конечности в ходе ОЭКС и продемонстрировать на клиническом примере варианты предотвращения и решения данной хирургической проблемы.

Материалы и методы. В клинику НМИЦ ТО им. Р.Р. Вредена поступила пациентка с жалобами на вальгусную деформацию на уровне коленного сустава, болезненность в области коленного сустава, невозможность ходьбы без опоры. Три года назад больной выполнено одномыщелковое эндопротезирование коленного сустава. На рентгенограммах обращали на себя внимание экономные резекции бедренной и большеберцовой костей, рабочая поверхность модуля полиэтиленового вкладыша / большеберцового компонента эндопротеза находилась на 5 мм проксимальнее суставной поверхности латерального мыщелка большеберцовой кости.

Результаты и обсуждение. В ходе ревизионной артропластики ось конечности скорректирована на 6°. Через год после ревизионного вмешательства пациентка ходит без хромоты, результат проведенной операции оценен как отличный (45 баллов по шкале OKS). Авторами проанализированы возможные предпосылки для развития рассматриваемого осложнения и пути по его профилактике. Рассматриваются преимущественно ятрогенные причины, связанные непосредственно с хирургической техникой.

Заключение. Некорректное механическое выравнивание в ходе ОЭКС имеет гетерогенную природу и может быть обусловлено как недостаточным планированием операции, так и анатомическими особенностями пациента, а также техническими ошибками непосредственно в ходе вмешательства.

1. Lim JW, Cousins GR, Clift BA, et al. Oxford unicompartmental knee arthroplasty versus age and gender matched total knee arthroplasty - functional outcome and survivorship analysis. J Arthroplasty. 2014;29(9):1779-1783. doi: 10.1016/j.arth.2014.03.043.

2. SAR. Annual report 2022. The Swedish Arthroplasty Register. Swedish Arthroplasty Register; 2022. Available at: https://registercentrum.blob.core.windows.net/sar/r/SAR-Annual-Report-2022_EN-HkgQE89Nus.pdf. Accessed Oct 17, 2024.

3. Goodfellow JW, Tibrewal SB, Sherman KP, O'Connor JJ. Unicompartmental Oxford Meniscal knee arthroplasty. J Arthroplasty. 1987;2(1):1-9. doi: 10.1016/s0883-5403(87)80025-6.

4. Liu C, Ge J, Jiang Y, et al. Preoperative valgus-corrected hip-knee-ankle angle and medial meniscal extrusion are useful for evaluating postoperative alignment in mobile-bearing UKA. Heliyon. 2023;9(11):e22234. doi: 10.1016/j.heliyon.2023.e22234.

5. NJR. 13th Annual Report 2016. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. National Joint Registry; 2016. Available at: https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2013th%20Annual%20Report%202016.pdf. Accessed Oct 17, 2024.

6. Liddle AD, Pandit H, Judge A, Murray DW. Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J. 2015;97-B(6):793-801. doi: 10.1302/0301-620X.97B6.35155.

7. Plancher KD, Brite JE, Briggs KK, Petterson SC. Pre-Arthritic/Kinematic Alignment in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty Results in Return to Activity at Mean 10-Year Follow-up. J Bone Joint Surg Am. 2022;104(12):1081-1089. doi: 10.2106/JBJS.21.00801.

8. Micicoi L, Machado A, Ernat J, et al. Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2023;31(11):5171-5179. doi: 10.1007/s00167-023-07588-5.

9. Felson DT, Niu J, Gross KD, et al. Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum. 2013;65(2):355-362. doi: 10.1002/art.37726.

10. Kamenaga T, Hiranaka T, Hida Y, et al. Lateral osteoarthritis progression is associated with a postoperative residual tibiofemoral subluxation in Oxford UKA. Knee Surg Sports Traumatol Arthrosc. 2022;30(9):3236-3243. doi: 10.1007/s00167-021-06729-y.

11. NJR. 19th Annual Report 2022. National Joint Registry; 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK587525/pdf/Bookshelf_NBK587525.pdf. Accessed Oct 17, 2024.

12. AOANJRR. Hip, knee and shoulder arthroplasty: 2022 annual report. Australian Orthopaedic Association National Joint Replacement Registry; 2022. Available at: https://aoanjrr.sahmri.com/annual-reports-2022. Accessed Oct 17, 2024.

13. NAR. 2022 Annual Report. Norwegian Arthroplasty Register; 2022. Available at: https://helse-bergen.no/seksjon/Nasjonal_ kompetansetjeneste_leddproteser_hoftebrudd/Share%20point%20Documents/Rapport/Report%202022%20english.pdf. Accessed Oct 17, 2024.

14. Sun XW, Lu FF, Zou K, et al. Does new instrument for Oxford unicompartmental knee arthroplasty improve short-term clinical outcome and component alignment? A meta-analysis. J Orthop Surg Res. 2020;15(1):386. doi: 10.1186/s13018-020-01926-w.

15. Ma J, Yan Y, Wang W, et al. Lower early revision rates after uncemented Oxford Unicompartmental Knee Arthroplasty (UKA) than cemented Oxford UKA: A meta-analysis. Orthop Traumatol Surg Res. 2021;107(3):102802. doi: 10.1016/j.otsr.2021.102802.

16. Zhang P, Bai J, Wang J, et al. How to perform better on Oxford UKA? A technical note from over 500 surgical experiences. Orthop Surg. 2023;15(9):2445-2453. doi: 10.1111/os.13811.

17. Ahn JH, Kang HW, Yang TY, Lee JY. Risk factors of post-operative malalignment in fixed-bearing medial unicompartmental knee arthroplasty. Int Orthop. 2016;40(7):1455-63. doi: 10.1007/s00264-015-3014-1.

18. Kozinn SC, Scott R. Unicondylar knee arthroplasty. J Bone Joint Surg Am. 1989;71(1):145-150.

19. Kuroda Y, Takayama K, Ishida K, et al. Medial joint line elevation of the tibia measured during surgery has a significant correlation with the limb alignment changes following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3468-3473. doi: 10.1007/s00167-018-4935-1.

20. Корнилов Н.Н., Куляба Т.А., Федоров Р.Э. Современные представления об одномыщелковом эндопротезировании в структуре хирургических методов лечения больных гонартрозом (обзор литературы). Травматология и ортопедия России. 2012;18(1):113-120. doi: 10.21823/2311-2905-2012-0-1-138-144.

21. Murray DW, Parkinson RW. Usage of unicompartmental knee arthroplasty. Bone Joint J. 2018;100-B(4):432-435. doi: 10.1302/0301-620X.100B4.BJJ-2017-0716.R1.

22. Marullo M, Tandogan RN, Kort N, et al. Trends in unicompartmental knee arthroplasty among 138 international experienced arthroplasty knee surgeons. Heliyon. 2024;10(2):e24307. doi: 10.1016/j.heliyon.2024.e24307.

23. Liu C, Chen H, Ge J, et al. Predicting valgus malalignment after mobile-bearing UKA using a new method: the arithmetic HKA of the arthritic knee. Arch Orthop Trauma Surg. 2023;143(10):6381-6391. doi: 10.1007/s00402-023-04921-y.

24. Rivière C, Sivaloganathan S, Villet L, et al. Kinematic alignment of medial UKA is safe: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2022;30(3):1082-1094. doi: 10.1007/s00167-021-06462-6.

25. Ghazal AH, Fozo ZA, Matar SG, et al. Robotic versus conventional unicompartmental knee surgery: a comprehensive systematic review and meta-analysis. Cureus. 2023;15(10):e46681. doi: 10.7759/cureus.46681.

26. Xu K, Chen Q, Yan Q, et al. Comparison of computer-assisted navigated technology and conventional technology in unicompartmental knee arthroplasty: a meta-analysis. J Orthop Surg Res. 2022;17(1):123. doi: 10.1186/s13018-022-03013-8.

27. Park KK, Han CD, Yang IH, et al. Robot-assisted unicompartmental knee arthroplasty can reduce radiologic outliers compared to conventional techniques. PLoS One. 2019;14(12):e0225941. doi: 10.1371/journal.pone.0225941.

28. Филь А.С., Антипов А.П., Куляба Т.А., Корнилов Н.Н. Целесообразна ли частичная артропластика коленного сустава: мнения ортопедов крупного центра эндопротезирования. Травматология и ортопедия России. 2021;27(3):43-55. doi: 10.21823/23112905-2021-27-3-43-55.

29. Hamilton TW, Rizkalla JM, Kontochristos L, et al. The interaction of caseload and usage in determining outcomes of unicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty. 2017;32(10):3228-3237.e2. doi: 10.1016/j.arth.2017.04.063.

30. Hamilton TW, Pandit HG, Jenkins C, et al. Evidence-based indications for mobile-bearing unicompartmental knee arthroplasty in a consecutive cohort of thousand knees. J Arthroplasty. 2017;32(6):1779-1785. doi: 10.1016/j.arth.2016.12.036.

31. Rodríguez-Merchán EC, Gómez-Cardero P. Unicompartmental knee arthroplasty: Current indications, technical issues and results. EFORT Open Rev. 2018;3(6):363-373. doi: 10.1302/2058-5241.3.170048.

32. Musbahi O, Hamilton TW, Crellin AJ, et al. The effect of obesity on revision rate in unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2021;29(10):3467-3477. doi: 10.1007/s00167-020-06297-7.

33. Zhang Q, Zhang Q, Guo W, et al. Risk factors of postoperative valgus malalignment in mobile-bearing medial unicompartmental knee arthroplasty. Arch Orthop Trauma Surg. 2019;139(2):241-248. doi: 10.1007/s00402-018-3070-2.

34. Asada S, Inoue S, Tsukamoto I, et al. Obliquity of tibial component after unicompartmental knee arthroplasty. Knee. 2019;26(2):410-415. doi: 10.1016/j.knee.2018.12.013.

35. Mullaji AB, Shetty GM, Kanna R. Postoperative limb alignment and its determinants after minimally invasive Oxford medial unicompartmental knee arthroplasty. J Arthroplasty. 2011;26(6):919-925. doi: 10.1016/j.arth.2011.03.008.

36. Kim SJ, Bae JH, Lim HC. Factors affecting the postoperative limb alignment and clinical outcome after Oxford unicompartmental knee arthroplasty. J Arthroplasty. 2012;27(6):1210-1215. doi: 10.1016/j.arth.2011.12.011.

37. Tashiro Y, Matsuda S, Okazaki K, et al. The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability. Knee Surg Sports Traumatol Arthrosc. 2014;22(12):3142-3149. doi: 10.1007/s00167-014-3248-2.

38. Hopgood P, Martin CP, Rae PJ. The effect of tibial implant size on post-operative alignment following medial unicompartmental knee replacement. Knee. 2004;11(5):385-388. doi: 10.1016/j.knee.2003.12.008.9.

39. Wen PF, Guo WS, Gao FQ, et al. Effects of lower limb alignment and tibial component inclination on the biomechanics of lateral compartment in unicompartmental knee arthroplasty. Chin Med J (Engl). 2017;130(21):2563-2568. doi: 10.4103/0366-6999.217076.

40. Zuiderbaan HA, van der List JP, Chawla H, et al. Predictors of subjective outcome after medial unicompartmental knee arthroplasty. J Arthroplasty. 2016;31(7):1453-1458. doi: 10.1016/j.arth.2015.12.038.

41. Vasso M, Del Regno C, D'Amelio A, et al. Minor varus alignment provides better results than neutral alignment in medial UKA. Knee. 2015;22(2):117-121. doi: 10.1016/j.knee.2014.12.004.

42. Nakano N, Tsubosaka M, Kamenaga T, et al. Predicting postoperative coronal alignment after fixed-bearing unicompartmental knee arthroplasty using a new morphological assessment method: the arithmetic hip-knee-ankle angle. Int Orthop. 2024;48(4):889-897. doi: 10.1007/s00264-023-06072-6.

43. Kokubu Y, Kawahara S, Hamai S, et al. Small change in the arithmetic hip-knee-ankle angle during unicompartmental knee arthroplasty improves early postoperative functional outcomes. Arch Orthop Trauma Surg. 2024;144(5):2297-2304. doi: 10.1007/s00402-024-05309-2.

44. Shih HT, Chen KH, Lee CH, et al. Factors predicting lower limb alignment after Oxford medial unicompartmental knee arthroplasty. Sci Rep. 2024;14(1):5597. doi: 10.1038/s41598-024-56285-x.

45. Khow YZ, Liow MHL, Lee M, et al. The effect of tibial and femoral component coronal alignment on clinical outcomes and survivorship in unicompartmental knee arthroplasty. Bone Joint J. 2021;103-B(2):338-346. doi: 10.1302/0301-620X.103B2.BJJ-2020-0959.R1.

46. Kuroda Y, Takayama K, Ishida K, et al. Medial joint line elevation of the tibia measured during surgery has a significant correlation with the limb alignment changes following medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3468-3473. doi: 10.1007/s00167-018-4935-1.

47. Liu C, Ge J, Jiang Y, et al. Preoperative valgus-corrected hip-knee-ankle angle and medial meniscal extrusion are useful for evaluating postoperative alignment in mobile-bearing UKA. Heliyon. 2023;9(11):e22234. doi: 10.1016/j.heliyon.2023.e22234.

48. Ishibashi K, Sasaki E, Otsuka H, et al. Valgus correctability and meniscal extrusion were associated with alignment after unicompartmental knee arthroplasty. Clin Orthop Relat Res. 2020;478(7):1636-1644. doi: 10.1097/CORR.0000000000001260.

49. Costa CR, Morrison WB, Carrino JA. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol. 2004;183(1):17-23. doi: 10.2214/ajr.183.1.1830017.

50. Hashemi J, Chandrashekar N, Gill B. et al. The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Joint Surg Am. 2008;90(12):2724-2734. doi: 10.2106/JBJS.G.01358.

51. Fuchs S, Tibesku CO, Genkinger M, et al. Proprioception with bicondylar sledge prostheses retaining cruciate ligaments. Clin Orthop Relat Res. 2003;(406):148-154. doi: 10.1097/01.blo.0000038053.29678.a5.

52. Fuchs S, Tibesku CO, Genkinger M, et al. Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement. Clin Biomech (Bristol, Avon). 2004;19(3):263-269. doi: 10.1016/j.clinbiomech.2003.11.004.

53. Zhang Q, Zhang Q, Guo W, et al. The learning curve for minimally invasive Oxford phase 3 unicompartmental knee arthroplasty: cumulative summation test for learning curve (LC-CUSUM). J Orthop Surg Res. 2014;9:81. doi: 10.1186/s13018-014-0081-8.

54. Banks SA, Fregly BJ, Boniforti F, et al. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc. 2005;13(7):551-556. doi: 10.1007/s00167-004-0565-x.

55. Pandit H, Mancuso F, Jenkins C, et al. Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement. Knee Surg Sports Traumatol Arthrosc. 2017;25(3):669-674. doi: 10.1007/s00167-016-4075-4.

56. Wada K, Price A, Gromov K, et al. Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review-is there proof of concept? Arch Orthop Trauma Surg. 2020;140(10):1503-1513. doi: 10.1007/s00402020-03492-6.

57. Parratte S, Pauly V, Aubaniac JM, Argenson JN. Survival of bicompartmental knee arthroplasty at 5 to 23 years. Clin Orthop Relat Res. 2010;468(1):64-72. doi: 10.1007/s11999-009-1018-0.