符得红;戴祝;

• 1:南华大学附属第一医院骨关节外科

摘要(Abstract)：

全膝关节置换技术已成为治疗重度膝骨性关节炎和类风湿性关节炎的重要手段。术后伸直位时无异常,但在伸直-屈曲过程中有部分患者一直存在膝关节疼痛、肿胀和功能受限等不适,半屈曲不稳定是其中的一个原因。半屈曲不稳定可以导致膝关节置换手术失败甚至存在早期翻修可能。目前关于全膝关节置换术后半屈曲不稳定的了解主要是理论而非临床,作者就全膝关节置换术后半屈曲不稳定的定义、临床表现、发生原因及机制、补救方法等方面进行探讨并做一综述。

关键词(KeyWords)： 半屈曲不稳;全膝关节置换术;膝关节;骨性关节炎

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 符得红;戴祝;

Email:

DOI:

参考文献(References)：

• [1] Bourne RB, Chesworth BM, Davis AM, et al. Patient satisfaction after total knee arthroplasty:who is satisfied and who is not[J]. Clin Orthop, 2010, 468(468):57-63.
• [2] Evangelista PJ, Laster SK, Lenz NM, et al. A computer model of mid-flexion instability in a balanced total knee arthroplasty[J]. J Arthroplasty, 2018, 33:265-269.
• [3] Sharkey PF, Hozack WJ, Rothman RH, et al. Insall Award paper.Why are total knee arthroplasties failing today[J]. Clin Orthop,2002(1):7-13.
• [4] Thiele K, Perka C, Matziolis G, et al. Current failure mechanisms after knee arthroplasty have changed:polyethylene wear is less common in revision surgery[J]. J Bone Joint Surg Am, 2015, 97:715-720.
• [5] Pitta M, Esposito CI, Li Z, et al. Failure after modern total knee arthroplasty:a prospective study of 18, 065 knees[J]. J Arthroplasty, 2018, 33(3):407-414.
• [6] Vince K. Mid-flexion instability after total knee arthroplasty:woolly thinking or a real concern[J]. Bone Joint J, 2016, 98-B:84-88.
• [7] McPherson EJ, Cuckler J, Lombardi AV. Midflexion instability in revision total knee arthroplasty[J]. Surg Technol Int, 2008, 17:249-252.
• [8] Stoddard JE, Deehan DJ, Bull AM, et al. The kinematics and stability of single-radius versus multi-radius femoral components related to mid-range instability after TKA[J]. J Orthop Res, 2013, 31(1):53-58.
• [9] Kaneko T, Kono N, Mochizuki Y, et al. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in midflexion range[J]. J Orthop, 2017, 14(2):201-206.
• [10] Grieco TF, Sharma A, Dessinger GM, et al. In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy[J]. J Arthroplasty, 2018, 33:565-571.
• [11] Minoda Y, Ikebuchi M, Mizokawa S, et al. Mobile-bearing TKA improved the anteroposterior joint stability in mid-flexion range comparing to fixed-bearing TKA[J]. Arch Orthop Trauma Surg,2016, 136:1601-1606.
• [12] Sharma A, Dennis DA, Zingde SM, et al. Femoral condylar contact points start and remain posterior in high flexing patients[J]. J Arthroplasty, 2014, 29:945-949.
• [13] Shimizu N, Tomita T, Yamazaki T, et al. In vivo movement of femoral flexion axis of a single-radius total knee arthroplasty[J]. J Arthroplasty, 2014, 29:2407-2411.
• [14] Jo AR, Song EK, Lee KB, et al. A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty[J]. J Arthroplasty, 2014, 29:2402-2406.
• [15] Liu S, Long H, Zhang Y, et al. Meta-analysis of outcomes of a single-radius versus multi-radius femoral design in total knee arthroplasty[J]. J Arthroplasty, 2016, 31:646-654.
• [16] Hino K, Ishimaru M, Iseki Y, et al. Mid-flexion laxity is greater after posterior-stabilised total knee replacement than with cruciateretaining procedures:a computer navigation study[J]. Bone Joint J, 2013, 95-B:493-497.
• [17] Hamai S, Okazaki K, Shimoto T, et al. Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques[J]. J Arthroplasty, 2015, 30:864-969.
• [18] Dimitriou D, Tsai TY, Park KK, et al. Weight-bearing condyle motion of the knee before and after cruciate-retaining TKA:In-vivo surgical transepicondylar axis and geometric center axis analyses[J]. J Biomech, 2016, 49:1891-1898.
• [19] Mueller JK, Wentorf FA, Moore RE. Femoral and tibial insert downsizing increases the laxity envelope in TKA[J]. Knee Surg Sports TraumatolArthrosc, 2014, 22:3003-3011.
• [20] Dai Y, Cross MB, Angibaud LD, et al. Posterior tibial slope impacts intraoperatively measured mid-flexion anteroposterior kinematics during cruciate-retaining total knee arthroplasty[J]. Knee Surg Sports TraumatolArthrosc, 2018, 1:1-10.
• [21] Kang KT, Koh YG, Son J, et al. Influence of increased posterior tibial slope in total knee arthroplasty on knee joint biomechanics:a computational simulation study[J]. J Arthroplasty, 2018, 33:572-579.
• [22] Shelburne KB, Kim HJ, Sterett WI, et al. Effect of posterior tibial slope on knee biomechanics during functional activity[J]. J Orthop Res, 2011, 29:223-231.
• [23] Hino K, Kutsuna T, Watamori K, et al. Varus-valgus stability at90°flexion correlates with the stability at midflexion range more widely than that at 0°extension in posterior-stabilized total knee arthroplasty[J]. Arch Orthop Trauma Surg, 2017, 137:1429-1434.
• [24] Minoda Y, Nakagawa S, Sugama R, et al. Midflexion laxity after implantation was influenced by the joint gap balance before implantation in TKA[J]. J Arthroplasty, 2015, 30:762-765.
• [25] Martin JW, Whiteside LA. The influence of joint line position on knee stability after condylar knee arthroplasty[J]. Clin Orthop,1990(1):146-156.
• [26] Cross MB, Nam D, Plaskos C, et al. Recutting the distal femur to increase maximal knee extension during TKA causes coronal plane laxity in mid-flexion[J]. Knee, 2012, 19(6):875-879.
• [27] K?nig C, Matziolis G, Sharenkov A, et al. Collateral ligament length change patterns after joint line elevation may not explain midflexion instability following TKA[J]. Med EngPhys, 2011, 33:1303-1308.
• [28] Incavo SJ, Schmid S, Sreenivas K, et al. Total knee arthroplasty using anatomic alignment can produce mid-flexion laxity[J]. ClinBiomech(Bristol, Avon), 2013, 28:429-435.
• [29] Minoda Y, Nakagawa S, Sugama R, et al. Intraoperative assessment of midflexion laxity in total knee prosthesis[J]. Knee, 2014,21:810-814.
• [30] Kurita M, Tomita T, Yamazaki T, et al. In vivo kinematics of highflex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion[J]. Int Orthop, 2012, 36:2465-2471.
• [31] Mochizuki T, Tanifuji O, Sato T, et al. Association between anteroposterior laxity in mid-range flexion and subjective healing of instability after total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25:3543-3548.