Abstract

Purpose

To determine the component fit by radiography or computed tomography after total knee arthroplasty and the relation of imaging with clinical examination of residual knee pain.

Methods

The study was conducted in 172 patients with residual knee pain after total knee arthroplasty. The patients were examined to determine whether they experienced pain upon palpation at nine regions surrounding the tibial and femoral components, and the results were noted. The Knee Society Clinical Rating System and The Western Ontario and McMaster Universities Arthritis Index pain scale score forms were completed for all patients. Radiologic evaluation was performed using computed tomography and anteroposterior, lateral, and oblique radiographs to determine component overhang/underhang status at these nine regions. Overhang, underhang, and cortical fit groups were created based on the position of the component at the bone margin. A statistical relationship was sought between the clinical scores and the values measured to determine which imaging method showed the best correlation with clinical scores. Consistency of CT and Rx measurements was compared using the McNemar–Bowker test. Comparisons between groups were made using Student’s t test for normally distributed data, and the Mann–Whitney U test.

Results

Computed tomography and radiographic measurements were similar in the medial, anterior, and lateral tibial regions. However, no similarities were observed in the anteromedial, anterolateral, posteromedial, and posterolateral tibial regions, and in the distal-medial and distal-lateral aspects of the femur. Statistical relationships among decreased clinical scores, pain with palpation, and the presence of overhang/underhang were only observed in the medial tibial region for imaging using radiography. A statistically significant relationship was observed in the medial, posteromedial, and posterolateral tibial regions, and in the distal-medial region of the femur for imaging based on computed tomography.

Conclusions

Radiography could only aid in assessing the component fit in the anteromedial, medial, and lateral regions of the tibia in patients with residual knee pain following knee arthroplasty, but it was not sufficient in comparison with computed tomography in six other regions.

Level of evidence

Prospective study, level of evidence II.

中文翻译：

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放射线照片不足以评估全膝关节置换术后轻微膝关节疼痛的部件配合情况。

摘要

目的

全膝关节置换术后通过放射线照相或计算机断层扫描确定组件的配合情况以及影像学与残余膝关节疼痛临床检查的关系。

方法

该研究对 172 名全膝关节置换术后仍有膝关节残余疼痛的患者进行了研究。对患者进行检查以确定他们在胫骨和股骨周围的九个区域触诊时是否感到疼痛，并记录结果。所有患者均填写了膝关节协会临床评级系统以及西安大略大学和麦克马斯特大学关节炎指数疼痛量表评分表。使用计算机断层扫描和前后位、侧位和倾斜X光片进行放射学评估，以确定这九个区域的组件悬垂/悬垂状态。悬垂、悬垂和皮质贴合组是根据组件在骨边缘的位置创建的。寻找临床评分和测量值之间的统计关系，以确定哪种成像方法显示与临床评分的最佳相关性。使用 McNemar-Bowker 检验比较 CT 和 Rx 测量的一致性。使用正态分布数据的 Student t 检验和 Mann-Whitney U 检验进行组间比较。

结果

胫骨内侧、前侧和外侧区域的计算机断层扫描和射线照相测量结果相似。然而，在胫骨前内侧、前外侧、后内侧和后外侧以及股骨的远端内侧和远端外侧方面没有观察到相似之处。仅在使用射线照相成像的胫骨内侧区域观察到临床评分下降、触诊疼痛以及悬垂/悬垂的存在之间的统计关系。在基于计算机断层扫描的成像中，在内侧、后内侧和后外侧胫骨区域以及股骨的远端内侧区域中观察到统计学上显着的关系。

结论

对于膝关节置换术后有残余膝关节疼痛的患者，放射线检查只能帮助评估胫骨前内侧、内侧和外侧区域的组件配合情况，但与其他六个区域的计算机断层扫描相比，其效果还不够。

证据级别

前瞻性研究，证据级别 II。