Study On The Influence Of Different Rotation Positioning Methods Of Tibial Prosthesis On Patellofemoral Joint In TKA

Background Total knee arthroplasty is considered as the best technique to relieve the end-stage pain of knee osteoarthritis.The knee joint is composed of femur,tibia,cartilage,meniscus,joint capsule and surrounding ligaments.Lower limb exercise shows the friction of cartilage between the two bone ends,and the essence of osteoarthritis is the outcome of progressive loss of articular cartilage.TKA not only replaces the worn surface cartilage with artificial prosthesis,TKA also needs to restore the normal force lines of the lower extremities,including coronal and sagittal force lines,as well as rotational force lines.The difficulty of TKA actually lies in how to deal with the rotation alignment better and more accurately,which mainly includes the rotation alignment of the femoral prosthesis and the metal support of the tibial plateau.Clinical evidence shows that malalignment of rotation will lead to a series of related complications such as knee pain after TKA,which seriously affect the recovery of knee joint function after operation.Objective Study on the influence of different rotation positioning methods of tibial prosthesis on patellofemoral joint in TKAMethods The patients who underwent primary TKA for knee osteoarthrosis in the Department of Osteoarthrosis of the people’s Hospital of three Gorges University from May2020 to December 2020 were randomly divided into different operation groups.One group was treated with tibial anatomical localization(1 beat 3 in tibial tubercle),and the other group was treated with kinematic localization(ROM)method.According to the statistics of previous operations,there were 25 patients in both groups,23 male patients and 27 female patients in the sample.The age composition was 50 to 65 years old,and the average age was 60 years old.The body mass index(BMI)was 19.28 to 24.93 kg / m2,and the average BMI was 21.71kg/m2.The knee surface replacement prosthesis(PS prosthesis)was used.The VAS score,patellofemoral index,patellar tilt angle,distance from tibial tubercle to trochlear midline(TT-TG)and HSS score of different knee flexion angles were measured between the two groups,and the short-term effects of the two groups were compared.Results The follow-up period was 3 months.The follow-up results showed that the general basic condition and postoperative 3-month VAS score of anatomical localization group and kinematic localization group were similar,and there was no significant difference between anatomical localization group and kinematic localization group(P> 0.05).Two weeks after operation,the HSS score was(74.92±2.857)in the anatomical localization group and(70.08±7.234)in the kinematic localization group(P<0.05),and the HSS score at 1 month after operation was(83.08±2.120)in the anatomical localization group and(80.60±5.431)in the kinematics localization group(P<0.05).Three months after operation,the HSS score was(92.52±2.257)in the anatomical positioning group and(89.64±5.049)in the kinematic positioning group(P<0.05),and the knee flexion 30° patellofemoral index was(0.498±0.026)°in the anatomical positioning group and(0.478±0.027),P<0.05)in the kinematic positioning group,and the knee flexion 60 ° patellofemoral index was statistically significant.The knee flexion index of 90° patellofemoral flexion was(0.970±0.042)in anatomical positioning group and(1.020±0.089),P<0.05)in kinematic positioning group,and the knee flexion 90°patellofemoral index was(0.630±0.032)in anatomical positioning group and(0.655±0.034),P<0.05)in kinematic positioning group,which was statistically significant.The inclination angle of the patella was(4.676±0.174)°in the anatomical positioning group and(5.216±0.787)°in the kinematic positioning group,P<0.05,and the distance from the tubercle of the tibia to the midline of the pulley(TT-TG)in the anatomical positioning group was(10.228 ± 0.600)mm,and(10.764 ± 0.854)mm,P<0.05 in the kinematic positioning group.Conclusion This study showed that there was no significant difference in VAS score 3months after operation between the kinematic positioning group and the anatomical positioning group in TKA.In the comparison of TT-TG distance,patellar inclination angle and patellofemoral index of knee flexion 60°and 90°,the anatomical location was more advantageous between the two groups.In the HSS score,the score in the anatomical localization group was significantly higher than that in the kinematic localization group.According to the imaging index and score scale,the distribution of the data in the kinematic localization group was diffuse,and the postoperative recovery fluctuated greatly,while the results and postoperative recovery in the anatomical localization group were more concentrated and stable than those in the kinematic localization group.Therefore,the two rotational positioning methods of tibial prosthesis in TKA can relieve the pain of patients and improve the function of knee joint,but the advantage of anatomical localization is more obvious for the influence of postoperative patellofemoral joint friendliness.Considering that there may be abnormal development and variation of tibial tubercle,it is difficult to identify the inner part of tibial tubercle or to locate it inaccurately.when placing tibial prosthesis,two rotational positioning methods can be referred to at the same time to support each other to avoid errors.