RESTORATION OF TIBIAL SLOPE IN PRIMARY TOTAL KNEE ARTHROPLASTY: RELATIONSHIP WITH POSTOPERATIVE OUTCOMES
Notice bibliographique
Résumé
The posterior slope of the proximal tibial articular surface is a biomechanically important parameter in native knee kinematics and varies substantially between individuals. The purpose of this study was to investigate whether recreating the native tibial slope during a primary total knee arthroplasty improves post-operative patient function. A single-centre retrospective review was conducted of patients undergoing primary total knee arthroplasty between 1998 and 2022. A prospectively collected database for arthroplasty patients at our institution captures all patients undergoing hip and knee arthroplasty secondary to osteoarthritis, and includes patient demographics, implant characteristics, and Knee Society Scores (KSS) and Oxford Knee Scores (OKS). Scores are collected within three months prior to surgery, six weeks post-surgery, and either six months or one year post-surgery. Pre- and post-operative lateral knee radiographs were reviewed using a picture archiving and communication system. Tibial slope was measured from each radiograph using a previously validated method. A delta slope was calculated for each patient as the difference in measured tibial slope from pre- to post-surgery. Two trainees worked independently to perform the measurements, with thirty radiographs reviewed in duplicate. Inter-rater reliability was determined through calculation of the inter-rater correlation coefficient (ICC). Patients were classified as having a decrease in tibial slope (Group 1, Δ slope 3). A one-way analysis of variance (ANOVA) and Tukey's HSD post hoc test were conducted to determine if patient functional outcome scores differed between groups. Analysis was performed using custom Python scripts and calculated using SciPy, Pinguin, and statistical modules. A value of P < 0.05 was considered statistically significant. Of 9569 patients who underwent either a posterior-cruciate retaining (CR) or posterior-stabilized (PS) primary total knee arthroplasty for a diagnosis of osteoarthritis captured in the database between 1998 and 2022, 612 were eligible for inclusion in the current study. The present study included 231 males (38%) and 381 females (62%) with a mean age at surgery of 67 years (SD 8.2) and mean BMI 30.0 (12.4). The ICC for preoperative and postoperative slope measurements were 0.92 and 0.93, respectively, indicating excellent inter-rater reliability. Tibial slope was decreased in 279 (46%, Group 1), re-created in 259 (41%, Group 2), and increased in 82 (13%, Group 3) patients. Both KSS and OKS improved from pre- to post-surgery. Patients in Group 2 demonstrated a 4.4-point higher mean KSS at 6-weeks post TKA than patients in Group 1 (p=0.01, 95% CI: 0.94-7.89). Knee Society Scores at other time points and OKS at all time points did not differ between groups. In this large retrospective review of patients undergoing primary total knee arthroplasty, recreation of native pre-operative tibial slope was not associated with a clinically important difference in patient functional outcome scores.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».