Elcil Kaya Biçer, Murat Celal Sözbilen, Semih Aydoğdu, Hakkı SUR

Total diz artroplastisi yaklaşımlarının komponent yerleşimine etkisi

Amaç: Bu çalışmanın amacı total diz protezi uygulanmış olgularda subvastus ve medial parapatellar yaklaşımın komponentlerin yerleşimine etkisini araştırmak; özellikle yüksek deformiteli dizlerde potansiyel olarak daha kısıtlayıcı yaklaşımların varsa olası olumsuz etkilerini ortaya koymaktır.Gereç ve Yöntem: Total diz protezi uygulanmış 84 hastanın 88 dizi çalışmaya alındı. Hastalardan 46’sına medial parapatellar (grup 1), 42’sine subvastus yaklaşımla total diz protezi (grup 2) yapılmıştır. Preoperatif radyografilerinde mekanik eksen ve posterior tibial eğim açıları; postoperatif radyografilerinde femoral ve tibial komponentlerin frontal ve sagittal planlarda anatomik eksenlere göre konumlanışı ölçüldü. Bulgular: Postoperatif femoral komponentin frontal planda konumlanışını gösteren alfa açısının ortalama değeri grup 1’de 96.79°±2.86°, grup 2’de ise 96.81°±3.22° olarak bulundu. Tibial komponentin frontal planda konumlanışını gösteren beta açısının ortalama değeri ise grup 1’de 89.07°±3.45°, grup 2’de 89.97°± 3.00° idi. Sagittal planda konumlanış açısından ortalama sagittal femoral açı grup 1 ve 2’de sırasıyla 4.85°±3.84° ve 3.31°±3.58°, sagittal tibial açı ise yine sırasıyla 5.10°±3.88° ve 4.08°±3.18° olarak bulundu. Hastaların posterior tibial eğimi ve postoperatif sagittal tibial komponent eğimi karşılaştırıldığında, her iki grupta azalmış bulundu. Sonuç: Total diz protezinde cerrahi yaklaşımın yüksek dereceli deforme dizlerde bile protezin konumlanışı üzerine etkisi gösterilememiştir. Her iki yaklaşımla da komponentler uygun şekilde yerleştirilebilmektedir ve tibianın proksimal posterior eğiminde azalmaya neden olmaktadır.

Anahtar Kelimeler:

Diz Artroplastisi; Osteoartrit, Subvastus Yaklaşım, Medial Parapatellar Yaklaşım

Influence of total knee arthroplasty approaches on component positioning

Purpose: The aim of this study was to evaluate the influence of subvastus and medial parapatellar total knee arthroplasty approaches on component positioning and to explore the possible negative effects of potentially more restrictive approaches especially in highly deformed knees.Materials and Methods: 88 knees of 84 patients (46 knees operated with medial parapatellar approach (group 1), and 46 knees operated with subvastus approach (group 2)) who had undergone total knee arthroplasty. The patients were also regrouped according to their preoperative mechanical axis deviations. Postoperative femoral and tibial component positioning on frontal and sagittal planes were evaluated.Results: Frontal femoral (α) and tibial (β) component angles as well as sagittal femoral and tibial component angles were not significantly different between two groups (mean values of α of groups 1&2: 96.79±2.86° and 96.81±3.22°, respectively, of β 89.07°± 3.45° and 89.97°± 3.00° respectively, of sagittal femoral angle 4.85° ± 3.84° and 3.31° ± 3.58°, respectively, of sagittal tibial angle 5.10° ± 3.88° and 4.08 °± 3.18°, respectively). Postoperatively, posterior tibial slope was significantly decreased in both groups. Conclusion: None of the total knee arthroplasty approaches tested in this study found to exert a significant effect on component positioning even in highly deformed knees. The components can be placed properly utilizing both approaches.

Keywords:

Knee Arthroplasty Osteoarthritis, Subvastus Approach, Medial Parapatellar Approach,

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