• MeSH
• totální endoprotéza kolene MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• NLK Publikační typ
• kolektivní monografie

• Klíčová slova
• mrzioborová spolupráce,
• MeSH
• artróza kolenních kloubů chirurgie   terapie   MeSH
• klinická studie jako téma MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• poranění kolena chirurgie   terapie   MeSH
• předoperační péče metody   MeSH
• protézy kolene kontraindikace   využití   MeSH
• rentgendiagnostika metody   využití   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• chirurgie operační * MeSH
• kongresy jako téma MeSH

• Publikační typ
• novinové články MeSH
• recenze MeSH

• Publikační typ
• recenze MeSH

PURPOSE OF THE STUDY The aim of the study was to find out whether the frequency and intensity of patellar pain can be affected by individual rotational alignment of the femoral component in total knee arthroplasty, as compared with the standard 3 degrees of external femoral rotation in conventional procedures. MATERIAL AND METHODS In randomly selected patients treated for knee osteoarthritis by total joint replacement between January 2007 and January 2011, the occurrence of patellar pain was assessed. The evaluated knees were allocated to two groups. Group 1 included 350 knee joints with conventional femoral rotational alignment, i.e., 3 degrees of external rotation. Group 2 comprised 380 knee joints with an individual rotational alignment of the femoral component based on the condylar twist angle. Post-operative anterior knee pain was assessed on the following scale: 1, no pain; 2, occasional mild pain; 3, moderate pain; 4, severe pain. RESULTS In group 1, 312 knee joints were free from pain, 15 occasionally experienced mild pain, 15 had moderate and eight had severe pain. A total of 23 revision operations were performed for patellar pain at the anterior knee and pain around the patella refractory to non-steroidal anti-rheumatic and rehabilitation therapy. In group 2, there were 331 pain-free knees, 48 with occasional mild pain, one with moderate pain and no knee with severe pain. No revision surgery was required. One patient with moderate patellar pain underwent surgery for spinal canal stenosis; after that knee pain was only mild. The groups were compared, as to pain assessment results, using the test of equality of relative frequencies, i.e., score categories 1+2 versus 3+4 of 350 (group 1) equalled 23 (6.57%) were compared with 1 (0.26%) of 380 (group 2); the difference was significant (p < 0.001). Using the same test for comparison of the frequency of repeat operations, i.e., 23 (0.57%) of 350 (group 1) versus 0 (0%) of 380 (group 2), also gave a significant result (p = 0.001). DISCUSSION Mild and occasional pain was recorded in both groups, suggesting that femoral component malrotation is not the only cause of patellar pain following total knee arthroplasty. A markedly lower incidence of moderate and severe pain and no need for revision surgery found in group 2 provides evidence that the use of individual rotational alignment of the femoral component is fully justified. CONCLUSIONS An individual rotational alignment of the femoral component can significantly reduce the incidence of moderate to severe patellar pain or even need for revision surgery.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• patela patofyziologie   MeSH
• pooperační bolest * etiologie   prevence a kontrola   MeSH
• rotace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene * klasifikace   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY The aim of this prospective randomised study was to compare and statistically analyse two methods of condylar twist angle (CTA) measurement in total knee arthroplasty in order to assess their applicability in routine practice. MATERIAL AND METHODS The study included 238 patients with 256 sites undergoing total knee arthroplasty (TKA) in the period from January 2009 to May 2011. There were 93 men (nine with bilateral TKA) and 145 women (nine with bilateral TKA) with an average age of 69.3 years and a range of 47 to 88 years. The implants NexGen (Zimmer) and ADVANCE? Medial-Pivot Knee (Wright) were used. In each patient, CTA was measured before surgery by the radiologist on a multidetector CT SOMATOM 64 (Siemens) using the Yoshioki method. The other CTA measurement was made intra-operatively by the surgeon using our modification of the Hofmann method which involved the identification of a reference line for optimal rotational alignment of the femoral component. A STATISTICA 9.0 software package was used for statistical analysis. In addition to basic statistical data, selected data were presented in graphical forms as Box and Whisker's plots and histograms. Changes in CTA and differences between the groups were evaluated using the Wilcoxon signed-rank test. Relationships among the variables were studied using Spearman's correlation coefficient. RESULTS The statistical analysis showed that the pre-operative CTA value obtained from CT scans was, on the average, higher by 0.5 degrees than the value from intra-operative measurement, as assessed at the level of significance p = 0.001 (signed-rank test). The intra-individual variability was lower than the inter-individual one (14.4% and 30.8%, respectively). This means that both methods are suitable for CTA measurement in the knee joint replacement procedures. Spearman's correlation coefficient was 0.6, which is the value of medium strong correlation. The post-operative CTA assessed on CT scans was in the range of 0 to 2 degrees in 87.5% of the patients. Both the pre-operative and intra-operative CTA values were significantly higher in women than in men (Wilcoxon two-sample test). There was no statistical difference between the left and the right side. DISCUSSION Malrotation of the femoral component is one of the causes leading to patellar subluxation and pain in the front part of the knee. The post-operative CTA value should be zero. Optimal rotational alignment of the femoral component varies with each patient; in our study it was found in the range of 0 to 7 degrees on the basis of CTA values. We do not recommend 7 degrees of external rotation to be exceeded because of the risk associated with balancing the flexion gaps; nor do we recommend to set internal rotation of the femoral component for the risk of patellar complications. The difference of 0.5 degree found in the CTA value between the two measuring methods can be explained by individual differences in the anatomy of the medial epicondylar region, and by the use of only selected whole numbers (0, 3, 5, 7) in intra-operative measurements. This difference does not play any role in routine surgical procedures. CONCLUSIONS The statistical evaluation of the results of CTA measurement with the two methods showed that both were equally suitable for routine total knee arthroplasty. The results of intra-operative CTA measurements are comparable with those obtained on CT scans; in addition, the intra-operative method is less expensive and eliminates exposure of the patient to radiation. CT-based CTA measurements are useful in the patients with chronic problems afterTKA in whom femoral component malrotation needs to be either confirmed or ruled out.

• Klíčová slova
• CTA, condylar twist angle, Advance Medial - Pivot Knee, NexGen,
• MeSH
• chirurgie operační metody   využití   MeSH
• financování organizované MeSH
• interpretace statistických dat MeSH
• kolenní kloub chirurgie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• peroperační péče statistika a číselné údaje   využití   MeSH
• počítačová rentgenová tomografie statistika a číselné údaje   MeSH
• prospektivní studie MeSH
• protézy a implantáty využití   MeSH
• protézy kolene statistika a číselné údaje   využití   MeSH
• reprodukovatelnost výsledků MeSH
• rotace škodlivé účinky   MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) statistika a číselné údaje   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

The aim of the project is the significant decrease of patellar disorders after total knee artrhroplasty without patellar resurfacing by the setting of the optimal femoral and tibial component rotation. This will minimize the number of patients who will need reoperation. This project requires the multidisciplinary cooperation with West Bohemian University -ZČU (Západočeská universita) because of the necessity to create computer biomechanical model of the knee joint and with the radiodiagnostic clinic FNand LF UK to measure the arotational alignment of both component on CT. Methods 1. Creation of the computer model of the knee to study biomechanics in the correlation to the patellar complications (co-worker ZČU) 2.Usage of the computer tomography (CT) to estimate the value of condylar twist úhlu (CTA) - angle between transepicondylar and condylar femoral axis on the transversal femoral scans (co-worker FN Plzeň)

Cílem projektu je výrazně snížit patelární komplikace po aloplastice kolenního kloubu totální endoprotézou bez náhrady čéšky, a to optimálním nastavením rotace femorální i tibální komponenty endoprotézy, a tím minimalizovat počet pacientů vyžadujících reoperaci. Jedná se o mulitidisciplinární projekt řešený Radiodiagnostickou klinikou FN a LF UK v Plzni - měření rotačního postavení obou komponent endoprotézy pomocí CT , ZČU - studium a modelování biomechaniky kolenního kloubu a na počítačovém modelu a Klinikou ortopedie a traumatologie pohybového ústrojí FN a LF UK v Plzni - optimalizace operačního postupu.

• MeSH
• artróza kolenních kloubů chirurgie   MeSH
• biomechanika MeSH
• luxace pately komplikace   MeSH
• počítačová rentgenová tomografie MeSH
• počítačová simulace MeSH
• rotace MeSH
• totální endoprotéza kolene MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR