臨床整形外科59巻6号

2024年06月発行

特集 TKAにおける最新Topics

TKAはNormal Knee Kinematicsを目指すべきか

著者： 乾洋¹ 河野賢一² 鹿毛智文²

所属機関： ¹埼玉医科大学総合医療センター整形外科 ²東京大学医学部整形外科

ページ範囲：P.789 - P.794

膝関節は大腿骨および脛骨が内外側で異なる関節面形態をしており，屈曲動作においても一軸を支点とした回転運動ではなく捻じれ運動が生じるため，全体としてscrew home movement，medial pivot motion，bicondylar rollbackといった3つのフェーズが存在する．近年そのような膝関節動態を意識した手術手技やインプラントが数多く開発されており術後成績向上が期待されている．本稿ではTKA手術はそのような正常膝と同様の膝関節動態を目指すべきなのかどうかを，最新の知見を交え考察する．

参考文献

1) 日本人工関節学会(編)．人工膝関節置換術．東京：南江堂；2023．

2) Van Onsem S, Verstraete M, Van Eenoo W, et al. Are TKA kinematics during closed kinetic chain exercises associated with patient-reported outcomes?:a preliminary analysis. Clin Orthop Relat Res 2020;478(2):255-63.

3) Kono K, Inui H, Tomita T, et al. Bicruciate-retaining total knee arthroplasty reproduces in vivo kinematics of normal knees to a lower extent than unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020;28(9):3007-15.

4) Kono K, Inui H, Tomita T, et al. The higher patient-reported outcome measure group had smaller external rotation of the femur in bicruciate-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022;30(4):1292-9.

5) Pizza N, Di Paolo S, Zinno R, et al. Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2022;30(2):661-7.

6) Hamai S, Moro-oka TA, Miura H, et al. Knee kinematics in medial osteoarthritis during in vivo weight-bearing activities. J Orthop Res 2009:27(12):1555-61.

7) Kawaguchi K, Inui H, Taketomi S, et al. Intraoperative rotational kinematics and its influence on postoperative clinical outcomes differ according to age in Unicompartmental knee Arthroplasty. BMC Musculoskelet Disord 2021;22(1):505. doi:10.1186/s12891-021-04371-w.

8) Kage T, Inui H, Tomita T, et al. The association between in vivo knee kinematics and patient-reported outcomes during squatting in bicruciate-stabilized total knee arthroplasty. J Knee Surg 2022;35(12):1342-8.

9) Kono K, Inui H, Kage T, et al. Femoral rollback at high-flexion during squatting is related to the improvement of sports activities after bicruciate-stabilized total knee arthroplasty:an observational study. BMC Musculoskelet Disord 2022;23(1):496. doi:10.1186/s12891-022-05464-w.