理学療法ジャーナル54巻8号

2020年08月発行

連載 臨床実習サブノート　運動器疾患の術後評価のポイント—これだけは押さえておこう！・5

変形性膝関節症—人工膝関節全置換術

著者： 早川雅代¹

所属機関： ¹医療法人社団JSI昭島整形外科

ページ範囲：P.960 - P.966

はじめに

　変形性膝関節症（osteoarthritis of the knee：膝OA）患者の主訴は疼痛です^1,2）．保存療法で奏効しない場合は手術療法が適応となります．一般的な手術療法は，高位脛骨骨切り術（high tibial osteotomy：HTO）や単顆型人工関節置換術（unicompartmental knee arthroplasty：UKA），人工膝関節全置換術（total knee arthroplasty：TKA）が挙げられます．

　TKAは，末期膝OAや関節リウマチに代表される関節病変に対する外科的治療法の1つとして確立されています^3）．本邦におけるTKAの件数は年間約10万件を超え，世界中で急速に増加傾向にあります^4）．TKAの主な目的は，除痛や内外反変形の矯正，支持性の獲得，関節可動域の改善です^5）．長期成績は15年以上が90％以上と安定していますが^6），術後疼痛や可動域制限に悩まされる例も少なくないのが現状です^7）．

　本稿では，膝OAに対するTKAの術式とTKA後の評価項目について述べます．

参考文献

1）Muraki S, et al：Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts：the ROAD study. Osteoarthritis Cartilage 2009；17：1137-1143

2）Felson DT, et al：An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 1998；41：1343-1355

3）Elkus M, et al：Total knee arthroplasty for severe valgus deformity. Five to fourteen-year follow-up. J Bone Joint Surg Am 2004；86：2671-2676

4）Kurtz S, et al：Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007；89：780-785

5）Gill GS, et al：Total condylar knee arthroplasty. 16 to 21 years results. Clin Orthop Relat Res 1999；356：144-153

6）Roberts VI, et al：A 15-year follow-up study of 4606 primary total knee replacements. J Bone Joint Surg Br 2007；89：1452-1456

7）Bourne RB, et al：Patient satisfaction after total knee arthroplasty：Who is satisfied and who is not? Clin Ortho Relat Res 2010；468：57-63

8）Bercik MJ, et al：Posterior crusiate-retaining versus posterior-stabilized total knee Arthroplasty：a meta-analysis. J Arthroplasty 2013；28：439-444

9）Pollock DC, et al：Synovial entrapment：a complication of posterior stabilized total knee arthroplasty. J Bone Joint Surg Am 2002；84：2174-2178

10）Nishitani K, et al：No differences in patient-reported outcomes between medial pivot insert and symmetrical insert in total knee arthroplasty：a randomized analysis. Knee 2018；25：1254-1261

11）Jarrad M, et al：Comparison of two extensile approaches to the knee：a cadaveric study Evaluating quadriceps snip and extensile medial parapatellar approach. J Orthop 2018；15：146-149

12）Matsueda M, et al：Soft tissue release in total knee arthroplasty cadaver study using knees without deformities. Clin Orthop Relat Res 1999；366：264-273

13）Mihalko WM, et al：Effects of medial epicondylar osteotomy on soft tissue balancing in total knee arthroplasty. Orthopedics 2013；36：e1353-e1357

14）Bellemans J, et al：Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. Influence of posterior condylar offset. J Bone Joint Surg 2002；84：50-53

15）Ritter MA, et al：Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg 2003；85：1278-1285

16）Bercik MJ, et al：Posterior cruciate-retaining versus posterior-stabilized total knee arthroplasty：a meta-analysis. J Arthroplasty 2013；28：439-444

17）Stevents-Lapsley JE, et al：Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res 2010；468：2460-2468

18）Mizner RL et al：Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005；35：424-436

19）Furu M, et al：Quadriceps strength affects patient satisfaction after total knee arthroplasty. J Orthop Aci 2016；21：38-43

20）McClelland JA, et al：Gait analysis of patients following total knee replacement：a systematic review. Knee 2007；14：253-263

21）Andriacchi TP, et al：A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am 1980；62：749-757

22）Sadoghi P, et al：Revision surgery after total joint arthroplasty：a complication-based analysis using word wide arthroplasty registers. J Arthroplasty 2013；28：1329-1332

23）Han HS, et al：High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. J Bone Joint Surg Br 2007；89：1457-1467