Rittmeister M, Starker M, Zichner L
Orthopedic University Hospital, Frankfurt, Germany.
Clin Orthop Relat Res. 2000 Feb(371):136-45. doi: 10.1097/00003086-200002000-00017.
This study determined whether patients with severe knee disease below a hip arthrodesis can be treated successfully with total knee replacement alone or whether such patients require total hip arthroplasty followed by knee replacement. Eighteen patients who had hip arthrodesis for a mean of 33 years underwent total hip replacement alone, total knee replacement alone, or a combination of both. The Harris hip score improved from a mean of 55.3 to a mean of 86.9 points at 45 months after total hip arthroplasty. The Hospital for Special Surgery knee score improved from a mean of 33 to a mean of 78 points in patients who had total knee replacement after total hip arthroplasty. The Hospital for Special Surgery knee score improved from a mean of 35 to a mean of 44 points in patients having total knee replacement alone below a hip arthrodesis. The followup after total knee replacement averaged 53 months. These data suggest that a knee replacement alone in a patient with a fused hip is unlikely to provide a satisfactory result. Patients with severe knee disease below hip arthrodesis require total hip arthroplasty followed by knee replacement. This applies even when severe osteoarthritis of the knee is the primary complaint.
本研究旨在确定髋关节融合术以下患有严重膝关节疾病的患者能否仅通过全膝关节置换术成功治疗，或者此类患者是否需要先进行全髋关节置换术，然后再进行膝关节置换术。18例平均髋关节融合33年的患者接受了单纯全髋关节置换术、单纯全膝关节置换术或两者联合手术。全髋关节置换术后45个月，Harris髋关节评分从平均55.3分提高到平均86.9分。在全髋关节置换术后接受全膝关节置换术的患者中，特种外科医院膝关节评分从平均33分提高到平均78分。在髋关节融合术以下单纯接受全膝关节置换术的患者中，特种外科医院膝关节评分从平均35分提高到平均44分。全膝关节置换术后的随访平均为53个月。这些数据表明，髋关节融合的患者单纯进行膝关节置换不太可能获得满意的结果。髋关节融合术以下患有严重膝关节疾病的患者需要先进行全髋关节置换术，然后再进行膝关节置换术。即使膝关节严重骨关节炎是主要诉求，这一结论同样适用。
