Soyer J, Iborra J P, Pries P, Clarac J P
Service d'Orthopédie et de Traumatologie Adulte et Infantile, CHU Poitiers, 86021 Poitiers.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Feb 1;87(1):40-9.
This retrospective work was conducted to analyze the quality of the bone-implant interface at mid-term in 45 cases treated with a non-cemented Miller-Galante 1 total knee arthroplasty.
All the protheses reviewed were implanted without cement. A patellar implant was cemented in 31.1 p. 100 of the cases. Female sex predominated in this series (77.5 p. 100) and the mean age at operation was 67 +/- 6 years. Pre- and postoperative assessment was based on the HSS score. Mean follow-up was 8.3 years (range 7-11 years). We used the method advocated by the International Knee Society to analyze lucent lines on tibial and femoral implants. Non-parametric tests were used for the statistical analysis with a significance level set at 5 p. 100.
The mean HSS score rose from 55 +/- 12 preoperatively to 80 +/- 13 postoperatively, with 62.2 p. 100 good or excellent results at last follow-up. One re-operation was required for aseptic loosening. The femoral implant presented a lucent line in 24.4 p. 100 of the cases at the first follow-up examination only. The tibial implant presented an anterior lucent line at the second follow-up examination then a medial line at the last follow-up in 22.2 p. 100 and 26.6 p. 100 of the cases respectively. Presence of a lucent line (tibial or femoral) on at least one view was significantly correlated with activity (p=0.01) and tibial slope (p=0.0087).
The disappearance of the lucent lines seen on the femoral component at the second follow-up examination was the expression of its secondary integration. Inversely, we observed an evolution in the lines observed on the tibia. This was probably the result of posterolateral impaction and anteromedial ascension micromovements of the tibial component. An excessive tibial slope was statistically related to development of lucent lines. It increased tibial translation on weight bearing and probably induced an abnormal alteration of the polyethylene. We did not observe any case of massive osteolysis of the tibial metaphysis as described in the literature for non-cemented knee arthroplasties. The screws of the Miller-Galante 1 prosthesis do not protrude from the tibial implant (which would risk generating polyethylene debris) and the pieces used (screws and implants) are all made of the same metal.
The quality of primary fixation of the non-cemented Miller-Galante 1 tibial implant was not totally satisfactory at mid-term. Inversely, simple impaction of the femoral component was sufficient to ensure stable positioning.
本回顾性研究旨在分析45例采用非骨水泥型Miller - Galante 1全膝关节置换术治疗的患者中期骨 - 植入物界面的质量。
所有纳入回顾的假体均为非骨水泥植入。31.1%的病例中髌骨假体采用骨水泥固定。本系列中女性占主导（77.5%），平均手术年龄为67±6岁。术前和术后评估基于HSS评分。平均随访时间为8.3年（范围7 - 11年）。我们采用国际膝关节协会提倡的方法分析胫骨和股骨植入物上的透亮线。采用非参数检验进行统计分析，显著性水平设定为5%。
HSS评分均值从术前的55±12提高到术后的80±13，末次随访时62.2%的结果为良好或优秀。因无菌性松动需要进行1次再次手术。仅在首次随访检查时，24.4%的病例股骨植入物出现透亮线。在第二次随访检查时，22.2%的病例胫骨植入物出现前方透亮线，在末次随访时，26.6%的病例出现内侧透亮线。至少在一个视图上出现透亮线（胫骨或股骨）与活动度（p = 0.01）和胫骨坡度（p = 0.0087）显著相关。
在第二次随访检查时股骨部件上所见透亮线的消失是其二次整合的表现。相反，我们观察到胫骨上的透亮线有演变。这可能是胫骨部件后外侧撞击和前内侧上升微动的结果。胫骨坡度过大与透亮线的形成在统计学上相关。它增加了负重时胫骨的平移，可能导致聚乙烯异常改变。我们未观察到文献中描述的非骨水泥膝关节置换术中胫骨近端大量骨溶解的任何病例。Miller - Galante 1假体的螺钉不会从胫骨植入物中突出（这有产生聚乙烯碎屑的风险），并且所使用的部件（螺钉和植入物）均由相同金属制成。
非骨水泥型Miller - Galante 1胫骨植入物的初期固定质量在中期并不完全令人满意。相反，股骨部件简单的嵌紧足以确保稳定定位。
