Parvizi J, Duffy G P, Trousdale R T
Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 2001 Sep;83(9):1312-6. doi: 10.2106/00004623-200109000-00003.
Ankylosing spondylitis is a seronegative spondyloarthropathy that primarily affects the sacroiliac joints, spine, hips, and, less commonly, the knee joints. The purpose of this study was to evaluate the results in a consecutive group of patients with ankylosing spondylitis who underwent total knee arthroplasty.
The results of thirty total knee arthroplasties in twenty patients with ankylosing spondylitis were reviewed. There were seventeen men and three women, with an average age of fifty-five years (range, twenty-eight to sixty-seven years) at the time of the arthroplasty. The diagnosis of ankylosing spondylitis was established preoperatively with use of the New York criteria. All patients received a cemented condylar-type implant. The average duration of follow-up was 11.2 years (range, three to sixteen years).
The average Knee Society pain score improved from 14 points preoperatively to 76.3 points at the time of the latest follow-up. The improvement in the average Knee Society function score was less impressive, with an increase from 16.3 points preoperatively to 58.7 points at the time of the latest follow-up. The average arc of motion was 84.8 degrees prior to the arthroplasty and 86.7 degrees at the time of the final follow-up. Six knees (20%) had heterotopic bone formation. Three knees required manipulation under anesthesia because of poor motion postoperatively. There was one revision, due to loosening of a patellar component. All other components were radiographically stable at the time of the latest follow-up.
Total knee arthroplasty with cement in patients with ankylosing spondylitis provided excellent pain relief and durable fixation at an average of 11.2 years postoperatively. However, patients with ankylosing spondylitis are at increased risk for the development of stiffness and heterotopic bone formation.
强直性脊柱炎是一种血清阴性脊柱关节病，主要影响骶髂关节、脊柱、髋关节，较少累及膝关节。本研究的目的是评估一组连续接受全膝关节置换术的强直性脊柱炎患者的手术结果。
回顾了20例强直性脊柱炎患者行30次全膝关节置换术的结果。其中男性17例，女性3例，置换术时平均年龄55岁（范围28至67岁）。术前根据纽约标准确诊强直性脊柱炎。所有患者均接受骨水泥型髁型假体植入。平均随访时间为11.2年（范围3至16年）。
膝关节协会疼痛评分平均从术前的14分提高到最近一次随访时的76.3分。膝关节协会功能评分的改善不太显著，从术前的16.3分增加到最近一次随访时的58.7分。置换术前平均活动弧度为84.8度，最后一次随访时为86.7度。6例膝关节（20%）出现异位骨化。3例膝关节因术后活动度差需在麻醉下进行手法治疗。有1例因髌骨假体松动而翻修。在最近一次随访时，所有其他假体在影像学上均稳定。
强直性脊柱炎患者行骨水泥型全膝关节置换术在术后平均11.2年时提供了良好的疼痛缓解和持久的固定。然而，强直性脊柱炎患者发生僵硬和异位骨化的风险增加。
