Sharkey Peter F, Hozack William J, Rothman Richard H, Shastri Shani, Jacoby Sidney M
The Rothman Institute, Philadelphia, PA 19107, USA.
Clin Orthop Relat Res. 2002 Nov(404):7-13. doi: 10.1097/00003086-200211000-00003.
The incidence of failure after knee replacement is low, yet it has been reported that more than 22,000 knee replacements are revised yearly. The purpose of the current study was to determine current mechanisms of failure of total knee arthroplasties. A retrospective review was done on all patients who had revision total knee arthroplasty during a 3-year period (September 1997-October 2000) at one institution. The preoperative evaluation in conjunction with radiographs, laboratory data, and intraoperative findings were used to determine causes of failure. Two hundred twelve surgeries were done on 203 patients (nine patients had bilateral surgeries). The reasons for failure listed in order of prevalence among the patients in this study include polyethylene wear, aseptic loosening, instability, infection, arthrofibrosis, malalignment or malposition, deficient extensor mechanism, avascular necrosis in the patella, periprosthetic fracture, and isolated patellar resurfacing. The cases reviewed included patients who had revision surgery within 9 days to 28 years (average, 3.7 years) after the previous surgery. More than half of the revisions in this group of patients were done less than 2 years after the index operation. Fifty percent of early revision total knee arthroplasties in this series were related to instability, malalignment or malposition, and failure of fixation.
膝关节置换术后失败的发生率较低，但据报道每年有超过22,000例膝关节置换需要翻修。本研究的目的是确定全膝关节置换术当前的失败机制。对某一机构在3年期间（1997年9月至2000年10月）接受翻修全膝关节置换术的所有患者进行了回顾性研究。结合术前评估、X线片、实验室数据和术中发现来确定失败原因。对203例患者进行了212次手术（9例患者接受了双侧手术）。本研究中患者失败原因按发生率排序包括聚乙烯磨损、无菌性松动、不稳定、感染、关节纤维化、对线不良或位置不当、伸肌机制缺陷、髌骨缺血性坏死、假体周围骨折以及单纯髌骨表面置换。所回顾的病例包括在上次手术后9天至28年（平均3.7年）内接受翻修手术的患者。该组患者中超过一半的翻修手术是在初次手术后不到2年进行的。本系列中50%的早期翻修全膝关节置换术与不稳定、对线不良或位置不当以及固定失败有关。
