Deroche P, Neyret P, Noel E, Dejour H
Clinique Chirurgicale et Orthopédique et Traumatologie, Centre Hospitalier Lyon Sud.
Rev Rhum Mal Osteoartic. 1992 Jun;59(6):421-7.
Results of 81 total knee replacements in 67 patients with rheumatoid arthritis were studied. Mean follow-up was three years. Pain was the main reason for knee replacement surgery; knee mobility was well preserved prior to surgery. Failure occurred in four patients, as the result of infection, due in three instances to skin necrosis. Arthrodesis of the knee proved necessary in these patients. The fourth patient developed delayed hematogenous infection which was treated by a change of prosthesis. At follow-up, 82% of patients reported no pain and 18% moderate pain. Mean passive flexion was 113 degrees +/- 17 degrees. HSS score was 83.6 +/- 1.3 and all the patients except for the four with prosthesis failure stated that they were satisfied on very satisfied. Mechanical results were satisfactory, with a mean mechanical femur-tibial angle of 180.4 degrees. A circling line was visible at follow-up in 40% of operated knees but was partial in every case. No reoperations for prosthesis loosening were required. These data show that total knee replacement is the only reliable and radical treatment of rheumatoid arthritis of the knee and should be performed as soon as fixed flessum or axial deviation develops.
对67例类风湿性关节炎患者的81次全膝关节置换结果进行了研究。平均随访时间为三年。疼痛是膝关节置换手术的主要原因；术前膝关节活动度保存良好。4例患者出现失败，原因是感染，其中3例是由于皮肤坏死。这些患者经证实需要进行膝关节融合术。第四例患者发生迟发性血源性感染，通过更换假体进行治疗。随访时，82%的患者报告无疼痛，18%的患者有中度疼痛。平均被动屈曲角度为113度±17度。HSS评分为83.6±1.3，除4例假体失败的患者外，所有患者均表示满意或非常满意。力学结果令人满意，平均股骨-胫骨力学角度为180.4度。随访时，40%的手术膝关节可见骨赘，但均为部分骨赘。无需因假体松动而进行再次手术。这些数据表明，全膝关节置换是膝关节类风湿性关节炎唯一可靠的根治性治疗方法，一旦出现固定性挛缩或轴向偏差就应尽快进行。
