Lombardi Adolph V, Berend Keith R, Mallory Thomas H
Joint Implant Surgeons, Inc., Department of Surgery, New Albany Surgical Hospital and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.
Surg Technol Int. 2004;13:253-60.
Survivorship analysis has demonstrated the excellent long-term clinical success of total knee arthroplasty (TKA). Despite multiple attempts to enhance fixation with cementless technology, cemented TKA continues to be the "gold standard." The rate of loosening has diminished as the accuracy of implantation has been improved through sophisticated instrumentation and enhanced experience. Current technology with respect to computer-assisted surgery serves only to improve the accuracy of implantation, leaving materials as the weakest link in the long-term survivorship of TKA. Failure secondary to polyethylene wear has ranked as one of the most frequent causes for revision. Many issues have been identified as contributory to polyethylene wear and include the quality of the polyethylene, manufacturing process, nature of the tibial-femoral or patellofemoral articulation, area of contact, sterilization process, and issues pertaining to modularity and so-called backside wear. Long-term clinical studies have documented the success of direct compression-molded monoblock tibial components. However, the benefits of modularity are widely recognized and include the ability to fine tune soft-tissue balance after implantation of metallic devices. In an effort to combine the long-term success of direct compression molded monoblock tibial components with the occasional need for modularity, a convertible tibial component has been introduced. This device is manufactured as a direct compression-molded monoblock tibial component. The surgeon has the ability at the time of the surgical intervention, or any subsequent intervention, to convert the tibial component into a modular device. Therefore, this device addresses, in the majority of cases, the concerns that arise from backside wear.
生存分析已证明全膝关节置换术（TKA）具有出色的长期临床成功率。尽管多次尝试采用非骨水泥技术来增强固定效果，但骨水泥型TKA仍然是“金标准”。随着通过精密器械和丰富经验提高了植入的准确性，松动率有所降低。当前的计算机辅助手术技术仅用于提高植入的准确性，而材料仍是TKA长期生存中的最薄弱环节。聚乙烯磨损导致的失败已成为翻修的最常见原因之一。许多问题已被确定为导致聚乙烯磨损的因素，包括聚乙烯的质量、制造工艺、胫股或髌股关节的性质、接触面积、灭菌过程以及与模块化和所谓的背面磨损有关的问题。长期临床研究已证明直接模压一体成型胫骨组件的成功。然而，模块化的优点已得到广泛认可，包括在植入金属装置后能够微调软组织平衡。为了将直接模压一体成型胫骨组件的长期成功与偶尔对模块化的需求相结合，一种可转换胫骨组件已被引入。该装置被制作为直接模压一体成型胫骨组件。外科医生在手术干预时或任何后续干预时，能够将胫骨组件转换为模块化装置。因此，在大多数情况下，该装置解决了由背面磨损引起的问题。
