Schwab Joseph H, Haidukewych George J, Hanssen Arlen D, Jacofsky David J, Pagnano Mark W
Mayo Clinic, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 2005 Nov;440:96-100. doi: 10.1097/00003086-200511000-00018.
Flexion instability after cruciate-retaining total knee arthroplasty has been well documented. We identified an analogous patient group with symptomatic flexion instability without dislocation after primary posterior stabilized total knee arthroplasty. We sought to determine the typical symptoms and exam findings that lead to the diagnosis, to assess the reliability of revision total knee arthroplasty as a treatment, and to assess the technical difficulties encountered during revision total knee arthroplasty. Between 1995 and 2001, 10 patients had revision of a well-fixed posterior stabilized total knee arthroplasty for isolated symptomatic flexion instability. The typical constellation of symptoms and physical findings included a sense of instability without giving way, recurrent knee effusions, multiple areas of soft tissue tenderness about the knee, and substantial anterior tibial translation at 90 degrees of flexion. The revision operation focused on balancing the flexion and extension gaps while taking care to fill the enlarged flexion gap. Revision total knee arthroplasty was reliable in alleviating pain (mean Knee Society Pain scores improved from 68 points preoperatively to 89 points postoperatively), improving stability (nine of 10 patients had < 5 mm anterior tibial translation postoperatively) and improving patient satisfaction (nine of 10 patients were satisfied). We had no particular technical difficulties with the revision total knee arthroplasty procedures and had reliably achieved well-balanced flexion and extension gaps.
Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.
保留交叉韧带的全膝关节置换术后的屈曲不稳定已得到充分记录。我们发现了一组类似的患者，他们在初次后稳定型全膝关节置换术后出现有症状的屈曲不稳定但无脱位。我们试图确定导致诊断的典型症状和检查结果，评估翻修全膝关节置换术作为一种治疗方法的可靠性，并评估翻修全膝关节置换术过程中遇到的技术困难。1995年至2001年间，10例患者因孤立的有症状屈曲不稳定对固定良好的后稳定型全膝关节置换术进行了翻修。典型的症状和体格检查结果包括无打软腿的不稳定感、反复膝关节积液、膝关节周围多个软组织压痛区域以及屈曲90度时胫骨明显向前移位。翻修手术重点在于平衡屈曲和伸直间隙，同时注意填充扩大的屈曲间隙。翻修全膝关节置换术在缓解疼痛方面可靠（膝关节协会疼痛评分平均从术前的68分提高到术后的89分），改善稳定性（10例患者中有9例术后胫骨向前移位<5mm），并提高患者满意度（10例患者中有9例满意）。我们在翻修全膝关节置换术过程中没有遇到特殊的技术困难，并且可靠地实现了良好平衡的屈曲和伸直间隙。
治疗性研究，IV-1级（病例系列）。有关证据水平的完整描述，请参阅作者指南。
