Harrison Richard J, Thacker Mihir M, Pitcher J David, Temple H Thomas, Scully Sean P
Miller School of Medicine at the University of Miami, Department of Orthopaedic Surgery, Miami, FL 33101, USA.
Clin Orthop Relat Res. 2006 May;446:113-20. doi: 10.1097/01.blo.0000214433.64774.1b.
Revision total knee arthroplasty can be considerably more difficult in cases involving severe bone loss, complete absence of collateral ligaments, and persistent periprosthetic supracondylar femoral fractures. Modular segmental endoprosthetic distal femur replacement is a limb salvage option when other surgical options are unfeasible. The clinical performance of rotating hinge knee prostheses has greatly improved with the evolution of second and third generation designs. The increased freedom of rotation decreases the prosthetic bone stresses and the longevity. While designs have improved, the prostheses still do not match the function and longevity of condylar components with approximately a 90% survivorship at 20 years. The modular endoprosthesis rotating hinge knee prosthesis is useful for total knee arthroplasty revision in patients with inadequate bone stock, ligamentous instability, or difficult supracondylar femur fractures, especially in low demand elderly patients.
Therapeutic study, level V (expert opinion). See Guidelines for Authors for a complete description of levels of evidence.
在涉及严重骨丢失、侧副韧带完全缺失以及假体周围股骨髁上持续骨折的病例中，全膝关节置换翻修术可能会困难得多。当其他手术选择不可行时，模块化节段性股骨远端假体置换是一种肢体挽救选择。随着第二代和第三代设计的发展，旋转铰链膝关节假体的临床性能有了很大提高。旋转自由度的增加降低了假体的骨应力并延长了使用寿命。虽然设计有所改进，但假体仍无法与髁部件的功能和使用寿命相匹配，20年时的生存率约为90%。模块化股骨远端假体旋转铰链膝关节假体对于骨量不足、韧带不稳定或股骨髁上骨折困难的患者进行全膝关节置换翻修很有用，尤其是对需求较低的老年患者。
治疗性研究，V级（专家意见）。有关证据水平的完整描述，请参阅作者指南。
