Whiteside Leo A
Missouri Bone and Joint Research Foundation, Missouri Bone and Joint Center, St. Louis, MO 63131, USA.
Clin Orthop Relat Res. 2006 May;446:140-8. doi: 10.1097/01.blo.0000218724.29344.89.
A surgical approach to revision total knee arthroplasty that includes minimal bone resection, minimal soft-tissue stripping, cementless fixation of the femoral and tibial components, and morselized allografting of defects was used and evaluated in 105 patients (110 knees) with severe bone loss. The patients were followed for 60 to 127 months postoperatively. Fixation included a tightly-fit fluted titanium stem in the femoral and tibial canals and rim contact on the peripheral rim of the tibia. One tibia loosened and one knee failed because of infection. Ligamentous stability and pain relief were consistent through the followup period. At 10 years the mean valgus laxity was 4 degrees +/- 2.5 degrees, and the mean varus laxity was 5.2 degrees +/- 3.3 degrees. Mean Knee Society pain score was 47 +/- 2.1. Pain was mild in 28 knees, moderate in eight knees, and severe in two knees. Evidence of bone healing occurred in the bone defects that could be seen on radiographs. Increase in radiodensity always was found at postoperative intervals greater than one year. An approach to revision total knee arthroplasty that maintains bone and soft tissue about the knee establishes an effective and durable construct.
Therapeutic study, level II (prospective study). See Guidelines for Authors for a complete description of levels of evidence.
对105例（110膝）严重骨缺损患者采用了一种翻修全膝关节置换术的手术方法，该方法包括最小化骨切除、最小化软组织剥离、股骨和胫骨组件的非骨水泥固定以及对骨缺损进行碎骨移植，并对其进行了评估。患者术后随访60至127个月。固定方式包括在股骨和胫骨髓腔内使用紧密配合的带槽钛柄以及在胫骨周边边缘进行边缘接触。1例胫骨松动，1例膝关节因感染失败。在随访期间韧带稳定性和疼痛缓解情况一致。10年时平均外翻松弛度为4度±2.5度，平均内翻松弛度为5.2度±3.3度。平均膝关节协会疼痛评分为47±2.1。28膝疼痛轻微，8膝中度疼痛，2膝重度疼痛。在X线片上可见的骨缺损处出现了骨愈合迹象。术后间隔超过1年时总是发现骨密度增加。一种在膝关节周围保留骨和软组织的翻修全膝关节置换术方法建立了一种有效且持久的结构。
治疗性研究，II级（前瞻性研究）。有关证据水平的完整描述，请参阅作者指南。
