Pour Aidin Eslam, Parvizi Javad, Slenker Nicholas, Purtill James J, Sharkey Peter F
Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA.
J Bone Joint Surg Am. 2007 Aug;89(8):1735-41. doi: 10.2106/JBJS.F.00893.
A rotating hinged total knee prosthesis may be utilized for the treatment of global instability or severe bone loss around the knee. Older generations of rotating hinged designs were associated with suboptimal outcomes. We evaluated the outcome of salvage knee reconstructions that had been performed with use of modern-generation modular segmental kinematic rotating hinged total knee prostheses.
The cohort included forty-three patients (twenty-nine women and fourteen men) who underwent forty-four knee arthroplasties for the treatment of a non-neoplastic condition with use of a modern-generation kinematic rotating hinged prosthesis. Revision of a previous total knee arthroplasty in the presence of massive bone loss was the most common indication for surgery. Complete clinical and radiographic data were collected for all patients after a mean duration of follow-up of 4.2 years.
Reconstruction with a rotating hinged total knee prosthesis provided substantial improvement in function and reduction in pain. However, a relatively large number of complications and failures (including revision because of periprosthetic infection [three knees], aseptic loosening [four], and periprosthetic fracture [one]) were encountered, with a mean time to failure of 1.7 years. The rate of prosthetic survival was 79.6% at one year and 68.2% at five years with revision or reoperation as the end point.
The present study highlights the commonly held opinion that a modular kinematic rotating hinged total knee prosthesis has a role for salvage reconstruction of the knee. In light of the relatively high rate of complications, we believe that this salvage procedure should be reserved primarily for elderly and sedentary patients.
旋转铰链式全膝关节假体可用于治疗膝关节周围的整体不稳定或严重骨缺损。早期的旋转铰链设计与不理想的治疗效果相关。我们评估了使用现代模块化节段性运动旋转铰链式全膝关节假体进行挽救性膝关节重建的效果。
该队列包括43例患者（29例女性和14例男性），他们接受了44次膝关节置换术，使用现代运动旋转铰链式假体治疗非肿瘤性疾病。在存在大量骨缺损的情况下翻修先前的全膝关节置换术是最常见的手术指征。在平均随访4.2年后，收集了所有患者完整的临床和影像学数据。
使用旋转铰链式全膝关节假体进行重建可显著改善功能并减轻疼痛。然而，出现了相对较多的并发症和失败情况（包括因假体周围感染[3例膝关节]、无菌性松动[4例]和假体周围骨折[1例]而进行翻修），平均失败时间为1.7年。以翻修或再次手术为终点，假体1年生存率为79.6%，5年生存率为68.2%。
本研究强调了一种普遍观点，即模块化运动旋转铰链式全膝关节假体在膝关节挽救性重建中具有作用。鉴于相对较高的并发症发生率，我们认为这种挽救性手术应主要保留给老年和久坐不动的患者。
