Hofmann A A, Murdock L E, Wyatt R W, Alpert J P
Division of Orthopedic Surgery, University of Utah Medical Center, Salt Lake City.
Clin Orthop Relat Res. 1991 Aug(269):78-88.
The design features of an implant system can be crucial to the success of cementless total knee arthroplasty (TKA). The implant system described in this study incorporates anatomic features including an asymmetric tibial tray that is smaller laterally than medially, and a deep trochlear-grooved femoral component. Two hundred consecutive primary total knees were implanted between October 18, 1985 and January 19, 1988 and were followed prospectively. One hundred ninety-two were implanted without cement. Clinical evaluation demonstrates good or excellent results in 96%, including a mean range of motion of 122 at two to four years after arthroplasty. Routine fluoroscopic spot roentgenograms have shown no complete radiolucency in this series of patients. Bone ingrowth was predictable if morselized autograft bone was interposed between implant and host bone. Implant retrievals demonstrated uniform bone ingrowth into the porous coating, increasing to 40% of the pore volume in the tibial tray at 27 months. Restoration of the normal kinematics appears to minimize the bone-implant stress permitting bone ingrowth fixation. The results of primary cementless TKA in this series is comparable to cemented TKA with the advantage of conserving bone stock.
植入系统的设计特点对于非骨水泥型全膝关节置换术（TKA）的成功至关重要。本研究中描述的植入系统包含解剖学特征，包括外侧比内侧小的不对称胫骨托以及带有深滑车沟的股骨组件。在1985年10月18日至1988年1月19日期间连续植入了200例初次全膝关节，并进行前瞻性随访。其中192例采用非骨水泥植入。临床评估显示96%的结果为良好或优秀，包括关节置换术后两到四年的平均活动范围为122度。常规荧光透视点片显示该系列患者中无完全的透射线区。如果在植入物和宿主骨之间植入碎骨自体移植骨，骨长入是可预测的。植入物取出显示骨均匀长入多孔涂层，在27个月时胫骨托的孔隙体积中有40%实现骨长入。恢复正常运动学似乎能使骨 - 植入物应力最小化，从而实现骨长入固定。本系列初次非骨水泥型TKA的结果与骨水泥型TKA相当，且具有保留骨量的优势。
