Chaudhary R, Beaupré L A, Johnston D W C
University of Alberta, Capital Health, 1F1.52 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
J Bone Joint Surg Am. 2008 Dec;90(12):2579-86. doi: 10.2106/JBJS.G.00995.
The impact of posterior cruciate ligament-substituting and posterior cruciate ligament-retaining devices on the range of motion of the knee following primary total knee arthroplasty is unclear. The primary objective of our study was to compare the range of motion of the knee over the first two postoperative years between subjects who had received the ligament-substituting design and those who had received the ligament-retaining design. Secondarily, pain, function, and health-related quality of life were compared between the two groups.
We undertook a prospective randomized study of 100 patients with noninflammatory osteoarthritis who were undergoing primary total knee arthroplasty. Patients were randomized at the time of surgery to receive one of the two study prosthesis designs. They were evaluated preoperatively, at the time of hospital discharge, at three months postoperatively, and at up to two years postoperatively by a physical therapist who was blinded to the group allocation. Active knee flexion and extension, measured with a goniometer, were the primary outcome measures. Self-reported pain, function, and health-related quality of life were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the RAND 36-Item Health Survey (RAND-36). Complications and revision rates were determined through hospital record review and at each patient evaluation.
Eighty percent (seventy-eight) of the ninety-eight available patients returned for the final assessment. At two years postoperatively, the mean difference between the groups with regard to knee flexion was 0.03 degrees (95% confidence interval, -5.9 degrees to 6.0 degrees ) and the mean difference in knee extension was 1.0 degrees (95% confidence interval, -0.36 degrees to 2.4 degrees ). Ninety-one (93%) of the ninety-eight available patients completed questionnaires at the time of the final assessment. The two treatment groups had similar pain, function, and quality-of-life scores and complication rates. One subject in the cruciate-retaining group required revision, secondary to a deep joint infection, and one subject in the cruciate-substituting group required manipulation to address poor knee flexion.
Overall, the two treatment groups had a similar range of motion of the knee over the initial two-year postoperative time period. A satisfactory range of motion was achieved by three months postoperatively and was maintained at the final assessment.
在后交叉韧带替代型和后交叉韧带保留型假体用于初次全膝关节置换术后对膝关节活动范围的影响尚不清楚。我们研究的主要目的是比较接受韧带替代型设计的患者与接受韧带保留型设计的患者在术后头两年的膝关节活动范围。其次，比较两组之间的疼痛、功能以及与健康相关的生活质量。
我们对100例接受初次全膝关节置换术的非炎性骨关节炎患者进行了一项前瞻性随机研究。患者在手术时随机接受两种研究假体设计中的一种。由对分组情况不知情的物理治疗师在术前、出院时、术后3个月以及术后长达两年的时间对患者进行评估。用角度计测量的主动膝关节屈伸是主要结局指标。用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及兰德36项健康调查（RAND - 36）来测量自我报告的疼痛、功能以及与健康相关的生活质量。通过查阅医院记录以及在每次患者评估时确定并发症和翻修率。
98例可用患者中有80%（78例）返回进行最终评估。术后两年，两组之间膝关节屈曲的平均差异为0.03度（95%置信区间，-5.9度至6.0度），膝关节伸展的平均差异为1.0度（95%置信区间，-0.36度至2.4度）。98例可用患者中有91例（93%）在最终评估时完成了问卷调查。两个治疗组在疼痛、功能、生活质量评分以及并发症发生率方面相似。韧带保留组中有1例患者因深部关节感染需要翻修，韧带替代组中有1例患者因膝关节屈曲不佳需要手法治疗。
总体而言，在术后最初两年期间，两个治疗组的膝关节活动范围相似。术后3个月时实现了令人满意的活动范围，并在最终评估时得以维持。
