Kim Young-Hoo, Kim Jun-Shik
The Joint Replacement Center of Korea, Ewha Womans University Mokdong Hospital, 911-1, Mokdong, YangChun-Ku, Seoul 158-710, South Korea.
J Bone Joint Surg Am. 2009 Jun;91(6):1440-7. doi: 10.2106/JBJS.H.00425.
The major goals of revision total knee arthroplasty include good clinical and radiographic results with a low complication rate. A retrospective review of a case series of revision total knee arthroplasties with a constrained condylar prosthesis by a single surgeon was performed in order to ascertain the role of this prosthesis and to determine whether it provided satisfactory results.
Ninety-seven patients (114 knees) underwent revision total knee arthroplasty with use of a constrained condylar knee prosthesis. There were eighty-four men and thirteen women. The mean age at the time of the index surgery was sixty-five years. The primary diagnosis was predominantly osteoarthritis (96%). The most common reason for revision was aseptic loosening of a component (54%). The mean time from the primary to the revision total knee arthroplasty was 6.1 years (range, six weeks to twenty-four years). The mean duration of follow-up was 7.2 years.
The mean Hospital for Special Surgery knee score and mean Knee Society knee and functional scores were 31, 35, and 16 points, respectively, before the operation and 83, 90, and 64 points at the time of the final follow-up. The preoperative and postoperative Western Ontario and McMaster Universities Osteoarthritis Index scores were 85 and 34.5 points, respectively. The complication rate was 9%. Five knees (4%) had a rerevision, and three knees (2.6%) had a quadriceps tendon rupture. Kaplan-Meier survivorship analysis, with revision or radiographic failure as the end point, revealed that the ten-year rate of survival of the components was 96% (95% confidence interval, 94% to 100%).
Revision total knee arthroplasty with use of a constrained condylar knee prosthesis had reproducible clinical success, but a complication rate of up to 9% can be expected at intermediate-term follow-up.
翻修全膝关节置换术的主要目标包括获得良好的临床和影像学结果以及较低的并发症发生率。为了确定限制性髁假体在翻修全膝关节置换术中的作用并判断其是否能提供满意的结果，我们对由一位外科医生实施的采用限制性髁假体的翻修全膝关节置换术病例系列进行了回顾性研究。
97例患者（114膝）接受了使用限制性髁膝关节假体的翻修全膝关节置换术。其中男性84例，女性13例。初次手术时的平均年龄为65岁。主要诊断为骨关节炎（96%）。翻修的最常见原因是假体无菌性松动（54%）。初次全膝关节置换术至翻修全膝关节置换术的平均时间为6.1年（范围为6周至24年）。平均随访时间为7.2年。
术前特种外科医院膝关节评分、膝关节协会膝关节评分及功能评分的平均值分别为31分、35分和16分，末次随访时分别为83分、90分和64分。术前和术后西安大略和麦克马斯特大学骨关节炎指数评分分别为85分和34.5分。并发症发生率为9%。5膝（4%）进行了再次翻修，3膝（2.6%）发生了股四头肌腱断裂。以翻修或影像学失败为终点的Kaplan-Meier生存分析显示，假体的10年生存率为96%（95%置信区间为94%至100%）。
使用限制性髁膝关节假体进行翻修全膝关节置换术可获得可重复的临床成功，但中期随访时并发症发生率可达9%。
