Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.
J Arthroplasty. 2009 Sep;24(6 Suppl):48-53. doi: 10.1016/j.arth.2009.04.033. Epub 2009 Jun 24.
Clinical and radiographic outcomes of 184 consecutive revision total knee arthroplasties (TKAs) placed with cemented components and press-fit fluted cementless stems were reviewed at average follow-up of 49 months. Revision was performed for septic failure in 53 of 184 knees, periprosthetic fracture in 10 of 184 knees, and aseptic failure in 121 of 184 knees. The press-fit cementless stems were placed to tightly contact the endosteum of the metadiaphyseal area of the femur and tibia. No knees were re-revised for aseptic loosening. There were 15 failures (15/184, 8.2%): 13 were septic failures, 9 of which were recurrence of sepsis and 4 of which were new cases of sepsis. Average Knee Society knee score improved from 134.6 to 167.8 (P < .05). Revision TKA with modular cementless stems provided excellent fixation with no revisions for aseptic loosening. Re-revision for sepsis was the dominant failure mechanism with an overall rate of 7%. Given the increasing prevalence of revision TKA, sepsis prevention strategies should receive increased attention.
对 184 例连续行翻修全膝关节置换术（TKA）患者的临床和影像学结果进行回顾性分析，所有患者均采用骨水泥固定组件和压配型带槽非骨水泥固定柄。平均随访 49 个月后发现，53 例（53/184）因感染性失败、10 例（10/184）因假体周围骨折、121 例（121/184）因无菌性失败而进行翻修。压配型非骨水泥固定柄的放置目的是使柄与股骨和胫骨骨干的皮质骨紧密接触。无一例因无菌性松动而再次翻修。共有 15 例（15/184，8.2%）失败：13 例为感染性失败，其中 9 例为感染复发，4 例为新发感染。平均膝关节学会膝关节评分从 134.6 分提高至 167.8 分（P<.05）。采用模块化非骨水泥固定柄的翻修 TKA 可提供良好的固定，无无菌性松动的翻修。因感染而再次翻修是主要的失败机制，总发生率为 7%。鉴于翻修 TKA 的发病率不断增加，应更加重视预防感染的策略。
