Department of Trauma and Orthopaedics, University College London Hospital, 250 Euston Road, London NW1 2PG, UK.
Clin Orthop Relat Res. 2010 May;468(5):1221-8. doi: 10.1007/s11999-009-1204-0.
There is limited information regarding revision total knee arthroplasty (TKA) with respect to etiology, outcome, and long-term survival comparing different implant types.
QUESTIONS/PURPOSES: We compared patient outcomes, survivorship and modes of failure and the most common etiologic factors for rerevision between different revision implant types.
We retrospectively reviewed 349 cases of revision TKA in 343 patients whose mean age was 67.8 years. Three implant types were used: posterior stabilized, condylar constrained knee, and rotating hinge. The etiologies included infection (32.7%), aseptic loosening (14.9%), and polyethylene wear (12.3%). The minimum followup was 12 months (mean, 57.7 months; range, 12-120 months).
The mean Knee Society scores were 89 (range, 48-94), 88.9 (range, 45-95), and 84 (range, 56-94) and the mean ranges of motion were 110.0 degrees (range, 70 degrees -125 degrees ), 106.1 degrees (range, 70 degrees -120 degrees ), and 111.7 degrees (range, 85 degrees -125 degrees ) for the posterior stabilized, condylar constrained knee, and rotating hinge types, respectively. The rotating hinge group had the highest satisfaction rates (88%). Overall 10-year survivorship was 90.6% with highest survivorship seen in the rotating hinge group. The most common causes for rerevision were infection (2.9% of our cohort), instability (1.7%), and aseptic loosening (1.4%). The mean overall time to rerevision was 69.9 months (range, 11-119 months).
In our experience periprosthetic infection is the most common cause of failure of both primary and revision TKA. Functional outcome and range of motion improve irrespective of revision implant type. The rotating hinge prosthesis provides patient satisfaction and survivorship similar to that of other implant types.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
对于不同假体类型的翻修全膝关节置换术（TKA），有关病因、结果和长期生存率的信息有限。
问题/目的：我们比较了不同翻修假体类型之间患者的结果、生存率和失败模式以及最常见的病因因素。
我们回顾性分析了 343 名患者的 349 例翻修 TKA 病例，这些患者的平均年龄为 67.8 岁。使用了三种假体类型：后稳定型、髁限制型膝关节和旋转铰链。病因包括感染（32.7%）、无菌性松动（14.9%）和聚乙烯磨损（12.3%）。最低随访时间为 12 个月（平均 57.7 个月；范围 12-120 个月）。
平均膝关节协会评分分别为 89（范围 48-94）、88.9（范围 45-95）和 84（范围 56-94），平均活动范围分别为 110.0 度（范围 70 度-125 度）、106.1 度（范围 70 度-120 度）和 111.7 度（范围 85 度-125 度），后稳定型、髁限制型膝关节和旋转铰链型。旋转铰链组的满意度最高（88%）。总体 10 年生存率为 90.6%，旋转铰链组生存率最高。最常见的翻修原因是感染（我们队列的 2.9%）、不稳定（1.7%）和无菌性松动（1.4%）。总体翻修时间的平均值为 69.9 个月（范围 11-119 个月）。
根据我们的经验，假体周围感染是初次和翻修 TKA 失败的最常见原因。无论翻修假体类型如何，功能结果和活动范围都会改善。旋转铰链假体可提供与其他假体类型相似的患者满意度和生存率。
四级，治疗研究。有关证据水平的完整描述，请参阅作者指南。
