Department of Orthopaedic Surgery, School of Medicine, University of Oviedo, Oviedo, Spain.
Clin Orthop Relat Res. 2010 May;468(5):1248-53. doi: 10.1007/s11999-009-1226-7.
Rotating-hinge total knee prostheses may be used for the treatment of global instability about the knee. The designs of previous generations were associated with suboptimal outcomes.
QUESTIONS/PURPOSES: We evaluated the clinical and radiographic outcomes of salvage knee reconstructions using modern-generation, modular, kinematic rotating-hinge total knee prostheses.
We retrospectively reviewed 26 rotating-hinge arthroplasty devices to examine whether acceptable results were obtainable using a single arthroplasty design. The average age of the patients was 77 years (SD, 9 years); the minimum followup was 24 months (mean, 46 months; range, 24-107 months). The indication was revision surgery in 21 patients and complex primary surgery in five. Patients were evaluated clinically (Knee Society score) and radiographically (positions of components, signs of loosening, bone loss).
Knee Society pain scores improved from 40 preoperatively to 77 postoperatively, and function scores improved from 36 to 51. ROM improved from -15 masculine to -10 masculine. None of the patients' knee pain or function worsened. No loosening of implants was observed. Nonprogressive radiolucent lines were identified around the femoral and tibial components in three knees. Three patients required reoperations: one showed a supracondylar periprosthetic fracture treated by open reduction and internal fixation, whereas the other two had periprosthetic infections.
Reconstruction with rotating-hinge total knee prostheses can provide substantial improvement in function and a reduction in pain in extreme circumstances, such as gross instability. We believe this salvage procedure should be reserved for severe ligamentous deficiencies in elderly and sedentary patients or whenever revision surgery techniques fail.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
旋转铰链式全膝关节假体可用于治疗膝关节的整体不稳定。前几代产品的设计与不理想的结果有关。
问题/目的：我们评估了使用现代代、模块化、运动学旋转铰链式全膝关节假体进行保膝重建的临床和影像学结果。
我们回顾性地检查了 26 例旋转铰链关节置换装置，以确定使用单一关节置换设计是否可获得可接受的结果。患者的平均年龄为 77 岁（标准差，9 岁）；最低随访时间为 24 个月（平均，46 个月；范围，24-107 个月）。适应证为 21 例患者的翻修手术和 5 例复杂的初次手术。患者接受临床（膝关节协会评分）和影像学（假体位置、松动迹象、骨丢失）评估。
膝关节协会疼痛评分从术前的 40 分提高到术后的 77 分，功能评分从 36 分提高到 51 分。ROM 从-15 提高到-10。没有患者的膝关节疼痛或功能恶化。未发现假体松动。在 3 例膝关节中，股骨和胫骨组件周围出现了非进行性透亮线。3 例患者需要再次手术：1 例出现髁上假体周围骨折，采用切开复位内固定治疗，另 2 例出现假体周围感染。
在极端情况下，如严重不稳定，旋转铰链式全膝关节假体重建可显著改善功能和减轻疼痛。我们认为，这种保膝手术应保留给老年和久坐不动的患者严重的韧带缺失，或在翻修手术技术失败时使用。
四级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
