Tanavalee Aree, Rojpornpradit Thana, Khumrak Sukree, Ngarmukos Srihatach
Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Bangkok 10330, Thailand.
Knee. 2011 Dec;18(6):483-7. doi: 10.1016/j.knee.2010.10.005. Epub 2010 Oct 30.
We prospectively evaluated a consecutive series of 314 patients (265 females and 49 males) who underwent unilateral TKA and received an average of 2 years of follow-up. In all patients, a standard (STD) or a gender-specific (GS) femoral component was selected based on the presentation of intra-operative medio-lateral overhanging of the femoral cutting guide over the femoral condyle. There were no significant differences in the pre-operative parameters of both groups. At the last follow-up, both STD and GS groups had similarly improved KS clinical scores (92.9 vs. 92.1 points), function scores (89.5 vs. 89.7 points) and ROM (133.5° vs. 134.1°) with no difference in the rate of lateral retinacular release. The overall percentage of the GS component selection was 52.5% (165/314) and was significantly higher in female patients than male patients (60.8% vs. 8.2%, p<0.0001). In addition, selected GS prostheses increased significantly with increasing femoral size (25% for size C, 53% for size D, 86% for size E, and 100% for size F, respectively). There were no complications or early loosening related to the GS prosthesis. The mean post-operative limb alignment was 5.5° of the anatomical valgus with no difference between groups. We concluded that the GS femoral component did not provide better clinical outcomes than the standard femoral component; however, it provided surgical ease to minimize prosthesis overhanging in patients with narrow femoral condyles.
我们前瞻性评估了连续314例接受单侧全膝关节置换术(TKA)的患者(265例女性和49例男性),平均随访2年。所有患者均根据股骨髁上股骨截骨导向器术中内外侧悬垂情况选择标准(STD)或性别特异性(GS)股骨假体。两组术前参数无显著差异。在最后一次随访时,STD组和GS组的膝关节协会(KS)临床评分(92.9分对92.1分)、功能评分(89.5分对89.7分)和活动度(ROM,133.5°对134.1°)均有相似改善,外侧支持带松解率无差异。GS假体选择的总体比例为52.5%(165/314),女性患者显著高于男性患者(60.8%对8.2%,p<0.0001)。此外,随着股骨尺寸增加,所选GS假体显著增加(C型为25%,D型为53%,E型为86%,F型为100%)。未发生与GS假体相关的并发症或早期松动。术后平均下肢力线为解剖学外翻5.5°,两组间无差异。我们得出结论,GS股骨假体并未比标准股骨假体提供更好的临床结果;然而,它在手术操作上更简便,可将股骨髁狭窄患者的假体悬垂降至最低。