Department of Orthopaedics, Leiden University Medical Center, Postzone J11R, P. O. Box 9600, 2300 RC, Leiden, the Netherlands.
Int Orthop. 2012 Mar;36(3):565-70. doi: 10.1007/s00264-011-1341-4. Epub 2011 Sep 1.
There is renewed interest in the all-polyethylene tibial component in total knee arthroplasty (TKA). Long-term results of this prosthesis in rheumatoid arthritis (RA) patients, however, are limited. Therefore, we studied 104 primary cemented all-polyethylene tibial TKA in 80 consecutive RA patients for up to 25 years to determine the long-term survival of all-polyethylene tibial components in patients suffering from end stage RA.
We estimated revision rates according the revision rate per 100 observed component years used in national joint registries. Kaplan-Meier was used to estimate survival curves.
During the 25-year follow-up, three revisions for tibial component loosening were performed. The mean revision rate of all-polyethylene tibial components with revision for aseptic loosening as the endpoint was 0.09 per 100 observed component years. This corresponds to a revision rate of 0.9% after ten years and 2.25% after 25 years. Survivorship according to Kaplan-Meier was 100% at ten years and 87.5% at 25 years [95% confidence interval (CI) 64.6-100)].
This study shows good long-term results of all-polyethylene tibial TKA in patients with RA. RA patients with multiple-joint inflammation may be less physically active than osteoarthritis patients, resulting in a lower demand on the prosthesis, and these patients may, indeed, be good candidates for all-polyethylene tibial TKA. Our results suggest that all-polyethylene tibial TKA could be a successful and cost-saving treatment for end-stage knee arthritis in RA patients.
全聚乙烯胫骨组件在全膝关节置换术（TKA）中重新受到关注。然而，这种假体在类风湿关节炎（RA）患者中的长期结果有限。因此，我们研究了 80 例连续 RA 患者的 104 例初次水泥固定全聚乙烯胫骨 TKA，最长随访 25 年，以确定患有终末期 RA 的患者中全聚乙烯胫骨组件的长期生存率。
我们根据国家关节登记处使用的每 100 个观察到的组件年计算的修订率来估计修订率。使用 Kaplan-Meier 估计生存曲线。
在 25 年的随访期间，有 3 例因胫骨组件松动而进行了翻修。以无菌性松动为终点的全聚乙烯胫骨组件的平均修订率为每 100 个观察到的组件年 0.09 次。这相当于 10 年时的修订率为 0.9%，25 年时的修订率为 2.25%。Kaplan-Meier 生存分析显示，10 年时的生存率为 100%，25 年时为 87.5%[95%置信区间（CI）64.6-100%]。
本研究表明，RA 患者的全聚乙烯胫骨 TKA 具有良好的长期结果。多关节炎症的 RA 患者可能比骨关节炎患者的身体活动量少，对假体的需求较低，这些患者确实可能是全聚乙烯胫骨 TKA 的良好候选者。我们的研究结果表明，全聚乙烯胫骨 TKA 可能是 RA 患者终末期膝关节关节炎的一种成功且具有成本效益的治疗方法。
