Haasper C, Kendoff D, Gebauer M, Gehrke T, Klauser W
Orthopädische Chirurgie, ENDO Klinik, Hamburg.
Z Orthop Unfall. 2012 Jun;150(3):290-5. doi: 10.1055/s-0031-1298529. Epub 2012 Jun 21.
Total knee arthroplasty (TKA) revisions are increasing due to the rising numbers of primary cases, younger patients and an aging population. The technical demand of these procedures is incomparable higher than in primary cases. Also the expectable clinical results are inferior. Measures to improve the clinical results are desireable. PATIENTS/MATERIAL: 203 unconstrained knee arthroplasties were explanted in 2009 in a single centre. In 150 cases those were TKAs. Fractures were excluded. These cases were analysed with special attention to the reason for the failure. Clinical and radiological data were included.
Survival of revised implants was in the mean 55 months (range: 0,5-125 months). In 46 cases components showed an aseptic loosening (30.7 %), 37 TKAs were unstable (24.7 %), in 26 cases stiffness was detected (17.3 %), and nine misplaced TKA components (five femoral, two tibial, two combined; total 6 %) as well as three broken inlays (2 %) were encountered. In 25 cases deep infection was observed (16.7 %) and four patients complained of an unspecific anterior knee pain (2.6 %). Three TKAs were removed for a two-staged procedure. In five cases an inlay exchange was performed and in another five cases a conversion from cruciate retaining to posterior stabilised state was performed. In 60 cases a rotating hinged TKA was implanted (40 %) and in 42 a pure hinge (28 %). In 45 cases a condylar constrained TKA system (CCK, 30 %) was used. Range of movement increased with the procedure. Plain radiographs were inferior in detecting all loosening in advance.
This study demonstrated that in more than one third of the cases the revision could have been avoided and was due to technical errors during the primary procedure. Infection and arthrofibrosis were besides unspecific complaints less often observed than is described in the literature. This study supports the high demand on the technical issues during the primary procedure which should be conducted by experienced surgeons. Registry data from Germany should allow the provision of more specific information in the future.
由于初次全膝关节置换术（TKA）病例数量不断增加、患者年轻化以及人口老龄化，TKA翻修手术的数量也在上升。这些手术的技术要求比初次手术高得多，而且预期的临床效果也较差。因此，需要采取措施来改善临床效果。
患者/材料：2009年，在一个中心取出了203例非限制性膝关节置换物，其中150例为TKA，排除了骨折病例。对这些病例进行了分析，特别关注失败原因，并纳入了临床和放射学数据。
翻修植入物的平均存活时间为55个月（范围：0.5 - 125个月）。46例组件出现无菌性松动（30.7%），37例TKA不稳定（24.7%），26例检测到僵硬（17.3%），发现9例TKA组件位置不当（5例股骨、2例胫骨、2例合并；共6%）以及3例嵌体断裂（2%）。25例观察到深部感染（16.7%），4例患者主诉膝关节前部非特异性疼痛（2.6%）。3例TKA因二期手术被取出。5例进行了嵌体置换，另外5例从保留交叉韧带状态转换为后稳定状态。60例植入了旋转铰链式TKA（40%），42例植入了纯铰链式（28%）。45例使用了髁限制型TKA系统（CCK，30%）。随着手术，活动范围增加。普通X线片在提前检测所有松动方面效果较差。
本研究表明，超过三分之一的病例翻修本可避免，原因在于初次手术时的技术失误。除了非特异性主诉外，感染和关节纤维化的发生率低于文献报道。本研究支持对初次手术技术问题的高要求，初次手术应由经验丰富的外科医生进行。德国的登记数据未来应能提供更具体的信息。
