Müller M, Matziolis G, Falk R, Hommel H
Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Klinik für Unfall- und Wiederherstellungschirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland.
Orthopade. 2012 Nov;41(11):894-904. doi: 10.1007/s00132-012-1963-2.
The Journey Deuce bicompartmental knee system is intended for patients with medial and patellofemoral arthritis of the knee and is aimed at diversifying the treatment options for knee arthritis. The prosthesis consists of a combined femoral shield with a medial condylar resurfacing component and a fixed bearing unicondylar tibial knee prosthesis. The advantages of the Journey Deuce system compared to total knee arthroplasty (TKA) are the bone sparing and cruciate retaining implantation. Outcome studies and investigation with respect to success and revision rates are rare. Thus the aim of this study was to investigate the early functional outcome as well as the revision and complication rates in patients with a Journey Deuce prosthesis within the first 2 years.
In this study 43 patients (25 female/18 male, average age 62.4 ± 8 years and mean body mass index27.3 ± 4.5 kg/m(2)) underwent bicompartmental knee arthroplasty using the Journey Deuce prosthesis between March 2008 and March 2009. Inclusion criteria were clinically and radiographically confirmed patellofemoral arthritis, ligament stability and flexion > 90°. Exclusion criteria were extension deficits > 5°, axis deviation > 10° and patellofemoral malalignment. Patients were followed up for 6, 12 and 24 months postoperatively. Follow-up consisted of clinical and radiographical examination as well as a survey of the Knee Society score (KSS), a pain score (visual analog scale VAS, range 0-10) and a satisfaction score.
Of the patients 35 (82%) patients reached the 2-year follow-up and of these 35 patients 26 (75%) had a good to very good satisfaction, a mean KSS of 93 (range 65-100) and a minimal pain score of 1.2 (range 0-4). After 12 months all patients had a knee flexion of more than 90° (mean 116°, range 95°-140°). Loosening was not detected but 8 (18%) patients had to undergo revision within the first year due to persistent knee pain and instability.
Under clear indications and exact anatomical positioning the Journey Deuce prosthesis enables a good functional outcome; however, a high revision rate occurred in this study caused by technical complexity and insufficient variety of implant sizes which led to malalignment and instability. Additional positional guidance and a higher variability in implant sizes are required to enable an adequate treatment with anatomically correct positioning. The Journey Deuce prosthesis would then be a reasonable diversification of the endoprosthesis spectrum in knee arthroplasty and would allow a more individual and selective treatment of patients with knee arthritis.
Journey Deuce双髁膝关节系统适用于膝关节内侧和髌股关节炎患者，旨在使膝关节关节炎的治疗选择多样化。该假体由一个带有内侧髁表面置换组件的组合股骨护罩和一个固定承重单髁胫骨膝关节假体组成。与全膝关节置换术（TKA）相比，Journey Deuce系统的优势在于保留骨质和保留交叉韧带植入。关于成功率和翻修率的结果研究和调查很少。因此，本研究的目的是调查使用Journey Deuce假体的患者在最初2年内的早期功能结果以及翻修率和并发症发生率。
在本研究中，43例患者（25例女性/18例男性，平均年龄62.4±8岁，平均体重指数27.3±4.5kg/m²）在2008年3月至2009年3月期间使用Journey Deuce假体进行了双髁膝关节置换术。纳入标准为临床和影像学证实的髌股关节炎、韧带稳定性和屈曲>90°。排除标准为伸直受限>5°、轴线偏差>10°和髌股排列不齐。患者在术后6、12和24个月进行随访。随访包括临床和影像学检查以及膝关节协会评分（KSS）、疼痛评分（视觉模拟量表VAS,范围0-10）和满意度评分调查。
43例患者中有35例（82%）完成了2年随访，在这35例患者中，26例（75%）满意度为良好至非常好，平均KSS为93（范围65-100），最小疼痛评分为1.2（范围0-4）。12个月后，所有患者膝关节屈曲均超过90°（平均116°，范围95°-140°）。未检测到松动，但8例（18%）患者因持续膝关节疼痛和不稳定在第一年内不得不接受翻修。
在明确的适应症和精确的解剖定位下，Journey Deuce假体可实现良好的功能结果；然而，本研究中翻修率较高，原因是技术复杂性和植入物尺寸种类不足，导致排列不齐和不稳定。需要额外的位置引导和更大的植入物尺寸变异性，以实现解剖位置正确的充分治疗。届时，Journey Deuce假体将是膝关节置换术中假体谱的合理多样化，并将允许对膝关节关节炎患者进行更个体化和选择性的治疗。
