Melton J T K, Mayahi R, Baxter S E, Facek M, Glezos C
Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
J Bone Joint Surg Br. 2012 Aug;94(8):1067-70. doi: 10.1302/0301-620X.94B8.28350.
A consecutive series of patients with a hydroxyapatite-coated uncemented total knee replacement (TKR) performed by a single surgeon between 1992 and 1995 was analysed. All patients were invited for clinical review and radiological assessment. Revision for aseptic loosening was the primary outcome. Assessment was based on the Knee Society clinical score (KSS) and an independent radiological analysis. Of 471 TKRs performed in 356 patients, 432 TKRs in 325 patients were followed for a mean of 16.4 years (15 to 18). The 39 TKRs in 31 patients lost to follow-up had a mean KSS of 176 (148 to 198) at a mean of ten years. There were revisions in 26 TKRs (5.5%), of which 11 (2.3%) were for aseptic loosening. Other further surgery was carried out on 49 TKRs (10.4%) including patellar resurfacing in 20, arthrolysis in 19, manipulation under anaesthetic in nine and extensor mechanism reconstruction in one. Survivorship at up to 18 years without aseptic loosening was 96% (95% confidence interval 91.9 to 98.1), at which point the mean KSS was 176 (134 to 200). Of 110 knees that underwent radiological evaluation, osteolysis was observed in five (4.5%), one of which was revised. These data indicate that uncemented hydroxyapatite-coated TKR can achieve favourable long-term survivorship, at least as good as that of cemented designs.
对1992年至1995年间由同一位外科医生进行的一系列连续的羟基磷灰石涂层非骨水泥全膝关节置换术（TKR）患者进行了分析。所有患者均被邀请进行临床复查和影像学评估。无菌性松动翻修是主要观察指标。评估基于膝关节协会临床评分（KSS）和独立的影像学分析。在356例患者中进行的471例TKR中，对325例患者的432例TKR进行了平均16.4年（15至18年）的随访。31例患者的39例TKR失访，平均十年时的平均KSS为176（148至198）。26例TKR（5.5%）进行了翻修，其中11例（2.3%）是因为无菌性松动。另外49例TKR（10.4%）进行了其他进一步手术，包括20例髌骨表面置换、19例关节松解、9例麻醉下手法操作和1例伸肌机制重建。至18年无无菌性松动的生存率为96%（95%置信区间91.9至98.1），此时平均KSS为176（134至200）。在接受影像学评估的110个膝关节中，观察到5例（4.5%）出现骨溶解，其中1例进行了翻修。这些数据表明，非骨水泥羟基磷灰石涂层TKR可实现良好的长期生存率，至少与骨水泥型设计相当。
