Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, South Korea.
Clin Orthop Relat Res. 2013 May;471(5):1498-503. doi: 10.1007/s11999-012-2629-4.
Recently, high-flexion PCL-retaining (CR) and -substituting (PS) knee prostheses were designed to allow greater and safer flexion after TKA. However, the advantages of high-flexion TKA over standard design have been debated in terms of early maximal flexion. A recent study reported a high incidence of early loosening of the femoral component related to the deep flexion provided by high-flexion PS TKA.
QUESTIONS/PURPOSES: We determined whether high-flexion fixed bearing CR and PS prostheses would provide (1) a better flexion, (2) a better function, and (3) a higher incidence of radiographic loosening than TKA performed using standard fixed bearing CR prostheses in Asian patients.
From a total of 182 patients with primary unilateral TKA, we retrospectively reviewed 137 TKAs: 47 with high-flexion CR, 42 with high-flexion PS, and 48 with standard CR designs. ROM, Knee Society scores, and WOMAC scores were evaluated and compared among the three groups. Radiographically, we assessed radiolucent zones and component loosening. Minimum followup was 5 years (mean, 6.2 years; range, 5-8 years).
We found no differences among the three groups in mean maximal flexion (high-flexion CR: 135°; high-flexion PS: 134°; standard CR: 136°), Knee Society scores, and WOMAC scores at last followup. Also, there were no differences among the three groups in terms of radiolucent lines around the prosthesis. No patient in any group had loosening of the femoral component.
The high-flexion CR or PS design had no advantages over the standard CR design with respect to ROM, clinical scores, and radiolucent lines around the femoral or tibial component after 5 years' followup.
最近，设计了高屈曲 PCL 保留（CR）和替代（PS）膝关节假体，以允许 TKA 后更大且更安全的屈曲。然而，高屈曲 TKA 在早期最大屈曲方面优于标准设计的优势存在争议。最近的一项研究报告称，与高屈曲 PS TKA 提供的深屈曲相关，股骨组件早期松动的发生率很高。
问题/目的：我们确定高屈曲固定轴承 CR 和 PS 假体是否会提供（1）更好的屈曲，（2）更好的功能，以及（3）与使用标准固定轴承 CR 假体进行的 TKA 相比，在亚洲患者中更高的放射学松动发生率。
从总共 182 例初次单侧 TKA 的患者中，我们回顾性地回顾了 137 例 TKA：47 例使用高屈曲 CR，42 例使用高屈曲 PS，48 例使用标准 CR 设计。评估并比较了三组的 ROM、膝关节协会评分和 WOMAC 评分。在放射学上，我们评估了透亮区和组件松动。最低随访时间为 5 年（平均 6.2 年；范围 5-8 年）。
我们发现三组之间的平均最大屈曲（高屈曲 CR：135°；高屈曲 PS：134°；标准 CR：136°）、膝关节协会评分和 WOMAC 评分在最后随访时均无差异。三组之间在假体周围的透亮线也没有差异。任何一组都没有患者出现股骨组件松动。
在 5 年随访后，高屈曲 CR 或 PS 设计在 ROM、临床评分以及股骨或胫骨组件周围的透亮线方面与标准 CR 设计相比没有优势。
