Chun Churl Hong, Kim Jeong Woo, Kim Sung Hun, Kim Bong Gyu, Chun Keun Churl, Kim Kwang Mee
Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.
Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Republic of Korea.
Knee. 2014 Mar;21(2):420-3. doi: 10.1016/j.knee.2013.04.012. Epub 2013 May 9.
Proper treatment of bone loss is essential for the long term durability of revision TKA. However, the method of choice in managing large bone defects is still under debate. We therefore assessed the mid to long term clinical and radiographic results of revision TKA using a fresh frozen femoral head allograft and a standard condylar implant or varus-valgus constrained prosthesis with a diaphyseal-engaging stem.
We retrospectively reviewed the records of 27 patients who had undergone revision TKA between August 1997 and March 2003 using a fresh frozen femoral head allograft and a standard condylar implant or varus-valgus constrained prosthesis with a diaphyseal-engaging stem. The median follow-up period was 107 months (range, 96-157 months).
Clinical evaluation revealed that the mean range of motion had increased from 71° to 113° and the mean Hospital for Special Surgery knee score had improved from 46 to 83 points. The overall tibio-femoral angle improved from varus 7.3° to valgus 6.l°. In 26 out of 27 knees, union was demonstrated at an average of seven months postoperatively, and there were no cases of collapse, disease transmission or stress fractures. In one knee, an infection recurred.
Our results demonstrate that femoral head allografts in treatment of severe bone defects are reliable and durable. If possible, less constrained prostheses with diaphyseal-engaging stems should be chosen for increased durability.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
对于翻修全膝关节置换术（TKA）的长期耐用性而言，恰当治疗骨质流失至关重要。然而，处理大的骨缺损时的选择方法仍存在争议。因此，我们评估了使用新鲜冷冻股骨头异体骨移植以及标准髁假体或带骨干嵌入柄的内翻-外翻限制性假体进行翻修TKA的中长期临床和影像学结果。
我们回顾性分析了1997年8月至2003年3月间27例行翻修TKA患者的记录，这些患者使用了新鲜冷冻股骨头异体骨移植以及标准髁假体或带骨干嵌入柄的内翻-外翻限制性假体。中位随访期为107个月（范围96 - 157个月）。
临床评估显示，平均活动范围从71°增加到113°，平均特种外科医院膝关节评分从46分提高到83分。整体胫股角从内翻7.3°改善为外翻6.1°。27例膝关节中有26例在术后平均7个月时显示骨愈合，且无塌陷、疾病传播或应力性骨折病例。1例膝关节感染复发。
我们的结果表明，股骨头异体骨移植治疗严重骨缺损可靠且持久。如有可能，应选择带骨干嵌入柄的限制性较小的假体以提高耐用性。
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者指南。
