Brown Thomas E, Harper Benjamin L, Bjorgul Kristian
Division of Adult Reconstruction, Department of Orthopaedics, University of Virginia, Charlottesville, Virginia 22903, USA.
Orthopedics. 2013 May;36(5):380-7. doi: 10.3928/01477447-20130426-10.
As a result of reading this article, physicians should be able to :1. Understand the rationale behind using uncemented fixation in total knee arthroplasty.2.Discuss the current literature comparing cemented and uncemented total knee arthroplasty3. Describe the value of radiostereographic analysis in assessing implant stability.4. Appreciate the limitations in the available literature advocating 1 mode of fixation in total knee arthroplasty. Total knee arthroplasty performed worldwide uses either cemented, cementless, or hybrid (cementless femur with a cemented tibia) fixation of the components. No recent literature review concerning the outcomes of cemented vs noncemented components has been performed. Noncemented components offer the potential advantage of a biologic interface between the bone and implants, which could demonstrate the greatest advantage in long-term durable fixation in the follow-up of young patients undergoing arthroplasty. Several advances have been made in the backing of the tibial components that have not been available long enough to yield long-term comparative follow-up studies. Short-term radiostereographic analysis studies have yielded differing results. Although long-term, high-quality studies are still needed, material advances in biologic fixation surfaces, such as trabecular metal and hydroxyapatite, may offer promising results for young and active patients undergoing total knee arthroplasty when compared with traditional cemented options.
阅读本文后，医生应能够：1. 理解全膝关节置换术中使用非骨水泥固定的基本原理。2. 讨论比较骨水泥型和非骨水泥型全膝关节置换术的当前文献。3. 描述放射立体分析在评估植入物稳定性方面的价值。4. 认识到现有文献中提倡全膝关节置换术单一固定方式的局限性。全球范围内进行的全膝关节置换术对假体部件采用骨水泥固定、非骨水泥固定或混合（股骨非骨水泥、胫骨骨水泥）固定方式。最近没有关于骨水泥型与非骨水泥型假体部件疗效的文献综述。非骨水泥型假体部件在骨与植入物之间提供了生物界面的潜在优势，这在接受关节置换术的年轻患者随访中可能在长期持久固定方面显示出最大优势。胫骨部件的衬背方面已取得了一些进展，但时间还不够长，无法得出长期的比较随访研究结果。短期放射立体分析研究得出了不同的结果。尽管仍需要长期、高质量的研究，但与传统骨水泥固定选项相比，生物固定表面（如小梁金属和羟基磷灰石）的材料进展可能为接受全膝关节置换术的年轻活跃患者带来有希望的结果。
