Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT, 84108, USA,
Clin Orthop Relat Res. 2014 Jan;472(1):175-80. doi: 10.1007/s11999-013-3068-6.
The use of a highly conforming, anterior-stabilized bearing has been associated with clinical success in a limited number of studies.
QUESTIONS/PURPOSES: We compared Knee Society scores, radiographic results, complication rates, and revision rates with the use of anterior-stabilized bearings compared with cruciate-retaining (CR) bearings.
A series of 382 patients with 468 primary total knee arthroplasties (TKAs) between 2003 and 2008 with minimum 2-year followup were reviewed. Anterior-stabilized bearings comprised 49% (n = 228) of the sample and CR bearings consisted of 51% (n = 240). The decision to use an anterior-stabilized bearing was based on integrity of the posterior cruciate ligament (PCL) intraoperatively or after sacrifice of the PCL to achieve soft tissue balance. The tibial and femoral component designs were the same regardless of bearing choice. Outcomes were measured with Knee Society scores, complications, revision TKA, and survival. Radiographs were analyzed for component alignment and evidence of loosening.
There was no difference in Knee Society knee scores, radiographic alignment, component loosening, manipulation rate, major complications, or time to revision for patients between the two groups. However, the CR group had significantly more revisions than the anterior-stabilized group (21 CR [1.5%] versus seven anterior-stabilized [4.6%], p = 0.03) at a minimum followup of 5 months (mean, 42 months; range, 5-181 months).
The use of a highly congruent anterior-stabilized bearing for PCL substitution has comparable clinical and radiographic results to traditional CR TKA. These results suggest that this approach is an effective method to achieve stability without the PCL in primary TKA.
在有限数量的研究中，使用高度顺应性、前稳定型轴承与临床成功相关。
问题/目的：我们比较了前稳定型轴承与交叉韧带保留型（CR）轴承相比，在膝关节协会评分、影像学结果、并发症发生率和翻修率方面的差异。
回顾了 2003 年至 2008 年间的 382 例患者（468 例初次全膝关节置换术），其中至少随访 2 年。前稳定型轴承组占样本的 49%（n=228），CR 轴承组占 51%（n=240）。使用前稳定型轴承的决定是基于术中或在牺牲后交叉韧带（PCL）以获得软组织平衡的情况下 PCL 的完整性。无论轴承选择如何，胫骨和股骨组件设计都是相同的。结果测量采用膝关节协会评分、并发症、翻修 TKA 和生存率。对 X 线片进行了分析，以评估组件的对齐和松动情况。
两组患者的膝关节协会膝关节评分、影像学对齐、组件松动、翻修率、主要并发症或翻修时间无差异。然而，CR 组的翻修率明显高于前稳定型组（21 例 CR [1.5%]比 7 例前稳定型 [4.6%]，p=0.03），随访时间至少为 5 个月（平均 42 个月；范围 5-181 个月）。
在初次 TKA 中，使用高度一致的前稳定型轴承替代 PCL 具有与传统 CR TKA 相当的临床和影像学结果。这些结果表明，这种方法是一种有效的方法，可以在没有 PCL 的情况下实现稳定性。
