He Yong, Ouyang Gui-lin, Xiao Lian-bo, Hu Jun-lin, Xia Qing, Huang Zheng, Han Da-peng, Zhu Fei, Sun Song-tao
Department of Orthopedics, Shanghai Guanghua Hospital, Shanghai 200052, China.
Department of Orthopedics, Shanghai Guanghua Hospital, Shanghai 200052, China. Email:
Zhonghua Yi Xue Za Zhi. 2013 Nov 19;93(43):3460-3.
To evaluate the outcomes of primary total knee arthroplasty (TKA) in the treatment of knee with severe lateral instability and summarize the essential points of operation and rehabilitation.
From February 2005 to August 2010, primary TKA was performed in 27 severe lateral unstable knees (25 cases), including 3 males (3 knees) and 22 females (24 knees). Their mean age was 57.8 (37-71) years. And their primary diseases included rheumatoid arthritis (22 knees in 21 cases) and osteoarthritis (5 knees in 4 cases). Thirteen lateral unstable knees were accompanied with 18.08° ± 5.96°(15-35°) varus deformity; in the rest 14 knees, there was medial instability with 20.71° ± 7.03° (15-35°) valgus deformity. Blood loss volume, operative duration and complications were recorded. During the follow-up period, HSS score, knee stability and varus/valgus status were recorded preoperatively, 1, 3, 6, 12 months and then annually postoperatively.
AORI type I bone defect was found at the proximal tibia in 18 knees and distal lateral femoral condyle in 10 knees. All defects were reconstructed with cement or autograft. AORI type II bone defects at proximal tibia in 3 knees were reconstructed with metal augmentation. Blood loss during the first 24 hours were (438.9 ± 109.5) (400-700) ml and operative duration (91.1 ± 11.6) (70-110) min. The mean follow-up period was (41.6 ± 10.9) (27-60) months. At the final follow-up, the HSS score increased from (45.8 ± 5.4) to (85.4 ± 4.5) (t = 30.15, P < 0.01) .Five knees in 5 cases had mild postoperative instability. All cases were allowed to walk with knee orthosis for 4-6 weeks. At the end of follow-up, mild lateral instability of 2 knees persisted. One augmented knee had osteolysis beneath metal block.
TKA for knees with severe lateral instability requires a deep understanding of causes and a rational treatment. Proper handling of bone defects and careful release of lateral soft tissue are two critical points for postoperative knee stability. Wearing knee orthosis during the early postoperative stage may be helpful or residual mild instability.
评估初次全膝关节置换术(TKA)治疗严重膝关节外侧不稳定的疗效,并总结手术及康复要点。
2005年2月至2010年8月,对27例(25例患者)严重膝关节外侧不稳定行初次TKA,其中男性3例(3膝),女性22例(24膝)。平均年龄57.8(37 - 71)岁。原发疾病包括类风湿关节炎(21例22膝)和骨关节炎(4例5膝)。13例外侧不稳定膝关节伴有18.08°±5.96°(15 - 35°)内翻畸形;其余14例膝关节存在内侧不稳定,伴有20.71°±7.03°(15 - 35°)外翻畸形。记录失血量、手术时间及并发症。随访期间,记录术前、术后1、3、6、12个月及之后每年的HSS评分、膝关节稳定性及内翻/外翻情况。
18例膝关节胫骨近端及10例膝关节股骨外侧髁发现AORI I型骨缺损。所有缺损均采用骨水泥或自体骨重建。3例胫骨近端AORI II型骨缺损采用金属垫块重建。术后24小时内失血量为(438.9±109.5)(400 - 700)ml,手术时间为(91.1±11.6)(70 - 110)分钟。平均随访时间为(41.6±10.9)(27 - 60)个月。末次随访时,HSS评分从(45.8±5.4)提高到(85.4±4.5)(t = 30.15,P < 0.01)。5例患者中的5膝术后有轻度不稳定。所有病例均佩戴膝关节矫形器行走4 - 6周。随访结束时,2膝仍存在轻度外侧不稳定。1例采用垫块重建的膝关节金属块下方出现骨溶解。
TKA治疗严重膝关节外侧不稳定需要深入了解病因并合理治疗。正确处理骨缺损及仔细松解外侧软组织是术后膝关节稳定的两个关键点。术后早期佩戴膝关节矫形器可能有助于改善残留的轻度不稳定。