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无柄受限髁假体是否会导致初次全膝关节置换术早期失败?

Does a non-stemmed constrained condylar prosthesis predispose to early failure of primary total knee arthroplasty?

作者信息

Deshmukh Ajit J, Rathod Parthiv A, Moses Michael J, Snir Nimrod, Marwin Scott E, Dayan Alan J

机构信息

NYU Hospital For Joint Diseases, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA.

VA New York Harbor Healthcare System, 423 E 23rd Street, New York, NY, 10010, USA.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3194-3199. doi: 10.1007/s00167-014-3494-3. Epub 2015 Jan 1.

Abstract

PURPOSE

The use of unlinked constrained condylar components (CCK) has been extended to primary total knee arthroplasty (TKA); however, there is limited literature on its outcomes. The purpose of this retrospective cohort study was to assess clinical outcomes of one particular design of primary, non-stemmed, unlinked constrained TKA and to compare them with a control group of PS-TKA utilizing the same implant design.

METHODS

The clinical and radiographic outcomes of 486-cemented, non-stemmed, primary TKA's performed by two surgeons at one institution using similar surgical algorithm, technique and prosthetic design were retrospectively reviewed. Primary TKA components were used in all knees; the only difference between groups was the type of polyethylene inserts used (CCK vs PS). Pre-operative deformity, knee society scores (KSS), range-of-motion (ROM), radiographic data and revision rates were compared.

RESULTS

Both groups had comparable demographics, pre-operative coronal plane alignment, ROM and KSS. At a mean follow-up of 3.5 years, no difference was found in ROM, KSS, radiographic outcomes and revision rates.

CONCLUSIONS

Cemented, primary, non-stemmed CCK-TKA offered comparable clinico-radiographic results to PS-TKA at short-term follow-up. Use of a semi-constrained insert without additional stems did not predispose to failure due to aseptic loosening with this implant design. Moreover, the rate of revision due to instability was lowered.

LEVEL OF EVIDENCE

Retrospective cohort study, Level III.

摘要

目的

非连接限制型髁间组件(CCK)已被应用于初次全膝关节置换术(TKA);然而,关于其疗效的文献有限。这项回顾性队列研究的目的是评估一种特定设计的初次、无柄、非连接限制型TKA的临床疗效,并将其与使用相同植入物设计的后交叉韧带保留型TKA(PS-TKA)对照组进行比较。

方法

回顾性分析了由同一机构的两位外科医生采用相似手术流程、技术和假体设计进行的486例骨水泥固定、无柄初次TKA的临床和影像学结果。所有膝关节均使用初次TKA组件;两组之间的唯一区别在于所使用的聚乙烯衬垫类型(CCK与PS)。比较了术前畸形、膝关节协会评分(KSS)、活动范围(ROM)、影像学数据和翻修率。

结果

两组在人口统计学、术前冠状面排列、ROM和KSS方面具有可比性。平均随访3.5年时,在ROM、KSS、影像学结果和翻修率方面未发现差异。

结论

在短期随访中,骨水泥固定的初次无柄CCK-TKA与PS-TKA的临床影像学结果相当。使用无额外柄的半限制型衬垫不会因这种植入物设计导致无菌性松动而引发失败。此外,因不稳定导致的翻修率降低。

证据水平

回顾性队列研究,III级。

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