Schlegel U J, Bruckner T, Schneider M, Parsch D, Geiger F, Breusch S J
Center for Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany,
Arch Orthop Trauma Surg. 2015 May;135(5):703-8. doi: 10.1007/s00402-015-2190-1. Epub 2015 Mar 5.
Despite the clinical success of cemented TKA, aseptic loosening of the tibial component remains a potential long-term complication. Considering the constantly growing revision burden, there is a need for clarification regarding controversial views on primary fixation techniques. In this retrospective analysis, surface (SC) or full cementation (FC) of tibial components was compared in a matched-pair and long-term setting.
Matching pairs were identified in a patient series from 1989 to 1994. Hence, 25 primary TKA (SC) were compared to 42 TKA (FC). The study population included 34 patients with rheumatoid arthritis. Patients were matched in a 1:1.7 fashion according to age, gender and initial diagnosis. Outcome was assessed by multiple clinical parameters, detailed radiographic evaluation and survivorship analysis.
Clinical follow-up (FU) was at 10.3 years (range 1.5-15.6) for the SC and 12 years (range 0.2-16.2) for the FC group. Survivorship at 10 years was 100 % for the surface cemented trays and 93.3 % (95 % CI 80.5-100) for the fully cemented implants considering aseptic loosening as endpoint (p = 0.3918). Improvement of the AKS Score was greater in the SC group (p = 0.044) and patients in this group were more satisfied (p = 0.013). For any other clinical parameter, no difference could be observed (p > 0.05).
Results of this study showed no statistically significant difference regarding long-term survivorship for the two cementing techniques. This finding questions the claimed advantage of full cementation for tibial components. The presented data do not support the concern that surface cementation results in insufficient fixation in patients with rheumatoid arthritis.
尽管骨水泥型全膝关节置换术（TKA）在临床上取得了成功，但胫骨部件的无菌性松动仍是一种潜在的长期并发症。考虑到翻修负担不断增加，有必要澄清关于初次固定技术的争议观点。在这项回顾性分析中，对胫骨部件的表面（SC）或全骨水泥固定（FC）在配对和长期情况下进行了比较。
在1989年至1994年的患者系列中确定配对。因此，将25例初次TKA（SC）与42例TKA（FC）进行比较。研究人群包括34例类风湿性关节炎患者。根据年龄、性别和初始诊断，患者以1:1.7的方式进行配对。通过多个临床参数、详细的影像学评估和生存率分析来评估结果。
SC组的临床随访（FU）时间为10.3年（范围1.5 - 15.6年），FC组为12年（范围0.2 - 16.2年）。以无菌性松动为终点，10年时表面骨水泥固定托盘的生存率为100%，全骨水泥固定植入物的生存率为93.3%（95%可信区间80.5 - 100）（p = 0.39l8）。SC组美国膝关节协会（AKS）评分的改善更大（p = 0.044），该组患者更满意（p = 0.013）。对于任何其他临床参数，未观察到差异（p > 0.05）。
本研究结果表明，两种骨水泥固定技术在长期生存率方面无统计学显著差异。这一发现对全骨水泥固定用于胫骨部件所宣称的优势提出了质疑。所呈现的数据不支持表面骨水泥固定会导致类风湿性关节炎患者固定不足的担忧。
