Cook S D, Barrack R L, Thomas K A, Haddad R J
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112.
J Arthroplasty. 1989;4 Suppl:S33-43. doi: 10.1016/s0883-5403(89)80005-1.
Histologic and radiographic analysis was performed on 85 porous-coated, uncemented knee components (26 femoral, 34 tibial, and 25 patellar) retrieved from 45 patients for malposition or instability, unexplained pain, late infection, postmortem or postamputation, and posttrauma. No component was clinically or radiographically loose at the time of removal. The average patient age at removal was 62.1 years (range, 39-85 years), and the average time in situ was 12.4 months (range, 2 weeks to 53 months). Radiographs from 31 of the 45 patients (69%) were examined for implant alignment, fit, subsidence, loose beads, and the presence of sclerotic and lucent lines. Histologic and microradiographic sections of the implant and adherent tissue were examined for type, amount, and anatomic location of tissue ingrowth. Overall, 52% of the components showed no evidence of bone ingrowth, 29% showed minimal (less than 2%), 12% showed moderate (2-5%), and 7% showed extensive (5-10%) bone ingrowth. In no case was bone present in more than 10% of the available pore volume of any component. There were no significant differences in the incidence or extent of bone ingrowth among femoral, tibial, and patellar components, nor in the extent of bone ingrowth observed in comparing different implant designs, materials, or porous coating types. When bone ingrowth was observed, the anatomic location was consistent in each type of component. The presence of a lucent line radiographically was indicative of fibrous encapsulation, while a sclerotic line or absence of any radiographic abnormality was seen with both fibrous tissue and bone ingrowth.
对从45例患者身上取出的85个多孔涂层、非骨水泥型膝关节组件（26个股骨组件、34个胫骨组件和25个髌骨组件）进行了组织学和影像学分析，这些组件因位置不当或不稳定、不明原因疼痛、晚期感染、尸检或截肢后以及创伤后而被取出。取出时，没有一个组件在临床或影像学上出现松动。取出时患者的平均年龄为62.1岁（范围39 - 85岁），平均在位时间为12.4个月（范围2周 - 53个月）。对45例患者中的31例（69%）的X线片进行了检查，以评估植入物的对线、匹配度、下沉情况、松动的骨珠以及硬化线和透亮线的存在情况。对植入物及附着组织的组织学和显微放射学切片进行了检查，以确定组织长入的类型、数量和解剖位置。总体而言，52%的组件没有骨长入的证据，29%显示少量（少于2%）骨长入，12%显示中度（2% - 5%）骨长入，7%显示广泛（5% - 10%）骨长入。在任何组件的可用孔隙体积中，骨长入均未超过10%。股骨、胫骨和髌骨组件在骨长入的发生率或程度上没有显著差异，在比较不同的植入物设计、材料或多孔涂层类型时观察到的骨长入程度也没有显著差异。当观察到骨长入时，每种类型组件的解剖位置是一致的。影像学上透亮线的存在表明存在纤维包裹，而在纤维组织和骨长入时均可见硬化线或无任何影像学异常。
