Feng Xiao-Bo, Yang Cao, Fu De-Hao, Ye Shu-Nan, Liu Xian-Zhe, Chen Zhe, Rai Saroj, Yang Shu-Hua
Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
J Huazhong Univ Sci Technolog Med Sci. 2016 Apr;36(2):231-236. doi: 10.1007/s11596-016-1572-0. Epub 2016 Apr 13.
This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy (TKA) with use of NexGen® Legacy® Constrained Condylar Knee (CCK) prosthesis for severe knee deformity. Clinical data of 46 patients (48 knees in total, aged 61 years on average) with severe knee deformity who underwent TKA with NexGen® Legacy® CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months (range 40-90 months). The New Knee Society scoring (NKSS) system and the Hospital for Special Surgery (HSS) score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale (VAS) was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion (ROM) from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus (≥7°) in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior (A/P) view of X-ray films showed 4 radiolucent lines (RLL) in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.
本研究旨在探讨使用奈杰尔（NexGen）®传承（Legacy）®限制性髁型膝关节（CCK）假体行初次全膝关节置换术（TKA）治疗严重膝关节畸形的临床和影像学结果。回顾性分析了2007年12月至2012年2月期间46例（共48膝，平均年龄61岁）因严重膝关节畸形接受奈杰尔（NexGen）®传承（Legacy）®CCK假体TKA手术患者的临床资料。其中34膝为严重外翻且内侧副韧带功能不全，11膝为严重屈曲挛缩，经后方软组织松解后屈伸时无法实现膝关节平衡，2膝为夏科氏关节炎伴严重内翻和骨质缺损，1膝为创伤性骨关节炎伴严重内翻和韧带不稳定。平均随访时间为71个月（范围40 - 90个月）。采用新膝关节协会评分（NKSS）系统和特种外科医院（HSS）评分评估功能和临床结果。采用视觉模拟评分法（VAS）测量疼痛，并依据膝关节协会标准评估影像学图像。结果显示，在全部48膝中，1例术后3个月因胫骨短柄部件松动接受翻修手术。该队列6年假体生存率为97.9%。6年内无部件感染发生。NKSS和HSS评分术后有显著改善。患者满意度显著提高。疼痛评分显著降低。总功能评分从31.46±11.43提高至86.42±8.87，活动范围（ROM）从42.42°±23.57°提高至95.31°±23.45°，屈曲挛缩从5.31°±7.87°降至0.92°±1.80°。术前影像学检查显示其中37膝有过度外翻（≥7°），3膝有内翻畸形。术后48膝的股胫关节对线为外翻3.88°±1.76°。X线片前后位（A/P）显示48个胫骨部件中有4条透亮线（RLL）。结论是，使用CCK假体行TKA治疗无法通过软组织平衡的严重不稳定膝关节有效。
