Streitbuerger Arne, Hardes Jendrik, Gosheger Georg, Dieckmann Ralf, Hoell Steffen
Department of Orthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, NRW, Germany.
Department of Orthopedics, Paracelsus-Klink Osnabrück, Osnabrück, Germany.
Arch Orthop Trauma Surg. 2016 Aug;136(8):1077-83. doi: 10.1007/s00402-016-2491-z. Epub 2016 Jul 1.
Massive bone loss of the femur condyles in revision arthroplasty often requires modular-hinged revision implants to restore a stable joint situation. In the present series, the outcome after knee revision surgery using a single modular-hinged revision implant in patients with severe bone defects (>Engh III) is investigated.
Sixty patients with severe bone defects (≥Engh III) after failed primary and revision knee arthroplasty were included. Medium follow-up was 47 (range 10-84) months after knee revision surgery. Medium patient age was 70 (range 33-87) years at the time of surgery. An average of 2.3 prior knee operations per patient was performed. 70 % of the patients required the knee revision implant after two-stage revision because of a deep implant infection.
Estimated 5 year extremity survival was 95 and 65 % implant survival. Reasons for implant revision in decreasing order were reinfection (30 %), aseptic loosening (13 %), and periprosthetic fracture (9.8 %). The average active range of motion in the knee joint was 88° (range 40°-115°) for flexion. An extension deficit of a mean of -6° was (range -50-5° hyper-extension) observed. Patient age influenced the functional results significantly in terms of reduced walking distances and decreased modified WOMAC score.
In consideration of this complex study, population acceptable functional results can be achieved using a modular knee revision endoprosthesis. In younger patients (<60 years), satisfying results in terms of walking ability and overall satisfactory can be expected. The outcome in older multimorbid patients is worse. Yet, operation in these patients can be feasible to restore enough mobility for daily household activities.
翻修关节成形术中股骨髁的大量骨质流失通常需要模块化铰链式翻修植入物来恢复稳定的关节状况。在本系列研究中，对严重骨缺损（>Engh III级）患者使用单一模块化铰链式翻修植入物进行膝关节翻修手术后的结果进行了调查。
纳入60例初次和翻修膝关节置换失败后出现严重骨缺损（≥Engh III级）的患者。膝关节翻修手术后的中位随访时间为47个月（范围10 - 84个月）。手术时患者的中位年龄为70岁（范围33 - 87岁）。每位患者平均接受过2.3次先前的膝关节手术。70%的患者因深部植入物感染在两阶段翻修后需要使用膝关节翻修植入物。
估计5年肢体生存率为95%，植入物生存率为65%。植入物翻修的原因按降序排列为再感染（30%）、无菌性松动（13%）和假体周围骨折（9.8%）。膝关节的平均主动活动范围为屈曲88°（范围40° - 115°）。观察到平均伸直受限为 - 6°（范围 - 50°至5°过伸）。患者年龄在行走距离缩短和改良WOMAC评分降低方面对功能结果有显著影响。
考虑到这项复杂的研究，使用模块化膝关节翻修假体可以获得患者可接受的功能结果。在年轻患者（<60岁）中，在行走能力方面可获得令人满意的结果，总体满意度较高。老年多病患者的结果较差。然而，对这些患者进行手术对于恢复日常家务活动的足够活动能力可能是可行的。
