Hospital Universitario Miguel Servet, Aragon Institute for Health Research (IIS Aragon), Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain.
Hospital Obispo Polanco, Avda Ruiz Jarabo S/N, 44002, Teruel, Spain.
Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3779-3785. doi: 10.1007/s00167-016-4298-4. Epub 2016 Sep 17.
Metaphyseal titanium sleeves have been used to provide cementless fixation in challenging bone defects in revision knee arthroplasty. The aim of this study was to evaluate the mid-term results of radiological and clinical outcomes, for metaphyseal sleeves in type 1B and 2 defects of tibia and femur under the hypothesis that they would provide stable and prolonged fixation.
One hundred and thirty-four patients were included in a prospective study to evaluate the outcomes of knee revision with sleeves, together with stems and varus-valgus constrained mobile bearing prosthesis. Median follow-up was 71.5 months (range 36-107). Analysis included American Knee Society Score (KSS), Western Ontario and Mcmaster Universities Osteoarthritis Index (WOMAC), SF12 Health Survey and radiographic assessment.
All clinical scores improved significantly in all patients during the follow-up. The median of Knee KSS increased from 33 to 78 and functional KSS from 30 to 80. The median of WOMAC pain index changed from 12 to 4; pre-operative median of WOMAC stiffness and WOMAC function score improved from 5 to 2 and from 45 to 14, respectively. The median of physical SF12 varied from 27 to 44, while mental SF-12 from 43 to 54. Radiological evaluation showed optimal osseous integration in all patients, and neither implant migration nor progressive radiolucency around components was observed. Complications included three cases of end-of-stem pain at tibial side and two revisions due to septic loosening in the first post-operative year. No aseptic loosening was reported.
The use of metaphyseal sleeves, in combination with uncemented stems and varus-valgus constrained components with rotating platform, has shown excellent mid-term results allowing osseous ingrowth with no evidence of osteolysis or displacement. This is a promising option for better implant fixation in revision TKA.
Case series with no comparison group, Level IV.
在膝关节翻修术中，使用干骺端钛套筒可提供骨水泥固定，以应对具有挑战性的骨缺损。本研究旨在评估在 1B 型和 2 型胫骨和股骨缺损中，干骺端套筒的中期影像学和临床结果，假设其能提供稳定且持久的固定。
对 134 例患者进行前瞻性研究，以评估带套筒、柄和内翻/外翻约束型活动平台假体的膝关节翻修结果。平均随访时间为 71.5 个月（范围 36-107）。分析包括美国膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、SF-12 健康调查和影像学评估。
所有患者在随访过程中所有临床评分均显著提高。Knee KSS 中位数从 33 增加到 78，功能 KSS 从 30 增加到 80。WOMAC 疼痛指数中位数从 12 变为 4；术前 WOMAC 僵硬和 WOMAC 功能评分中位数从 5 变为 2，从 45 变为 14。物理 SF12 中位数从 27 变为 44，而心理 SF-12 从 43 变为 54。影像学评估显示所有患者均获得了最佳的骨质整合，未观察到任何植入物迁移或组件周围进行性透亮线。并发症包括 3 例胫骨侧末端柄疼痛和 2 例术后第一年因感染性松动而翻修。未报告无菌性松动。
使用干骺端套筒，联合非骨水泥柄和内翻/外翻约束型带旋转平台的组件，已显示出出色的中期结果，可实现骨质长入，无骨质溶解或移位的证据。这是一种有前途的选择，可改善膝关节翻修术中的植入物固定。
无对照的病例系列研究，IV 级。
