Gaillard R, Lustig S, Peltier A, Villa V, Servien E, Neyret P
Service d'orthopédie, Albert-Trillat Center, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
Service d'orthopédie, Albert-Trillat Center, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France.
Orthop Traumatol Surg Res. 2016 Dec;102(8):1061-1068. doi: 10.1016/j.otsr.2016.08.015. Epub 2016 Oct 19.
Despite excellent long-term outcomes, posterior stabilisation by a third condyle continues to receive unwarranted criticism regarding patellar complications and instability.
Complication rates with a tri-condylar posterior-stabilised implant are similar to those with other posterior-stabilised prostheses and have diminished over time due to improvements in prosthesis design.
Post-operative complications and revision rates were assessed retrospectively in a prospective cohort of 4189 consecutive patients who had primary total knee arthroplasty (TKA) using a tri-condylar posterior-stabilised implant (Wright-Tornier) and were then followed-up for at least 24 months. The analysis included 2844 knees. The prosthesis generations were HLS1, n=20; HLS2, n=220; HLS Evolution, n=636; HLS Noetos, n=1373; and HLS KneeTec, n=595. Complications were compared across generations by applying Fisher's exact test, and survival was compared using the Kaplan-Meier method.
At last follow-up, there had been 341 (12%) post-operative complications in 306 (10.8%) knees, including 168 (5.9%) related to the implant, 41 (1.4%) infections, and 132 (4.6%) secondary complications unrelated to the implant. Re-operation was required for 200 complications (7%), including 87 (3.1%) consisting in revision of the prosthesis. Implant-related complications were stiffness (n=67, 2.4%), patellar fracture (n=34, 1.2%), patellar clunk syndrome (n=25, 0.9%), patellar loosening (n=3, 0.1%), tibial/femoral loosening (n=15, 0.5%), polyethylene wear (n=3, 0.1%), and implant rupture (n=1, 0.04%). Significant differences across generations were found for stiffness (P<0.0001), patellar fracture (P=0.03), clunk syndrome (P=0.03), and polyethylene wear (P=0.004), whose frequencies declined from one generation to the next. Overall 10-year survival was 92% with no significant difference across generations (P=0.1).
Outcomes of tri-condylar posterior-stabilised TKA are similar to those obtained using other posterior-stabilised implants. Neither patellar complications nor instability are more common, and improvements in implant design have contributed to correct early flaws.
IV, historical cohort, retrospective assessment of prospectively collected data.
尽管长期效果良好，但三髁后稳定术在髌股并发症和不稳定方面仍受到无端批评。
三髁后稳定型植入物的并发症发生率与其他后稳定型假体相似，并且由于假体设计的改进，随着时间的推移并发症发生率有所降低。
对4189例连续接受初次全膝关节置换术（TKA）并使用三髁后稳定型植入物（Wright-Tornier）的患者进行前瞻性队列研究，对其术后并发症和翻修率进行回顾性评估，然后随访至少24个月。分析包括2844个膝关节。假体代别为HLS1，n = 20；HLS2，n = 220；HLS Evolution，n = 636；HLS Noetos，n = 1373；以及HLS KneeTec，n = 595。通过Fisher精确检验比较各代之间的并发症，并使用Kaplan-Meier方法比较生存率。
在最后一次随访时，306个（10.8%）膝关节出现了341例（12%）术后并发症，包括168例（5.9%）与植入物相关的并发症、41例（1.4%）感染以及132例（4.6%）与植入物无关的继发性并发症。200例并发症（7%）需要再次手术，其中87例（3.1%）为假体翻修。与植入物相关的并发症包括僵硬（n = 67，2.4%）髌骨折（n = 34，1.2%）、髌撞击综合征（n = 2个，0.9%）、髌骨松动（n = 3，0.1%）、胫骨/股骨松动（n = 15，0.5%）、聚乙烯磨损（n = 例，0.1%）以及植入物破裂（n = 1，0.04%）。各代之间在僵硬（P < 0.0001）、髌骨折（P = 0.03）、撞击综合征（P = 0.03）和聚乙烯磨损（P = 0.004）方面存在显著差异，其发生率逐代下降。总体10年生存率为92%，各代之间无显著差异（P = 0.1）。
三髁后稳定型TKA的结果与使用其他后稳定型植入物的结果相似。髌股并发症和不稳定都不更常见，并且植入物设计的改进有助于纠正早期缺陷。
IV级，历史队列研究，对前瞻性收集数据的回顾性评估。
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