Windsor R E, Scuderi G R, Moran M C, Insall J N
Hospital for Special Surgery, New York, NY 10021.
Clin Orthop Relat Res. 1989 Nov(248):15-9; discussion 19-20. doi: 10.1097/00003086-198911000-00005.
From 1974 to 1986, 1430 cemented primary total knee arthroplasties were available for analysis. These included 224 total condylar prostheses with a polyethylene tibial component, 289 posterior stabilized prostheses with a polyethylene tibial component, and 917 posterior stabilized prostheses with a metal-backed tibial component. There were 12 failures in the total condylar series including three infections (one early and two late), five loose tibial components, two loose femoral and tibial components, and two unstable arthroplasties. The posterior stabilized prosthesis with the polyethylene tibia demonstrated six failures including two loose tibial components, two loose femoral components, and one supracondylar femur fracture. The posterior stabilized prosthesis with the metal-backed tibial component was associated with seven failures including six infections (three early and three late) and one femoral loosening. No metal-backed tibial components have been revised for loosening. The overall failure rate in this series was 1.7% for all prostheses. The incidence of tibial loosening was 0.53% with an average time to failure of 4.7 years. The incidence of femoral loosening was 0.35% with an average time to failure of 2.0 years. Tibial loosening was related to error in technique: postoperative varus tibiofemoral alignment, varus tibial component position, and excessive tibial resection. The overall infection rate was 0.63% for all total knee arthroplasties, and all were secondary to gram-positive organisms. Presently, the posterior stabilized prosthesis with a metal-backed tibia is the authors' implant of choice. Technical error and infection are the major causes of failure.
1974年至1986年期间，共有1430例骨水泥固定型初次全膝关节置换术可供分析。其中包括224例带有聚乙烯胫骨部件的全髁假体、289例带有聚乙烯胫骨部件的后稳定型假体以及917例带有金属背衬胫骨部件的后稳定型假体。全髁假体系列中有12例失败，包括3例感染（1例早期和2例晚期）、5例胫骨部件松动、2例股骨和胫骨部件松动以及2例关节置换不稳定。带有聚乙烯胫骨的后稳定型假体有6例失败，包括2例胫骨部件松动、2例股骨部件松动和1例股骨髁上骨折。带有金属背衬胫骨部件的后稳定型假体有7例失败，包括6例感染（3例早期和3例晚期）和1例股骨松动。尚无因松动而翻修金属背衬胫骨部件的情况。该系列中所有假体的总体失败率为1.7%。胫骨松动的发生率为0.53%，平均失败时间为4.7年。股骨松动的发生率为0.35%，平均失败时间为2.0年。胫骨松动与技术失误有关：术后胫股内翻对线、胫骨部件内翻位置以及胫骨切除过多。所有全膝关节置换术的总体感染率为0.63%，均继发于革兰氏阳性菌。目前，作者首选的植入物是带有金属背衬胫骨的后稳定型假体。技术失误和感染是失败的主要原因。
