Gwam Chukwuweike U, Chughtai Morad, Khlopas Anton, Mohamed Nequesha, Elmallah Randa K, Malkani Arthur L, Mont Michael A
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2017 Aug;32(8):2480-2483. doi: 10.1016/j.arth.2017.02.065. Epub 2017 Mar 2.
Revision total knee arthroplasty (TKA) can often be challenging. The use of a new revision system may aid in providing better stability, improved function, fit, and implant longevity. Therefore, we assessed: (1) survivorship, (2) clinical outcomes, (3) postoperative complications, and (4) radiographic outcomes of patients who underwent revision TKA using this system.
Patients from 2 hospitals who underwent revision TKA using a newer generation revision knee system between June 2008 and December 2013 for component instability or aseptic loosening were included. There were 93 patients, who had a mean age of 65 years (range, 41-84 years), and a mean follow-up of 4 years (range, 2-7 years). Survivorship was assessed using Kaplan-Meier analysis. Radiographic analysis was performed using the new Knee Society Roentgenographic Evaluation and Scoring System.
Aseptic survivorship was 96% (95% confidence interval, 6.6-7.3), and all-cause survivorship was 94% (95% confidence interval, 6.4-7.2). There were 2 infections and 4 aseptic loosening cases. The mean Knee Society score was 86 points (range, 38-100 points) and the mean functional Knee Society score was 52 points (range, 15-90 points) at final follow-up. The mean postoperative extension and flexion were 2° (range, 0°-20°) and 106° (range, 20°-130°), respectively. There were 3 medical and 11 surgical complications. Excluding the aseptic and septic failures, there were no progressive radiolucencies or osteolysis at final follow-up.
At up to 7-year follow-up, this new revision system demonstrated excellent survivorship and good functional outcomes. Future studies should be prospective, comparative, and include larger cohorts for further assessment of this device.
全膝关节置换翻修术（TKA）通常具有挑战性。使用新的翻修系统可能有助于提供更好的稳定性、改善功能、贴合度以及植入物的使用寿命。因此，我们评估了：（1）生存率，（2）临床结果，（3）术后并发症，以及（4）使用该系统进行TKA翻修的患者的影像学结果。
纳入2008年6月至2013年12月期间在2家医院因假体不稳定或无菌性松动而使用新一代翻修膝关节系统进行TKA翻修的患者。共有93例患者，平均年龄65岁（范围41 - 84岁），平均随访4年（范围2 - 7年）。采用Kaplan - Meier分析评估生存率。使用新的膝关节协会X线评估和评分系统进行影像学分析。
无菌性生存率为96%（95%置信区间，6.6 - 7.3），全因生存率为94%（95%置信区间，6.4 - 7.2）。有2例感染和4例无菌性松动病例。末次随访时，膝关节协会平均评分为86分（范围38 - 100分），膝关节协会功能平均评分为52分（范围15 - 90分）。术后平均伸直和屈曲角度分别为2°（范围0° - 20°）和106°（范围20° - 130°）。有3例内科并发症和11例外科并发症。排除无菌性和感染性失败病例后，末次随访时无进行性透亮区或骨溶解。
在长达7年的随访中，这种新的翻修系统显示出优异的生存率和良好的功能结果。未来的研究应该是前瞻性、比较性的，并纳入更大的队列以进一步评估该装置。
