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使用限制性髁膝关节假体联合后稳定型关节面进行全膝关节翻修术

Revision Total Knee Arthroplasty Using a Constrained Condylar Knee Prosthesis Combined with a Posterior Stabilized Articular Surface.

作者信息

Tsai Shang-Wen, Chen Cheng-Fong, Wu Po-Kuei, Chen Chao-Ming, Chen Wei-Ming

机构信息

Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.

Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

J Knee Surg. 2018 Feb;31(2):197-201. doi: 10.1055/s-0037-1603337. Epub 2017 May 23.

Abstract

Intraoperative assessment of valgus-varus stability is crucial for choosing articular surfaces with different levels of constraint. Legacy constrained condylar knee (CCK) prostheses are readily available to assemble and use with a CCK articular surface or a posterior stabilized (PS) articular surface in revision knee arthroplasty surgeries. We wanted to validate outcomes of revision total knee arthroplasty (TKA) using legacy CCK prostheses combined with a PS articular surface. Thirty-seven patients were enrolled and followed up for more than 2 years. Range of motion (ROM), the Knee Society score (KSS), the Knee Society functional score (KSS-F), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to evaluate outcomes. Follow-up was a mean of 86.5 months (range: 28-152 months). The mean age of the participants was 69.8 years (range: 31-86 years). The mean ROM was 110.5 degrees, the KSS was 86.2 points, the KSS-F was 68.3 points, and the WOMAC score was 22.6 points. Seven participants had implant failures: five because of delayed infections and two because of posterior dislocations. In conclusion, revision TKA using a CCK prosthesis combined with a PS articular surface might provide satisfactory mid-term outcomes. Delayed infection was the most common cause of implant failure. Dislocation might occur in middle-old or older patients despite careful intraoperative examination of valgus-varus stability, extension-flexion gap balancing, and signs of recurvatum.

摘要

术中评估内外翻稳定性对于选择不同约束程度的关节面至关重要。传统的限制性髁型膝关节(CCK)假体在翻修膝关节置换手术中很容易组装并与CCK关节面或后稳定型(PS)关节面配合使用。我们想要验证使用传统CCK假体结合PS关节面进行全膝关节置换翻修术(TKA)的效果。纳入37例患者并随访2年以上。采用活动范围(ROM)、膝关节协会评分(KSS)、膝关节协会功能评分(KSS-F)以及西安大略和麦克马斯特大学骨关节炎指数(WOMAC)来评估效果。随访时间平均为86.5个月(范围:28 - 152个月)。参与者的平均年龄为69.8岁(范围:31 - 86岁)。平均ROM为110.5度,KSS为86.2分,KSS-F为68.3分,WOMAC评分为22.6分。7名参与者出现植入物失败:5例是由于延迟感染,2例是由于后脱位。总之,使用CCK假体结合PS关节面进行TKA翻修术可能会提供令人满意的中期效果。延迟感染是植入物失败最常见的原因。尽管术中仔细检查了内外翻稳定性、屈伸间隙平衡和反屈迹象,但中老年人仍可能发生脱位。

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