Marczak Dariusz, Kowalczewski Jacek, Czubak Jarosław, Okoń Tomasz, Synder Marek, Sibiński Marcin
Department of Orthopaedics, Postgraduate Medical Education Center, Otwock, Poland.
Department of Orthopaedics, Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland.
Indian J Orthop. 2017 May-Jun;51(3):324-329. doi: 10.4103/0019-5413.205684.
The original knee megaprostheses with fixed or rotating hinge articulation were custom made and only used for reconstruction of the knee following distal femoral or proximal tibial tumor resections. The aim of the study was to analyze the short- and mid-term results of revision total knee arthroplasty with Global Modular Replacement System (GMRS) used in difficult situations not amenable to reconstruction with standard total knee replacement implants.
Nine patients (9 knees) were treated with this comprehensive modular implant system, with a mean age of 73.7 years (range 56-83 years) and a mean followup of 5 years (range 3-8 years). Two patients were treated for distal femoral nonunion, five for distal femur periprosthetic fracture and two for periprosthetic joint infection.
The mean Knee Society Score: Knee and functional scores were 77.9 and 40 points, respectively. All demonstrated full extension and flexion was at least 90°. Recurrence of infection was present in one patient. No signs of loosening, dislocation, or implant failure were observed.
Based on our small series of patients that represent severe cases, GMRS provides relatively good mid-term functional results, pain relief, and good implant survivorship with a low complication rate. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability.
最初的带有固定或旋转铰链关节的膝关节大假体是定制的，仅用于股骨远端或胫骨近端肿瘤切除术后的膝关节重建。本研究的目的是分析在无法使用标准全膝关节置换植入物进行重建的困难情况下，使用全球模块化置换系统（GMRS）进行翻修全膝关节置换术的短期和中期结果。
9例患者（9个膝关节）接受了这种综合模块化植入系统治疗，平均年龄73.7岁（范围56 - 83岁），平均随访5年（范围3 - 8年）。2例患者因股骨远端骨不连接受治疗，5例因股骨远端假体周围骨折接受治疗，2例因假体周围关节感染接受治疗。
膝关节协会平均评分：膝关节评分和功能评分分别为77.9分和40分。所有患者均表现为完全伸直，屈曲至少90°。1例患者出现感染复发。未观察到松动、脱位或植入物失败的迹象。
基于我们这一小系列代表严重病例的患者，GMRS提供了相对良好的中期功能结果、疼痛缓解以及良好的植入物生存率，并发症发生率低。这种挽救性手术使年老体弱的患者能够尽早恢复行走能力。
