Chun Keun Churl, Lee Sung Hyun, Baik Jong Seok, Kook Seng Hwan, Han Joung Kyue, Chun Churl Hong
Department of Orthopedic Surgery, School of Medicine, Wonkwang University, 895, Muwang-Ro, Iksan, 54538, South Korea.
Collage of Sports Science, Chung-Ang University, Anseong, South Korea.
J Orthop Surg Res. 2017 Oct 2;12(1):144. doi: 10.1186/s13018-017-0646-4.
The purpose of this study is to analyze clinical and radiological outcomes of patients (with a minimum of 14 years of follow-up) who underwent cruciate-retaining (CR) total knee arthroplasty (TKA) using a NexGen®-CR, comparing a patellar resurfacing group with a patellar retention group.
From June 1996 to April 2002, 116 cases of TKA using a NexGen®-CR who had at least 14 years of follow-up were enrolled in this study. Among them, 68 cases had patellar resurfacing and 48 had patellar retention. The average follow-up period was 14.8 years (14.1-18.7). Clinical scores and range of motion (ROM) were evaluated preoperatively and at the last follow-up in all patients. The Hospital for Special Surgery (HSS) score, Knee Society Score (KSS), Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score, and a new patellar score were assessed. Radiological evaluations are done by analyzing the tibiofemoral angle, loosening, and a radiolucent line on the radiograph by American Knee Society Roentgen Graphic Evaluation.
The average HSS score of both the patellar resurfacing group and retention group increased from 42.3 and 41.2 preoperatively to 90.2 and 90.8 at the last follow-up, respectively. The KSS, WOMAC score, patellar score, and knee joint ROM also improved significantly in both groups. However, there were no significant differences in clinical results between the two groups. On the radiological evaluation, the tibiofemoral angle in both groups had improved from varus 7.8° and 7.2° preoperative to valgus 4.9° and 4.8°, respectively. The average angles of α, β, γ, and δ were 94.1°, 90.4°, 3.2°, and 87.8° in the patellar resurfacing group and 94.4°, 89.8°, 3.3°, and 88.1° in the patellar retention group, respectively. A radiolucent line shown on radiograph was noted in a total of seven cases, three in the patellar resurfacing group and four in the patellar retention group. In the patellar resurfacing group, among the seven zones on the tibia radiograph, all cases were located at the medial side of tibia and two cases were in zone 1 and one case in zone 2, and in the patellar retention group, three cases were in zone 1 and 1 case was in zone 2, also located on the same side.
We achieved satisfactory clinical and radiological outcomes on long-term follow-up when performing TKAs with a NexGen®-CR. There was no significant difference in clinical or radiological results between the patellar resurfacing and retention groups in our study.
本研究旨在分析使用NexGen®-CR进行十字韧带保留型（CR）全膝关节置换术（TKA）的患者（至少随访14年）的临床和放射学结果，比较髌骨表面置换组和髌骨保留组。
1996年6月至2002年4月，本研究纳入了116例使用NexGen®-CR且至少随访14年的TKA病例。其中，68例进行了髌骨表面置换，48例进行了髌骨保留。平均随访期为14.8年（14.1 - 18.7年）。对所有患者在术前和最后一次随访时评估临床评分和活动范围（ROM）。评估了特种外科医院（HSS）评分、膝关节协会评分（KSS）、西安大略和麦克马斯特大学骨关节炎（WOMAC）评分以及一项新的髌骨评分。通过美国膝关节协会X线片评估分析X线片上的胫股角、松动情况和透亮线进行放射学评估。
髌骨表面置换组和保留组的平均HSS评分分别从术前的42.3和41.2提高到最后一次随访时的90.2和90.8。两组的KSS、WOMAC评分、髌骨评分和膝关节ROM也均有显著改善。然而，两组之间的临床结果无显著差异。在放射学评估中，两组的胫股角分别从术前的内翻7.8°和7.2°改善到外翻4.9°和4.8°。髌骨表面置换组α、β、γ和δ的平均角度分别为94.1°、90.4°、3.2°和87.8°，髌骨保留组分别为94.4°、89.8°、3.3°和88.1°。X线片上共发现7例有透亮线，髌骨表面置换组3例，髌骨保留组4例。在髌骨表面置换组的胫骨X线片的7个区域中，所有病例均位于胫骨内侧，2例在区域1，1例在区域2，而在髌骨保留组中，3例在区域1，1例在区域2，也位于同一侧。
使用NexGen®-CR进行TKA时，我们在长期随访中获得了满意的临床和放射学结果。在我们的研究中，髌骨表面置换组和保留组之间的临床或放射学结果无显著差异。
