Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2018 Mar;33(3):766-770. doi: 10.1016/j.arth.2017.10.009. Epub 2017 Oct 16.
Contemporary rotating hinge knee (RHK) prosthesis has shown improved survival rates over earlier generations. However, reports of high complication and mechanical failure rates highlight the need for more clinical outcome data in the complex primary and revision setting. The purpose of this study is to report our results of using a contemporary rotating hinge for complex primary and revision total knee arthroplasty.
Using a prospectively maintained surgical database, 79 knees in 76 patients who underwent an RHK of a single design for either a complex primary (14 knees) or revision total knee arthroplasty (65 knees) were identified. This included 19% undergoing an RHK for periprosthetic joint infection and 32.9% who had concomitant extensor mechanism repair. The cohort consisted of 60 women and 16 men with a mean age of 66.7 years (range 39-89) at the time of surgery. Patient outcomes were assessed using Knee Society Scores and radiographs were reviewed for signs of wear and loosening. Failure rates were estimated using Kaplan-Meier survival curves.
At a minimum of 2 years, 13 patients had died and 4 were lost to follow-up, leaving 62 knees in 59 patients who were followed for a mean of 55.2 months (range 24-146). The mean Knee Society Scores improved from 35.7 to 66.2 points (P < .01). The incidence of complications was 38.7%. The most common complications were periprosthetic fracture, extensor mechanism rupture, and periprosthetic infection. Estimated survival was 70.7% at 5 years.
Despite improvements in design and biomaterials, there remains a relatively high complication rate associated with the use of a modern RHK implant. While aseptic loosening was rare, periprosthetic fracture, infection, and extensor mechanism failure were substantial emphasizing the complex nature of these cases.
与早期几代产品相比，现代旋转铰链膝关节（RHK）假体的存活率有所提高。然而，高并发症和机械故障发生率的报告突显了在复杂的初次和翻修环境中需要更多临床结果数据。本研究的目的是报告我们使用现代旋转铰链进行复杂初次和翻修全膝关节置换术的结果。
使用前瞻性维护的手术数据库，确定了 76 名患者的 79 膝接受了单一设计的 RHK，其中 14 膝为复杂初次置换，65 膝为翻修全膝关节置换。这包括 19%的患者因假体周围关节感染而行 RHK，32.9%的患者同时行伸肌机制修复。该队列包括 60 名女性和 16 名男性，手术时的平均年龄为 66.7 岁（范围 39-89）。使用膝关节协会评分评估患者的结果，并对影像学进行检查以观察磨损和松动的迹象。使用 Kaplan-Meier 生存曲线估计失败率。
至少随访 2 年时，有 13 名患者死亡，4 名患者失访，59 名患者中有 62 膝随访，平均随访时间为 55.2 个月（范围 24-146）。膝关节协会评分从 35.7 分提高到 66.2 分（P<0.01）。并发症发生率为 38.7%。最常见的并发症是假体周围骨折、伸肌机制破裂和假体周围感染。估计 5 年生存率为 70.7%。
尽管设计和生物材料有所改进，但现代 RHK 植入物的使用仍存在相对较高的并发症发生率。虽然无菌性松动罕见，但假体周围骨折、感染和伸肌机制失败较为严重，强调了这些病例的复杂性。
