Department of Orthopaedics, State University of New York at Buffalo, Erie County Medical Center, Buffalo, New York.
Department of Orthopaedics, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2018 Apr;33(4):1082-1088. doi: 10.1016/j.arth.2017.11.043. Epub 2017 Dec 1.
Aseptic loosening of cemented and uncemented tibial components continues to be a source of implant failure after total knee arthroplasty (TKA) in the obese population. There is limited literature reviewing uncemented cruciate retaining (CR) components in the obese population.
A clinical and radiographic review was performed on 325 patients who underwent a cemented or uncemented TKA with a CR knee prosthesis and body mass index ≥30 kg/m between January 2010 and June 2013. Charts were reviewed for the incidence of revision due to aseptic loosening of the tibial baseplate, revision for any reason, incidence of radiolucent lines around the tibial baseplate, range of motion, and patient reported outcomes.
There was no statistically significant difference between groups in survivorship for aseptic loosening of the tibial component (99.4% uncemented, 99.3% cemented, P = .94) and overall survivorship (98.1% uncemented, 98.3% cemented, P = .90). The Lower Extremity Activity Scale and Forgotten Joint Score-12 clinical outcome measures were similar between groups (10.2 ± 3.7 vs 9.7 ± 3.4 and 66.1 ± 28.2 vs 64.9 ± 24.3, P = .33, P = .78, respectively). Postoperative knee flexion was similar between groups (114.6 ± 9.3 vs 114.1 ± 9.3, P = .67).
Our study demonstrated similar survivorship of this CR design for aseptic loosening of the tibial baseplate and overall revision rates in obese patients undergoing either an uncemented or cemented TKA. The uncemented and cemented groups had comparable clinical and radiographic short to mid-term outcomes when implanted in good alignment when treating end-stage knee osteoarthritis.
在肥胖人群中，全膝关节置换术（TKA）后，水泥固定和非水泥固定的胫骨部件的无菌性松动仍然是植入物失败的原因。关于肥胖人群中使用非水泥固定的交叉韧带保留型（CR）假体的文献有限。
对 2010 年 1 月至 2013 年 6 月间，BMI≥30kg/m²的 325 例接受水泥或非水泥固定 TKA 并使用 CR 膝关节假体的患者进行了临床和影像学回顾。对胫骨基板无菌性松动的翻修率、任何原因的翻修率、胫骨基板周围放射性透光线的发生率、活动范围以及患者报告的结果进行了图表审查。
在胫骨组件无菌性松动的生存率方面，两组之间无统计学差异（非水泥固定组为 99.4%，水泥固定组为 99.3%，P=0.94）和总体生存率（非水泥固定组为 98.1%，水泥固定组为 98.3%，P=0.90）。下肢活动量表和遗忘关节评分-12 临床结果测量在两组之间相似（10.2±3.7 与 9.7±3.4，66.1±28.2 与 64.9±24.3，P=0.33，P=0.78）。术后膝关节屈曲度在两组之间相似（114.6±9.3 与 114.1±9.3，P=0.67）。
我们的研究表明，在肥胖患者中，无论是接受非水泥固定 TKA 还是水泥固定 TKA，这种 CR 设计的胫骨基板无菌性松动和整体翻修率的生存率相似。当以良好的对线植入治疗终末期膝骨关节炎时，非水泥固定组和水泥固定组在短期至中期的临床和影像学结果具有可比性。
