Yang Cheng-Pang, Hsu Kuo-Yao, Chang Yu-Han, Chan Yi-Sheng, Shih Hsin-Nung, Chen Alvin Chao-Yu
Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou and University College of Medicine, 5th, Fu-Shin Street, Kweishan Dist, Taoyuan, 333, Taiwan, Republic of China.
J Orthop Surg Res. 2018 Feb 13;13(1):35. doi: 10.1186/s13018-018-0738-9.
Reports of diverse outcomes in modular mini-keel tibial componentry for total knee arthroplasty (TKA) have raised concerns about early aseptic loosening. Cruciate-retaining (CR) prostheses, using mini-keel implants, have yet to be reported and compared to posterior-stabilizing (PS) designs.
A retrospective, case-matched study of 91 consecutive TKAs (n = 46 CR; n = 45 PS prostheses), using modular mini-keel tibial componentry with a 45-mm drop down stem extension, was conducted. The Knee Society Score functional survey, radiographic analysis including alignment and periprosthetic radiolucency, TKA prosthesis longevity, and surgical complications were reported and compared between CR and PS groups.
The Knee Society Score at 5-year follow-up averaged 81.67 ± 11.97 and 80.12 ± 14.16 in the CR and PS groups, respectively (p = 0.29). The femorotibial angle averaged 5.85° ± 2.62° and 5.85° ± 3.27° valgus in the CR and PS groups, respectively (p = 0.60). The average tibial component angle was 0.46° ± 1.6° and 0.61° ± 1.3° varus in the CR and PS groups, respectively (p = 0.30); posterior inclination averaged 2.28° ± 2.36° and 1.93° ± 2.72° in the CR and PS groups, respectively (p = 0.51). Radiolucency was noted in 17 zones of the CR group and in 9 zones of the PS group (p = 0.24). Three TKAs required further surgery: one locking plate fixation for a periprosthetic tibial fracture (PS group) and two revision TKAs (one CR infection and one PS fracture).
Modular mini-keel tibial components showed good reliability and results with both CR and PS prostheses in minimally invasive surgery TKA.
全膝关节置换术（TKA）中模块化微型龙骨胫骨组件出现了多种不同结果的报道，这引发了人们对早期无菌性松动的担忧。使用微型龙骨植入物的保留交叉韧带（CR）假体尚未见报道，也未与后稳定（PS）设计进行比较。
对91例连续的TKA进行回顾性病例对照研究（n = 46例CR；n = 45例PS假体），使用带有45毫米下拉式柄部延长的模块化微型龙骨胫骨组件。报告并比较CR组和PS组的膝关节协会评分功能调查、包括对线和假体周围透亮线的影像学分析、TKA假体使用寿命以及手术并发症。
CR组和PS组在5年随访时膝关节协会评分平均分别为81.67±11.97和80.12±14.16（p = 0.29）。CR组和PS组股胫角平均分别为外翻5.85°±2.62°和5.85°±3.27°（p = 0.60）。CR组和PS组胫骨组件平均角度分别为内翻0.46°±1.6°和0.61°±1.3°（p = 0.30）；后倾角在CR组和PS组平均分别为2.28°±2.36°和1.93°±2.72°（p = 0.51）。CR组17个区域和PS组9个区域出现透亮线（p = 0.24）。3例TKA需要进一步手术：1例为PS组因假体周围胫骨骨折行锁定钢板固定，2例为翻修TKA（1例CR感染和1例PS骨折）。
在微创TKA中，模块化微型龙骨胫骨组件在CR和PS假体中均显示出良好的可靠性和效果。
