Vaishya Raju, Vijay Vipul, Agarwal Amit K
Department of Orthopaedics, Joint Replacement and Arthroscopy, Indraprastha Apollo Hospitals, New Delhi, India.
Indian J Orthop. 2018 Mar-Apr;52(2):154-160. doi: 10.4103/ortho.IJOrtho_166_16.
The options to perform total knee arthroplasty (TKA) with retained hardware in femur are mainly - removal of hardware, use of extramedullary guide, or computer-assisted surgery. Patient-specific blocks (PSBs) have been introduced with many potential advantages, but their use in retained hardware has not been adequately explored. The purpose of the present study was to outline and assess the usefulness of the PSBs in performing TKA in patients with retained femoral hardware. Materials and.
Nine patients with retained femoral hardware underwent TKA using PSBs. All the surgeries were performed by the same surgeon using same implants. Nine cases (7 males and 2 females) out of total of 120 primary TKA had retained hardware. The average age of the patients was 60.55 years. The retained hardware were 6 patients with nails, 2 with plates and one patient had screws. Out of the nine cases, only one patient needed removal of a screw which was hindering placement of pin for the PSB.
All the patients had significant improvement in their Knee Society Score (KSS) which improved from 47.0 to postoperative KSS of 86.77 ( < 0.00). The mechanical axis was significantly improved ( < 0.03) after surgery. No patient required blood transfusion and the average tourniquet time was 41 min.
TKA using PSBs is useful and can be used in patients with retained hardware with good functional and radiological outcome.
在股骨中保留内固定装置进行全膝关节置换术（TKA）的选择主要有——取出内固定装置、使用髓外导向器或计算机辅助手术。患者特异性截骨模块（PSB）已被引入，具有许多潜在优势，但在保留内固定装置的情况下其应用尚未得到充分探索。本研究的目的是概述并评估PSB在有股骨内固定装置的患者中进行TKA的实用性。材料与……
9例有股骨内固定装置的患者使用PSB进行了TKA。所有手术均由同一位外科医生使用相同的植入物进行。在总共120例初次TKA中，有9例（7例男性和2例女性）保留了内固定装置。患者的平均年龄为60.55岁。保留的内固定装置中，6例为钉子，2例为钢板，1例为螺钉。在这9例中，只有1例患者需要取出一颗妨碍PSB销钉放置的螺钉。
所有患者的膝关节协会评分（KSS）均有显著改善，从47.0提高到术后的KSS 86.77（<0.00）。术后机械轴显著改善（<0.03）。没有患者需要输血，平均止血带时间为41分钟。
使用PSB进行TKA是有用的，可用于有保留内固定装置的患者，功能和影像学结果良好。
