Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
J Bone Joint Surg Am. 2018 May 16;100(10):865-870. doi: 10.2106/JBJS.17.00724.
Although tibial component loosening has been considered a concern after total knee arthroplasty without cement, such implants have been used in younger patients because of the potential for ingrowth and preservation of bone stock. However, mid-term and long-term studies of modern uncemented implants are lacking. We previously reported promising prospective 5-year outcomes after using an uncemented porous tantalum tibial component in patients who underwent surgery before the age of 60 years. The purpose of this study was to determine clinical and radiographic implant survivorship at 10 years in this large series of young patients.
The original cohort included 79 patients (96 knees) who were <60 years old at the time of surgery. All procedures were performed with an uncemented, posterior-stabilized femoral component and a porous tantalum monoblock tibial component by 1 high-volume arthroplasty surgeon at a single institution. Patients were followed prospectively. The Knee Society Score (KSS), radiographic findings, and any complications or revisions were recorded.
At the latest follow-up, 76% (60) of the 79 patients (74% [71] of the 96 knees) were available for evaluation or had undergone revision (n = 6); 7 patients had died with the implants in place, and 12 patients were lost to follow-up. The average follow-up for the available implants was 10 years (range, 8 to 12 years). There were no progressive radiolucencies on radiographic review. The mean functional KSS was 68 points (range, 0 to 100 points). All revisions were for reasons unrelated to tibial fixation: femoral component loosening (1), stiffness (1), pain and swelling (2), and instability (2). The all-cause revision rate was 6% (6 of 96 knees).
Uncemented porous tantalum monoblock tibial components provided reliable fixation, excellent radiographic findings, and satisfactory functional outcomes at a mean of 10 years postoperatively. We identified no cases of tibial component loosening. These promising clinical and radiographic results support the use of uncemented tibial components. Such implants may produce well-integrated, durable long-term constructs in young patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
虽然在全膝关节置换术中不使用水泥的情况下，胫骨部件松动已被认为是一个问题，但由于有植入物内生长和保留骨量的潜力，这些植入物已被用于年轻患者。然而，缺乏现代非骨水泥植入物的中期和长期研究。我们之前报道了在 60 岁以下患者中使用非骨水泥多孔钽胫骨组件的有前景的前瞻性 5 年结果。本研究的目的是确定在这一大群年轻患者中，该大型系列患者 10 年时的临床和影像学植入物存活率。
原始队列包括 79 名（96 膝）患者，在手术时年龄小于 60 岁。所有手术均由同一位高容量关节置换外科医生在一家机构中使用非骨水泥、后稳定股骨组件和多孔钽单体胫骨组件进行。对患者进行前瞻性随访。记录膝关节学会评分（KSS）、影像学发现以及任何并发症或修订情况。
在最近一次随访时，79 名患者中有 76%（60 名）（96 膝中的 74%[71 膝]）可进行评估或已接受翻修（n=6）；7 名患者去世时植入物仍在位，12 名患者失访。可评估植入物的平均随访时间为 10 年（8 至 12 年）。影像学检查未见进行性透亮线。平均功能 KSS 为 68 分（0 至 100 分）。所有翻修均与胫骨固定无关：股骨组件松动（1）、僵硬（1）、疼痛和肿胀（2）和不稳定（2）。所有原因的翻修率为 6%（96 膝中的 6 膝）。
非骨水泥多孔钽单体胫骨组件在平均 10 年的随访中提供了可靠的固定、出色的影像学发现和满意的功能结果。我们未发现胫骨组件松动的病例。这些有前途的临床和影像学结果支持使用非骨水泥胫骨组件。此类植入物可能在年轻患者中产生整合良好、耐用的长期结构。
治疗 IV 级。请参阅作者说明以获取完整的证据水平描述。
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