Stempin Radosław, Stempin Kacper, Kaczmarek Wiesław, Dutka Julian
Department of Orthopedic & Trauma Surgery, J. Strus Memorial (Multispecialistic City) Hospital, Poznan, Poland.
Department of Orthopedic & Trauma Surgery, Westallgäu Clinic, Wangen, Germany.
Open Orthop J. 2018 Jun 14;12:196-202. doi: 10.2174/1874325001812010196. eCollection 2018.
There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA).
The study aimed to assess midterm survivorship of the Vanguard cementless system, and to demonstrate the utility of the Bone Hardness Test (BHT) for the selection of cementless fixation TKA.
From September 2009 through November 2014, 123 total knee arthroplasties were completed, with cementless Vanguard Cruciate Retaining TKA in 110 knees (102 patients) and cemented Vanguard in 13 cases (12 patients). Implant fixation was based on intraoperative assessment of posterior cruciate ligament stability, bone quality, and BHT. All patients with a cementless Vanguard implant were eligible for this retrospective study. Preoperative and postoperative Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were obtained. Standardized standing anteroposterior and lateral radiographs were taken.
Three patients (4 TKAs) were lost to follow-up. The mean follow-up time was 5.5 ± 1.4 years. All scores significantly improved postoperatively. No radiographic failures were observed. Five-year implant survival, with revision of any component for any reason as an endpoint, was 97.2% (95% confidence interval, 91.7 - 99.1%). Five-year survival with revision for aseptic loosening was 100%. Only one knee required revision due to an isolated unrelated bearing exchange, and two additional knees required secondary resurfacing of the patella for retropatellar pain.
Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis. The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA.
对于全膝关节置换术（TKA）使用非骨水泥型或骨水泥型固定存在持续的争论。
本研究旨在评估先锋非骨水泥系统的中期生存率，并证明骨硬度测试（BHT）在选择非骨水泥固定TKA中的实用性。
从2009年9月至2014年11月，共完成123例全膝关节置换术，其中110膝（102例患者）采用非骨水泥型先锋十字韧带保留TKA，13例（12例患者）采用骨水泥型先锋。植入物固定基于术中对后交叉韧带稳定性、骨质和BHT的评估。所有使用非骨水泥型先锋植入物的患者均符合本回顾性研究的条件。获取术前和术后的膝关节协会评分以及西安大略和麦克马斯特大学骨关节炎指数。拍摄标准化的站立前后位和侧位X线片。
3例患者（4个TKA）失访。平均随访时间为5.5±1.4年。所有评分术后均显著改善。未观察到影像学失败。以因任何原因对任何组件进行翻修为终点的5年植入物生存率为97.2%（95%置信区间为91.7 - 99.1%）。因无菌性松动进行翻修的5年生存率为100%。仅1膝因孤立的无关轴承更换需要翻修，另外2膝因髌后疼痛需要进行髌骨二次表面置换。
非骨水泥型先锋十字韧带保留TKA治疗骨关节炎取得了良好的中期结果。骨硬度测试似乎是确定非骨水泥型TKA选择的有效方法。
