Orthopedic and Traumatology Unit 2, Santa Corona Hospital, Pietra Ligure, Savona, Italy.
Department of Surgical Sciences (DISC), Orthopaedic Clinic, Policlinico San Martino IST, Genova, Italy.
J Arthroplasty. 2018 Dec;33(12):3739-3745. doi: 10.1016/j.arth.2018.08.026. Epub 2018 Aug 30.
Femoral and tibial massive bone defects are common findings in septic total knee revision and pose considerable challenges for the orthopedic surgeon. The aim of this study was to report the midterm clinical and radiographic outcomes with the use of tantalum cones for the management of massive bone defects after 2-stage knee revision.
We retrospectively reviewed the medical records of 60 patients (mean age, 67.9 ± 8.8 years) treated with 94 tantalum cones associated with constrained or semiconstrained knee for massive bone loss (mean follow-up, 43.5 ± 17.4 months). In all cases, the indication was a staged revision for periprosthetic knee infection. Functional scores, radiographic outcomes, and implant survivorship were analyzed.
The mean Knee Society Score and Oxford Knee Score improved from 44.1 ± 7.4 and 19.2 ± 4.1 to 85.4 ± 5.6 and 38.4 ± 3.9 (P < .01), respectively. The mean flexion increased from 60.6° ± 15.5° to 96.8° ± 10.9° at the last evaluation (P < .01). The mean improvement in flexion contracture was 6.2 ± 8.0 (P < .01). Two failures (3.3%) due to periprosthetic knee infection recurrence were observed, but no cone-related mechanical failures were reported. The cone-related survival rate was 97.8%.
Excellent clinical and radiographic midterm outcomes were achieved with a low complication rate. Tantalum cones may be considered a safe and effective option in the management of massive bone defects also in septic knee revision surgery.
感染性全膝关节翻修中常见股骨和胫骨大骨缺损，这给骨科医生带来了相当大的挑战。本研究旨在报告使用钽锥体治疗 2 期膝关节翻修后大量骨缺损的中期临床和影像学结果。
我们回顾性分析了 60 例（平均年龄 67.9 ± 8.8 岁）患者的病历，这些患者因假体周围膝关节感染接受了 94 个钽锥体联合约束或半约束膝关节治疗大量骨丢失（平均随访 43.5 ± 17.4 个月）。所有病例的适应证均为分期翻修假体周围膝关节感染。分析了功能评分、影像学结果和植入物存活率。
膝关节协会评分和牛津膝关节评分从 44.1 ± 7.4 和 19.2 ± 4.1 分别提高到 85.4 ± 5.6 和 38.4 ± 3.9（P <.01）。最后评估时，平均屈曲度从 60.6°±15.5°增加到 96.8°±10.9°（P <.01）。平均屈曲挛缩改善 6.2 ± 8.0（P <.01）。观察到 2 例（3.3%）因假体周围膝关节感染复发而失败，但未报告与锥体相关的机械故障。锥体相关的存活率为 97.8%。
在感染性膝关节翻修手术中，使用钽锥体治疗大量骨缺损可获得良好的中期临床和影像学结果，并发症发生率低。钽锥体可被视为一种安全有效的选择。
