Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, The Netherlands.
Department of Orthopedics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1043-1048. doi: 10.1007/s00167-018-5235-5. Epub 2018 Oct 26.
Management of the severely stiff total knee arthroplasty (TKA) is challenging, with the outcome of revision arthroplasty being inferior compared to the outcome for other indications. The aim of this study was to analyse the outcome after revision TKA with hinged-type implants for severely stiff TKA [range of motion (ROM) ≤ 70°] at 2 years.
A cohort of 38 patients with a hinged-type revision TKA (Waldemar Link or RT-Plus) and preoperative ROM ≤ 70° were selected from a prospectively collected database. ROM, visual analogue scale (VAS) for pain and satisfaction and Knee Society Score (KSS) were obtained preoperatively and at 3 months, 1 year and 2 years. Pre- and postoperative outcome were compared at 2 years.
There was a significant increase in ROM and KSS. VAS pain scores did not differ significantly. The median ROM at 2 years was 90° (range 50°-125°) with a median gain of 45° (range 5°-105°). Median VAS pain was 28.5 (range 0-96) points and median VAS satisfaction was 72 (range 0-100) points at 2 years. Twelve patients suffered a complication. Recurrent stiff knee was the most frequently reported complication (n = 5).
Hinged-type revision TKA following a severely stiff TKA renders a significant, although moderate, clinical improvement at 2 years.
Retrospective case series. Level IV.
严重僵硬性全膝关节置换术（TKA）的治疗颇具挑战性，与其他适应证相比，翻修关节置换术的效果较差。本研究旨在分析严重僵硬性 TKA（活动度[ROM]≤70°）行铰链式翻修 TKA 术后 2 年的结果。
从前瞻性收集的数据库中选择了 38 例因严重僵硬性 TKA（Waldemar Link 或 RT-Plus）而行铰链式翻修 TKA 且术前 ROM≤70°的患者。在术前、术后 3 个月、1 年和 2 年时获取 ROM、视觉模拟评分（VAS）疼痛评分和满意度以及膝关节协会评分（KSS）。在术后 2 年时比较术前和术后的结果。
ROM 和 KSS 显著增加。VAS 疼痛评分无显著差异。2 年时的中位数 ROM 为 90°（范围 50°-125°），中位数增加 45°（范围 5°-105°）。2 年时的中位数 VAS 疼痛评分为 28.5（范围 0-96）分，中位数 VAS 满意度为 72（范围 0-100）分。12 例患者发生并发症。复发性僵硬性膝是最常报告的并发症（n=5）。
铰链式翻修 TKA 可显著改善严重僵硬性 TKA 的临床效果，尽管改善程度为中等。
回顾性病例系列。IV 级。
