Driesman Adam S, Macaulay William, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York.
J Knee Surg. 2019 Aug;32(8):704-709. doi: 10.1055/s-0039-1678686. Epub 2019 Feb 8.
Successful arthroplasty of the knee requires a stable foundation for implant placement, adequate mechanical alignment, and durable fixation. In the revision setting, the later may be difficult to obtain, especially in the setting of significant bone loss. While augments, cones, and sleeves have greatly enhanced the modern knee surgeon's ability to gain fixation in metaphyseal bone, stems continue to be a cornerstone tool in revision arthroplasty to bypass deficient or damaged bone surfaces to enhance structural stability of a revision construct. When placing a revision construct, there remains two options to assist with fixation, either fully cementing the entire implant or using a "hybrid" system, which combines an uncemented press-fit diaphyseal stem with cement in both the metaphysis and metaphysis-diaphysis junction of the keel. In this review, we discuss the history of these two techniques, evaluate the theoretical benefits and pitfalls, and assess the best evidence supporting each in the literature. To conclude, we will examine future directions and questions needed to better elucidate the best treatment options in a variety of revision scenarios.
成功的膝关节置换术需要为植入物放置提供稳定的基础、适当的机械对线以及持久的固定。在翻修手术中，后者可能难以实现，尤其是在存在大量骨丢失的情况下。虽然垫块、锥形体和套筒极大地提高了现代膝关节外科医生在干骺端骨中获得固定的能力，但柄仍然是翻修关节置换术中的一种基石工具，用于绕过缺损或受损的骨表面，以增强翻修结构的稳定性。在放置翻修结构时，仍有两种辅助固定的选择，要么将整个植入物完全用骨水泥固定，要么使用“混合”系统，该系统将非骨水泥压配骨干柄与干骺端及骨干-干骺端交界处的骨水泥相结合。在本综述中，我们讨论这两种技术的历史，评估其理论上的益处和缺陷，并评估文献中支持每种技术的最佳证据。最后，我们将探讨未来的方向以及为更好地阐明各种翻修情况下的最佳治疗选择所需解决的问题。
