Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
Kouseiren Takaoka Hospital, 5-10 Eirakutyo, Takaoka, Toyama, 933-8555, Japan.
Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2181-2188. doi: 10.1007/s00167-019-05512-4. Epub 2019 Apr 23.
Very little is known about the use of combined surface cementation (only tibial tray) and mobile-bearing tibial components in total knee arthroplasty (TKA). This study was investigated whether the index combinations show satisfactory clinical outcomes after mobile-bearing TKA using posterior cruciate ligament (PCL)-retaining meniscal-bearing (MB) and PCL-substituting rotating-platform (RP) TKA designed using different anteroposterior constraints.
This study is a retrospective evaluation of a prospective database. Five-year postoperative clinical outcomes were assessed in 127 patients (127 knees) and 122 patients (122 knees) who underwent TKA with an MB and RP design, respectively. The Hospital for Special Surgery (HSS) score, range of motion, loosening/radiolucency, and subsidence around both components were evaluated in the two designs.
The postoperative median HSS score was excellent in both the MB and RP groups (93 and 92, respectively). Postoperative flexion and extension did not differ between the two designs. Neither design showed > 2-mm radiolucencies raising concern for femoral or tibial implant stability. Five (2%) of 249 patients (5 knees) (MB, n = 4; RP, n = 1) showed detectable subsidence of the tibial component. However, no revision TKA had been performed by the 5-year follow-up because no patients had complaints severe enough to necessitate revision surgery.
Clinically good outcomes comparable with previous studies were obtained 5 years after mobile-bearing TKA with surface cementation using both MB and RP implant designs. Thus, equivalent mid-term clinical outcomes of the index combination can be obtained with other implant designs and cementation techniques.
Level II.
对于全膝关节置换术（TKA）中联合使用表面水泥固定（仅胫骨托）和活动衬垫胫骨组件，我们知之甚少。本研究旨在探讨在使用后交叉韧带（PCL）保留半月板承重（MB）和 PCL 替代旋转平台（RP）设计的 TKA 中，不同前后约束设计下，该指数组合采用活动衬垫 TKA 后是否能获得满意的临床结果。
本研究是对前瞻性数据库的回顾性评估。对分别接受 MB 和 RP 设计 TKA 的 127 例（127 膝）和 122 例（122 膝）患者进行了 5 年的术后临床结果评估。对两种设计的 HSS 评分、活动范围、松动/放射透亮性以及两个组件周围的下沉进行了评估。
两种设计的术后中位数 HSS 评分均为优秀（分别为 93 分和 92 分）。两种设计的术后膝关节屈伸度无差异。两种设计均未出现>2mm 的放射透亮线，提示股骨或胫骨植入物的稳定性无问题。在 249 例患者（5 例膝关节）（MB 组，n=4；RP 组，n=1）中，有 5 例（2%）可见胫骨组件可检测到的下沉。然而，在 5 年随访时，没有患者因出现足以需要进行翻修手术的严重问题而进行翻修 TKA。
在使用 MB 和 RP 植入物设计进行活动衬垫 TKA 后 5 年，获得了与之前研究相当的临床良好结果。因此，采用其他植入物设计和水泥固定技术也可获得相同的中期临床结果。
II 级。
