Department for Joint Replacement and Restoration, Diakovere Annastift Hannover, Hannover, Germany.
Department for Joint Replacement and Restoration, Paracelsus-Klinik am Silbersee Hannover-Langenhagen, Langenhagen, Germany.
J Arthroplasty. 2019 Sep;34(9):2022-2029. doi: 10.1016/j.arth.2019.04.024. Epub 2019 Apr 16.
Cementless metaphyseal implant fixation of revision total knee arthroplasty has encouraging early results. We analyzed midterm results and implant survival of osteointegrative augments in Anderson Orthopedic Research Institute (AORI) type 2a, 2b, and 3 defects. Reasons for implant failure were explored and the potential for anatomic joint line reconstruction evaluated.
Sixty-seven consecutive patients (68 revision total knee arthroplasties) received cementless metaphyseal sleeves between 2011 and 2014. The mean follow-up was 5.0 years, mean age was 68.5 years, and mean body mass index was 31.4 kg/m. The clinical and radiographic results were determined using established scoring systems. Additionally, the survival rate was calculated and reasons for failure were analyzed.
In 2 patients (4.3%), sleeves had to be removed early postoperatively for deep infection after second-stage reimplantation. With continuously functioning remaining implants, the aseptic survival rate was 93.6%. Cleared up for initial technical issues due to poor bone quality, it is as high as 98%. The scores remained to be significantly improved by 64.8 points (Western Ontario and McMaster Universities Osteoarthritis Index) and 25.8 points (Knee Society score) (P < .001). In 10 patients (29.4%), diaphyseal radiolucencies were observed without suspicion of loosening. The mean joint line was noted to be 0.36 mm lower to the anatomic level.
At a mean follow-up of 5.0 years, cementless osteointegrative sleeves for metaphyseal fixation in AORI 2a, AORI 2b, and AORI 3 defects yielded continuous implant fixation even in cases with preceding revisions. The cleared up aseptic survival rate was 98% at 5 years. The modular sleeve design allowed joint line reconstruction near the anatomic level.
非骨水泥性干骺端植入物固定翻修全膝关节置换术具有令人鼓舞的早期结果。我们分析了安德森骨科研究所（AORI）2a、2b 和 3 型缺损的骨整合增强物的中期结果和植入物存活率。探讨了植入物失败的原因，并评估了解剖关节线重建的潜力。
2011 年至 2014 年间，67 例连续患者（68 例翻修全膝关节置换术）接受了非骨水泥性干骺端袖套治疗。平均随访时间为 5.0 年，平均年龄为 68.5 岁，平均体重指数为 31.4kg/m2。使用既定的评分系统确定临床和影像学结果。此外，还计算了生存率并分析了失败的原因。
在 2 例患者（4.3%）中，由于第二期再植入后的深部感染，术后早期需要取出袖套。在连续功能正常的剩余植入物中，无菌生存率为 93.6%。由于最初的技术问题（由于骨质量差）得到解决，其生存率高达 98%。Western Ontario and McMaster Universities Osteoarthritis Index 评分提高了 64.8 分，Knee Society 评分提高了 25.8 分（均<0.001）。在 10 例患者（29.4%）中，观察到骨干透亮线，但没有松动的迹象。平均关节线比解剖水平低 0.36 毫米。
在平均 5.0 年的随访中，AORI 2a、AORI 2b 和 AORI 3 缺损的非骨水泥性骨整合性袖套用于干骺端固定，即使在前次翻修的情况下，也能获得持续的植入物固定。5 年时无菌生存率为 98%。模块化袖套设计允许在接近解剖水平的关节线重建。
