Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Bone Joint J. 2019 Jun;101-B(6):660-666. doi: 10.1302/0301-620X.101B6.BJJ-2018-1334.R2.
There is little literature about total knee arthroplasty (TKA) after distal femoral osteotomy (DFO). Consequently, the purpose of this study was to analyze the outcomes of TKA after DFO, with particular emphasis on: survivorship free from aseptic loosening, revision, or any re-operation; complications; radiological results; and clinical outcome.
We retrospectively reviewed 29 patients (17 women, 12 men) from our total joint registry who had undergone 31 cemented TKAs after a DFO between 2000 and 2012. Their mean age at TKA was 51 years (22 to 76) and their mean body mass index 32 kg/m (20 to 45). The mean time between DFO and TKA was ten years (2 to 20). The mean follow-up from TKA was ten years (2 to 16). The prostheses were posterior-stabilized in 77%, varus-valgus constraint (VVC) in 13%, and cruciate-retaining in 10%. While no patient had metaphyseal fixation (e.g. cones or sleeves), 16% needed a femoral stem.
The ten-year survivorship was 95% with aseptic loosening as the endpoint, 88% with revision for any reason as the endpoint, and 81% with re-operation for any reason as the endpoint. Three TKAs were revised for instability (n = 2) and aseptic tibial loosening (n = 1). No femoral component was revised for aseptic loosening. Patients under the age of 50 years were at greater risk of revision for any reason (hazard ratio 7; p = 0.03). There were two additional re-operations (6%) and four complications (13%), including three manipulations under anaesthetic (MUA; 10%). The Knee Society scores improved from a mean of 50 preoperatively (32 to 68) to a mean of 93 postoperatively (76 to 100; p < 0.001).
A cemented posterior-stabilized TKA has an 88% ten-year survivorship with revision for any reason as the endpoint. No femoral component was revised for aseptic loosening. Patients under the age of 50 years have a greater risk of revision. The clinical outcome was significantly improved but balancing the knee was challenging in 13% of TKAs requiring VVC. Overall, 10% of TKAs needed an MUA, and 6% of TKAs were revised for instability. Cite this article: 2019;101-B:660-666.
股骨远端截骨（DFO）后全膝关节置换术（TKA）的相关文献较少。因此，本研究的目的是分析 DFO 后 TKA 的结果，特别关注：无无菌性松动、翻修或任何再手术的生存率；并发症；影像学结果；临床结果。
我们从我们的关节登记处回顾性分析了 29 名患者（17 名女性，12 名男性），这些患者在 2000 年至 2012 年期间接受了 31 例 DFO 后骨水泥固定 TKA。他们的 TKA 平均年龄为 51 岁（22 至 76 岁），平均体重指数为 32kg/m（20 至 45kg/m）。DFO 与 TKA 之间的平均时间为 10 年（2 至 20 年）。TKA 的平均随访时间为 10 年（2 至 16 年）。假体为后稳定型 77%，内翻-外翻限制型（VVC）13%，保留后交叉韧带型 10%。虽然没有患者有干骺端固定（如锥体或套管），但 16%需要股骨柄。
以无菌性松动为终点的 10 年生存率为 95%，以任何原因翻修为终点的生存率为 88%，以任何原因再手术为终点的生存率为 81%。3 例 TKA 因不稳定（n=2）和胫骨无菌性松动（n=1）而翻修。没有股骨部件因无菌性松动而翻修。50 岁以下的患者有更高的任何原因翻修风险（风险比 7；p=0.03）。另外有 2 例再次手术（6%）和 4 例并发症（13%），包括 3 例全身麻醉下的手法松解（MUA；10%）。膝关节协会评分从术前的平均 50 分（32 至 68 分）提高到术后的平均 93 分（76 至 100 分；p<0.001）。
骨水泥固定的后稳定型 TKA 以任何原因翻修为终点，10 年生存率为 88%。没有股骨部件因无菌性松动而翻修。50 岁以下的患者有更高的翻修风险。临床结果显著改善，但在需要 VVC 的 13%的 TKA 中，平衡膝关节具有挑战性。总体而言，10%的 TKA 需要 MUA，6%的 TKA 因不稳定而翻修。
2019;101-B:660-666.
