Hôpital Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France; Université Pierre et Marie-Curie, Paris VI, 75013 Paris, France; Clinique Jouvenet, 6, square Jouvenet, 75016 Paris, France.
Hôpital Pitié-Salpêtrière, 47, boulevard de l'hôpital, 75013 Paris, France; Université Pierre et Marie-Curie, Paris VI, 75013 Paris, France.
Orthop Traumatol Surg Res. 2019 Oct;105(6):1047-1054. doi: 10.1016/j.otsr.2019.04.010. Epub 2019 Jun 14.
In patients with advanced knee osteoarthritis and extra-articular knee deformity (EKD), ligament balance may be difficult to achieve during total knee arthroplasty (TKA). Treatment options include two-stage surgery with the first stage involving correction of the EKD and same-stage TKA and tibial osteotomy (1S-TKA-TO). The objective of this study was to assess outcomes in 26 patients managed with 1S-TKA-TO.
1S-TKA-TO produces satisfactory clinical and anatomical outcomes and is not associated with higher morbidity rates compared to TKA alone or two-stage TKA-TO.
A prospective study was conducted in 25 patients (26 knees) managed with 1S-TKA-TO between 1995 and 2014. There were 16 males and 9 females with a mean age of 64 years (range, 29-80 years) and a mean body mass index of 29.6 (range, 24-49). The EKD was constitutional in 14 knees, post-traumatic in 5 knees, and induced by TO in 7 knees. None of the patients received a hinged knee implant. In each patient, the clinical International Knee Society (IKS score) was assessed and the hip-knee-ankle angle (HKA), tibial mechanical angle (TMA), and femoral mechanical angle (FMA) were measured on radiographs before surgery and at last follow-up.
The mean IKS score increased significantly, from 70 before surgery to 170 at the end of the mean 9-year follow-up. Mean flexion range increased from 98° to 107°. The clinical and anatomical outcomes were satisfactory in 25 patients. In the remaining patient, who had a history of multiple surgeries for Blount disease and a body mass index of 49, a severe complication consisting in massive skin necrosis followed by infection occurred; this was the only patient who required revision surgery with implant removal.
These findings are consistent with the satisfactory outcomes observed in earlier studies, most of which included small numbers of patients. The alternatives to 1S-TKA-TO are under evaluation. The best indication for 1S-TKA-TO may be knee osteoarthritis with a greater than 10° intra-osseous deformity.
IV, prospective observational cohort study.
在患有晚期膝关节骨关节炎和膝关节外畸形（EKD）的患者中，全膝关节置换术（TKA）期间可能难以实现韧带平衡。治疗选择包括两阶段手术，第一阶段涉及 EKD 的矫正和同期 TKA 和胫骨截骨术（1S-TKA-TO）。本研究的目的是评估 26 例接受 1S-TKA-TO 治疗患者的结果。
1S-TKA-TO 产生令人满意的临床和解剖结果，与单独 TKA 或两阶段 TKA-TO 相比，发病率并不高。
1995 年至 2014 年间对 25 例（26 膝）接受 1S-TKA-TO 治疗的患者进行了前瞻性研究。16 名男性和 9 名女性，平均年龄 64 岁（范围，29-80 岁），平均体重指数为 29.6（范围，24-49）。EKD 在 14 个膝关节中为先天性，在 5 个膝关节中为创伤性，在 7 个膝关节中由 TO 引起。没有患者接受铰链膝关节植入物。在每个患者中，均评估了临床国际膝关节协会（IKS）评分，并在术前和最后随访时测量了髋关节-膝关节-踝关节角（HKA）、胫骨机械角（TMA）和股骨机械角（FMA）。
平均 IKS 评分从术前的 70 分显著增加到平均 9 年随访结束时的 170 分。平均屈曲范围从 98°增加到 107°。25 例患者的临床和解剖结果均令人满意。在其余 1 例患者中，患者患有 Blount 病的多次手术史，体重指数为 49，发生了严重的并发症，包括大量皮肤坏死继发感染；这是唯一需要去除植入物进行翻修手术的患者。
这些发现与早期研究中观察到的令人满意的结果一致，这些研究大多数纳入的患者数量较少。1S-TKA-TO 的替代方案正在评估中。1S-TKA-TO 的最佳适应证可能是骨内畸形大于 10°的膝关节骨关节炎。
IV，前瞻性观察队列研究。
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