Poboży Tomasz, Wojciech Konarski, Hordowicz Martyna
Department of Orthopaedic Surgery, Medicover Hospital, Warsaw, Poland.
Department of Orthopaedic Surgery, Ciechanów Hospital, Ciechanów, Poland.
BMC Surg. 2019 Sep 2;19(1):126. doi: 10.1186/s12893-019-0585-6.
When a conservative management of gonarthrosis yields unsatisfactory results, a total knee arthroplasty (TKA) is recommended as an alternative approach. The implant survival is crucial for the long-term success of the procedure. However, in case of patients with retained hardware after past orthopedic procedures, providing correct alignment of the implant, which contributes to its longevity, is especially challenging. Here we present the use of an intra-operative ultrasonography for implant positioning in a 83-year-old male, undergoing TKA, without hardware removal, which was contraindicated due to his advanced age and comorbidities. Other imaging modalities taken into consideration are also described.
The right knee joint was approached with anterior incision. A femoral guide was introduced extramedullary. Ultrasonography was used to pinpoint the center of the femur's head. Tibial's guide was introduced intramedullary followed by a standard cut of the proximal part. Cemented ZIMMER NEXGEN prosthesis was used. Layered closure was applied. The placement of implant in neutral axis was confirmed on radiographs.
Our case demonstrates that ultrasonography might be helpful during TKA-procedure for implant positioning. However, more studies are needed to evaluate accuracy and application of ultrasound in the intraoperative settings.
当膝关节病的保守治疗效果不理想时，推荐全膝关节置换术（TKA）作为替代方法。植入物的存活率对该手术的长期成功至关重要。然而，对于既往接受过骨科手术且体内留有金属植入物的患者，要使植入物正确对线以延长其使用寿命，尤其具有挑战性。在此，我们介绍了在一名83岁男性患者行TKA手术时，在未取出金属植入物（因其高龄和合并症而禁忌取出）的情况下，使用术中超声进行植入物定位的情况。还描述了所考虑的其他成像方式。
采用前侧切口进入右膝关节。在髓外引入股骨导向器。使用超声确定股骨头中心。在髓内引入胫骨导向器，随后对近端进行标准截骨。使用骨水泥型ZIMMER NEXGEN假体。进行分层缝合。通过X线片确认植入物位于中立轴位置。
我们的病例表明，在TKA手术中超声可能有助于植入物定位。然而，需要更多研究来评估超声在术中的准确性和应用情况。
