旋转铰链 TKA 翻修术后的早期并发症及原因。

Early complications and causes of revision after rotating-hinge TKA.

机构信息

Orthopedic Surgery Department, Hôpital de la Croix-Rousse, Université Lyon 1, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.

出版信息

Arch Orthop Trauma Surg. 2020 Jan;140(1):109-119. doi: 10.1007/s00402-019-03290-9. Epub 2019 Oct 29.

DOI:10.1007/s00402-019-03290-9

PMID:31664574

Abstract

INTRODUCTION

The use of rotating-hinge total knee arthroplasties (TKA), despite several developments in prosthetic design, remains controversial. Results as well as indications of these devices are still discussed in primary intention and for young patients. The aim was to analyze early complications and survival rate of rotating-hinge TKA in primary intention and for revisions.

METHODS

A retrospective study included all the patients operated for primary or revision TKA procedure using a rotating-hinge TKA between 2015 and 2018. Clinical and radiological data were collected before surgery and then at a minimum follow-up of 1 year. The primary endpoint was the aseptic revision-free survival rate. Secondary endpoints were the overall survival rate, IKS scores, range of motion and patellar complications.

RESULTS

Forty patients were included at an average follow-up of 18 months. Primary implantation was performed for 12 patients (30%), and revision for 28 cases (70%). At a mean follow-up of 18 months, only one implant was removed for a septic cause. The cumulative survival rate at 24 months was 95%. At final review, eight knees (20%) had been revised, five (12.5%) due to infection, two (5%) because of extensor mechanism failure, two (5%) for global stiffness. The objective and subjective IKS were significantly higher postoperatively in both primary and revision groups (p < 0.0001). Patellar height was significantly smaller after revision (p = 0.04), while ROM significantly improved in this group (p = 0.02). At final endpoint, one implant was removed for a septic cause.

CONCLUSION

This rotating-hinge TKA provides satisfying clinical and functional outcomes in primary intentions and in revision cases. There was no implant-associated complication. The complication rate remains high for revision surgery cases, mostly due to previous joint infections and poor soft tissue quality causing extensor mechanism failure. A longer-term study should be conducted to confirm this trend.

摘要

引言

尽管在假体设计方面取得了多项进展，但旋转铰链式全膝关节置换术（TKA）的应用仍存在争议。这些设备的结果和适应证仍在原发性和年轻患者中进行讨论。目的是分析原发性和翻修手术中旋转铰链 TKA 的早期并发症和生存率。

方法

本回顾性研究纳入了 2015 年至 2018 年间所有接受旋转铰链 TKA 进行原发性或翻修 TKA 手术的患者。在手术前收集临床和影像学数据，然后进行至少 1 年的随访。主要终点是无菌性无翻修生存率。次要终点是总生存率、IKA 评分、活动范围和髌骨并发症。

结果

40 例患者平均随访 18 个月。原发性植入术为 12 例（30%），翻修术为 28 例（70%）。在平均 18 个月的随访中，仅因感染原因取出 1 例植入物。24 个月的累积生存率为 95%。最终随访时，8 例膝关节（20%）进行了翻修，其中 5 例（12.5%）因感染，2 例（5%）因伸肌机制失败，2 例（5%）因整体僵硬。原发性和翻修组术后客观和主观 IKA 评分均显著升高（p<0.0001）。翻修后髌骨高度显著减小（p=0.04），而该组 ROM 显著改善（p=0.02）。最终随访时，因感染原因取出 1 例植入物。