Division of Orthopaedics - Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopedics - Adult Joint Reconstruction, NYU Langone, New York, NY.
Division of Orthopaedics - Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Arthroplasty. 2020 Aug;35(8):2072-2075. doi: 10.1016/j.arth.2020.03.017. Epub 2020 Mar 14.
The effect of using thicker liners in primary total knee arthroplasty (TKA) on functional outcomes and aseptic failure rates remains largely unknown. As such, we devised a multicenter study to assess both the clinical outcomes and survivorship of thick vs thin liners after primary TKA.
A search of our institutional databases was performed for patients having undergone bilateral (simultaneous or staged) primary TKA with similar preoperative and surgical characteristics between both sides. Two cohorts were created: thick liners and thin liners. Outcomes collected were as follows: change in Knee Society Score (ΔKSS), change in range of motion, and aseptic revision. Ad hoc power analysis was performed for ΔKSS (⍺ = 0.05; power = 80%). Differences between cohorts were assessed.
About 195 TKAs were identified for each cohort. ΔKSS and change in range of motion in the thin vs thick cohorts were similar: 51.4 vs 51.6 (P = .86) and 11.1° vs 10.0° (P = .66), respectively. No difference in aseptic revision rates were observed between thin and thick cohorts: all cause (4.1%, 3.1%; P = .59), aseptic loosening (0.5%, 0.5%; P = 1.0), instability (0.5%, 0.5%; P = 1.0), all-cause revision for stiffness (3.1%, 2.1%; P = .52), manipulation under anesthesia (2.1%, 2.1%; P = 1.0), and liner exchange (0.5%, 0%; P = .32).
The results of this study suggest that both rates of revision surgery and clinical outcomes are similar for TKAs performed with thick and thin liners. Preoperative factors are likely to play an important role in liner thickness selection, and emphasis should be placed on ensuring sound surgical technique.
在初次全膝关节置换术（TKA）中使用更厚的衬垫对功能结果和无菌性失败率的影响在很大程度上仍不清楚。因此，我们设计了一项多中心研究，以评估初次 TKA 后厚衬垫和薄衬垫的临床结果和存活率。
我们对我们的机构数据库进行了搜索，以寻找在两侧具有相似术前和手术特征的双侧（同期或分期）初次 TKA 的患者。创建了两个队列：厚衬垫和薄衬垫。收集的结果如下：膝关节协会评分的变化（ΔKSS）、运动范围的变化和无菌性翻修。对 ΔKSS 进行了专门的功效分析（α=0.05；功效=80%）。评估了队列之间的差异。
每个队列都确定了约 195 例 TKA。薄衬垫和厚衬垫组的 KSS 变化和运动范围变化相似：51.4 对 51.6（P=0.86）和 11.1°对 10.0°（P=0.66）。薄衬垫和厚衬垫组的无菌性翻修率无差异：所有原因（4.1%，3.1%；P=0.59）、无菌性松动（0.5%，0.5%；P=1.0）、不稳定（0.5%，0.5%；P=1.0）、所有原因僵硬翻修（3.1%，2.1%；P=0.52）、麻醉下手法复位（2.1%，2.1%；P=1.0）和衬垫更换（0.5%，0%；P=0.32）。
这项研究的结果表明，使用厚衬垫和薄衬垫进行的 TKA 的翻修手术和临床结果相似。术前因素可能在衬垫厚度选择中发挥重要作用，应强调确保正确的手术技术。
