Arnholdt Jörg, Boelch Sebastian Philipp, Dogan Fatma, Hoberg Maik, Holzapfel Boris Michael, Rudert Maximilian
Department of Orthopaedic Surgery, Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstr. 11, 97074, Würzburg, Germany.
Department of Orthopaedic Surgery, Marienstift Arnstadt, Arnstadt, Germany.
Oper Orthop Traumatol. 2020 Aug;32(4):298-308. doi: 10.1007/s00064-020-00663-x. Epub 2020 May 29.
Restoring stability after total knee arthroplasty (TKA) and improving joint function using a cemented rotating hinge system.
Ligament instability and/or osseous defects (including Anderson Orthopaedic Research Institute [AORI] classification type II defects) after primary TKA or TKA revision surgery.
Distal femoral or proximal tibial bowing requiring implant systems that provide femoral or tibial offset stems. Persistent periprosthetic infection. Poor therapeutic compliance. AORI type III defects.
Medial arthrotomy. Femoral and tibial component removal with small saw blades and chisels. Intramedullary alignment for the tibial and femoral cuts. Debridement and removal of membranes and cement remnants. Reconstruction of joint line and correct TKA alignment. Trial reduction. Cement fixation.
Unrestricted range of motion, partial weight bearing for 4 weeks.
Between 2012 and 2013, 18 patients suffering from ligament insufficiency after TKA were revised using the described system and included in a prospective study protocol. The mean follow-up was 37 months (range 30-46 months). There was a significant improvement of the Oxford Knee Score (OKS) from 19 (range 7-29) preoperatively to 29 (range 10-45) postoperatively (p = 0.004). The Knee Society Score (KSS) knee assessment subscore improved from 35 (range 9-70) to 67 (range 35-97) (p = 0.002) and the pain score from 7 (range 0-50) to 24 (range 0-50) (p = 0.008).
使用骨水泥固定旋转铰链系统恢复全膝关节置换术（TKA）后的稳定性并改善关节功能。
初次TKA或TKA翻修术后的韧带不稳定和/或骨缺损（包括安德森骨科研究所[AORI]分类II型缺损）。
股骨远端或胫骨近端弯曲，需要提供股骨或胫骨偏移柄的植入系统。假体周围持续感染。治疗依从性差。AORI III型缺损。
内侧关节切开术。用小锯片和凿子去除股骨和胫骨组件。对胫骨和股骨截骨进行髓内对线。清创并去除膜和骨水泥残余物。重建关节线并纠正TKA对线。试行复位。骨水泥固定。
活动范围不受限制，4周内部分负重。
2012年至2013年期间，18例TKA术后韧带功能不全的患者使用所述系统进行翻修，并纳入前瞻性研究方案。平均随访37个月（范围30 - 46个月）。牛津膝关节评分（OKS）从术前的19分（范围7 - 29分）显著提高到术后的29分（范围10 - 45分）（p = 0.004）。膝关节协会评分（KSS）膝关节评估子评分从35分（范围9 - 70分）提高到67分（范围35 - 97分）（p = 0.002），疼痛评分从7分（范围0 - 50分）提高到24分（范围0 - 50分）（p = 0.008）。
