OrthCarolina Hip & Knee Center, Charlotte, North Carolina, USA.
Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA.
Bone Joint J. 2020 Jun;102-B(6_Supple_A):123-128. doi: 10.1302/0301-620X.102B6.BJJ-2019-1401.R1.
Aseptic loosening of the tibial component is a frequent cause of failure in primary total knee arthroplasty (TKA). Management options include an isolated tibial revision or full component revision. A full component revision is frequently selected by surgeons unfamiliar with the existing implant or who simply wish to "start again". This option adds morbidity compared with an isolated tibial revision. While isolated tibial revision has a lower morbidity, it is technically more challenging due to difficulties with exposure and maintaining prosthetic stability. This study was designed to compare these two reconstructive options.
Patients undergoing revision TKA for isolated aseptic tibial loosening between 2012 and 2017 were identified. Those with revision implants or revised for infection, instability, osteolysis, or femoral component loosening were excluded. A total of 164 patients were included; 88 had an isolated tibial revision and 76 had revision of both components despite only having a loose tibial component. The demographics and clinical and radiological outcomes were recorded.
The patient demographics were statistically similar in the two cohorts. The median follow-up was 3.5 years (interquartile range (IQR) 1 to 12.5). Supplementary femoral metaphyseal fixation was required in five patients in the full revision cohort. There was a higher incidence of radiological tibial loosening in the full component revision cohort at the final follow-up (8 (10.5%) vs 5 (5.7%); p = 0.269). Three patients in the full component revision cohort developed instability while only one in the isolated tibial cohort did. Three patients in the full revision cohort developed a flexion contracture greater than 5° while none in the isolated tibial cohort did.
Isolated tibial revision for aseptic tibial loosening has statistically similar clinical and radiological outcomes at a median follow-up of 3.5 years, when compared with full component revision. Substantial bone loss can occur when removing a well-fixed femoral component necessitating a cone or sleeve. Femoral component revision for isolated tibial loosening can frequently be avoided provided adequate ligamentous stability can be obtained. Cite this article: 2020;102-B(6 Supple A):123-128.
胫骨部件的无菌性松动是初次全膝关节置换术（TKA）失败的常见原因。治疗选择包括单独的胫骨翻修或全部件翻修。对于不熟悉现有植入物或只是想“重新开始”的外科医生来说，全部件翻修通常是首选。与单独的胫骨翻修相比，这种选择会增加发病率。虽然单独的胫骨翻修发病率较低，但由于暴露和维持假体稳定性方面的困难，技术上更具挑战性。本研究旨在比较这两种重建选择。
确定了 2012 年至 2017 年期间因孤立性无菌胫骨松动而行翻修 TKA 的患者。排除了因翻修植入物或感染、不稳定、溶骨或股骨部件松动而进行翻修的患者。共纳入 164 例患者；88 例行单独胫骨翻修，76 例行全部件翻修，尽管仅存在胫骨部件松动。记录患者的人口统计学和临床及影像学结果。
两组患者的患者人口统计学特征在统计学上相似。中位数随访时间为 3.5 年（四分位距（IQR）1 至 12.5）。在全翻修组中，有 5 例患者需要进行额外的股骨近段固定。在最终随访时，全部件翻修组的胫骨松动放射学发生率更高（8（10.5％）比 5（5.7％）；p = 0.269）。全翻修组中有 3 例患者出现不稳定，而单独胫骨组中仅有 1 例。全翻修组中有 3 例患者出现屈曲挛缩大于 5°，而单独胫骨组中没有。
与全部件翻修相比，在 3.5 年的中位数随访中，单独的胫骨翻修治疗无菌性胫骨松动在统计学上具有相似的临床和影像学结果。当去除固定良好的股骨部件时，可能会发生大量骨丢失，需要使用锥体或套管。只要能够获得足够的韧带稳定性，就可以经常避免为孤立性胫骨松动而进行股骨部件翻修。
Bone Joint J. 2020 Jun 1;102-B(6 Supple A):123-128. doi: 10.1302/0301-620X.102B6.BJJ-2019-1201.R1.
