Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
J Arthroplasty. 2021 Feb;36(2):670-675. doi: 10.1016/j.arth.2020.08.057. Epub 2020 Sep 1.
In revision total knee arthroplasty, osteolysis, mechanical abrasion, and infection may leave patellar bone stock severely attenuated with cavitary and/or segmental rim deficiencies that compromise fixation of patellar implant pegs. The purpose of this study was to retrospectively review the use of cortical "rebar" screws to augment cement fixation in revision patelloplasty.
From 2006 to 2018, dorsal patellar rebar technique was used for patellar reconstruction in 128 of 1037 revision total knee arthroplasty cases (12.3%). Follow-up was achieved with serial radiographs and prospective comparison of Knee Society Scores (KSSs) for clinical outcome. Complications and implant failures requiring reoperation or modified rehabilitation were also assessed.
Of the 128 patellar revisions performed using the rebar technique, 69 patients were women and 59 patients were men. The average age of the group was 69.5 years (range, 32-83 years). The mean follow-up of the cohort was 37 months (range, 13-109 months). The most common causes for revision were kinematic conflict, periprosthetic joint infection, and aseptic loosening. The median number of rebar screws used was 5 (range, 1-13). Preoperative KSSs for the study cohort averaged 50 (range, 0-90) At latest follow-up, mean KSS was 85 (range, 54-100). There were 4 patellar-related complications (3.1%) with no implant failures at study conclusion. Retrieval analysis revealed rigid fixation of the reconstructed patellar component in all cases.
Patellar rebar screw augmentation is a useful technique when there are significant cavitary deficiencies and limited segmental rim deficiencies. This technique allows the surgeon to extend indications for patellar revision arthroplasty.
在翻修全膝关节置换术中，骨溶解、机械磨损和感染可能导致髌骨骨量严重减少，出现空洞性和/或节段性边缘缺陷，从而影响髌骨植入物钉的固定。本研究的目的是回顾性分析皮质“钢筋”螺钉在翻修髌骨成形术中增强骨水泥固定的效果。
2006 年至 2018 年，我们对 1037 例翻修全膝关节置换术患者中的 128 例（12.3%）采用背侧髌骨钢筋技术进行髌骨重建。通过连续影像学检查和前瞻性比较膝关节协会评分（KSS）来评估临床结果。还评估了并发症和需要再次手术或修改康复的植入物失败。
采用钢筋技术进行的 128 例髌骨翻修中，69 例为女性，59 例为男性。该组的平均年龄为 69.5 岁（范围，32-83 岁）。该队列的平均随访时间为 37 个月（范围，13-109 个月）。翻修的最常见原因是运动学冲突、假体周围关节感染和无菌性松动。使用钢筋螺钉的中位数为 5 枚（范围，1-13 枚）。研究队列的术前 KSS 平均为 50 分（范围，0-90 分）。在最新的随访中，平均 KSS 为 85 分（范围，54-100 分）。研究结束时，有 4 例髌骨相关并发症（3.1%），无植入物失败。取出分析显示所有病例重建髌骨组件均固定牢固。
当存在严重的空洞性缺陷和有限的节段性边缘缺陷时，髌骨钢筋螺钉增强是一种有用的技术。该技术可扩大髌骨翻修关节置换术的适应证。
