Department of Orthopedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Brettreichstraße 11, Würzburg, Germany.
Campus Bad Neustadt, Klinik für Orthopädie, Unfallchirurgie, Schulterchirurgie und Endoprothetik, Rhön Klinikum, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany.
Oper Orthop Traumatol. 2021 Apr;33(2):170-180. doi: 10.1007/s00064-020-00690-8. Epub 2020 Dec 8.
Treatment of tricompartimental osteoarthritis (OA) using customized instruments and implants for cruciate-retaining total knee arthroplasty. Use of patient-specific instruments and implants (ConforMIS iTotal CR G2) together with a 3D-planning protocol (iView®). Retropatellar resurfacing is optional.
Symptomatic tricompartmental OA of the knee (Kellgren-Lawrence stage IV) with preserved posterior cruciate ligament (PCL) after unsuccessful conservative or joint-preserving surgical treatment.
Knee ligament instabilities of the posterior cruciate or collateral ligaments. Infection. Relative contraindication: knee deformities >15° (varus, valgus, flexion); prior partial knee replacement.
Midline or parapatellar medial skin incision, medial arthrotomy; distal femoral resection with patient-specific cutting block; tibial resection using either a cutting jig for the anatomic slope or a fixed 5° slope. Balancing the knee in extension and flexion gap using patient-specific spacer. The final tibial preparation achieved with gap-balanced placement of the femoral cutting jigs. Kinematic testing using anatomic trial components. Final implant components are cemented in extension. Wound layers are sutured. Drainage is optional.
Sterile wound dressing; compressive bandage. No limitation of the active and passive range of motion. Optional partial weight bearing during the first 2 weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52 weeks, then every 1-2 years.
Overall 60 patients with tricompartmental knee OA and preserved PCL were treated. Mean age was 66 (range 45-76) years. Minimum follow-up was 12 months. There was 1 septic revision after a low-grade infection, 1 reoperation to replace the patellar due to patellar osteoarthritis and 3 manipulations under anesthesia (MUAs) to increase range of motion. Radiographic analyses demonstrated an ideal implant fit with less than 2 mm subsidence or overhang. The WOMAC score improved from 154.8 points preoperatively to 83.5 points at 1 year and 59.3 points at 2 years postoperatively. The EuroQol-5D Score also improved from 11.1 points preoperatively to 7.7 points at 1 year postoperatively.
使用定制的器械和植入物治疗三分区骨关节炎（OA），用于保留十字韧带的全膝关节置换。使用患者特异性器械和植入物（ConforMIS iTotal CR G2）以及 3D 规划方案（iView®）。髌骨关节可选择再处理。
膝关节三分区 OA 伴未成功的保守或保膝手术治疗后保留的后十字韧带（PCL）（Kellgren-Lawrence 分期 IV 级）。
PCL 或侧副韧带不稳定的膝关节。感染。相对禁忌证：膝关节畸形＞15°（内翻、外翻、屈曲）；既往部分膝关节置换。
正中或髌旁内侧皮肤切口，内侧入路；使用患者特异性截骨块进行股骨远端切除；胫骨截骨术使用解剖斜率截骨导向器或固定 5°斜率截骨导向器。使用患者特异性间隔物在膝关节伸展和屈曲间隙平衡。通过股骨截骨导向器的间隙平衡放置实现最终胫骨准备。使用解剖试模组件进行运动学测试。最终植入物组件在伸展位进行骨水泥固定。缝合各层切口。可选择引流。
无菌伤口包扎；加压包扎。无主动和被动活动范围限制。术后 2 周内可部分负重，然后过渡到完全负重。术后即刻、术后 12 周和 52 周、之后每 1-2 年进行随访。
共治疗 60 例三分区膝关节 OA 伴保留 PCL 的患者，平均年龄 66（45-76）岁。最小随访时间为 12 个月。1 例因低度感染发生感染性翻修，1 例因髌股关节炎更换髌骨，3 例因关节活动度增加行麻醉下手法复位（MUA）。影像学分析显示，假体适配理想，下沉或突出＜2mm。WOMAC 评分从术前的 154.8 分改善至术后 1 年的 83.5 分和术后 2 年的 59.3 分。EuroQol-5D 评分从术前的 11.1 分改善至术后 1 年的 7.7 分。
