Reddy Neelam, Saini Mukesh K, Naresh Gattu, Thakur Ajay, Podili Rajesh, Reddy Jayavardhan
Orthopaedics (Arthroplasty), Star Hospitals Hyderabad, Hyderabad, IND.
Orthopaedics, Star Hospitals Hyderabad, Hyderabad, IND.
Cureus. 2020 Nov 17;12(11):e11519. doi: 10.7759/cureus.11519.
Posterior-stabilized (PS) total knee arthroplasty (TKA) poses problems such as the need for intercondylar notch bone resection as well as cam and post wear and patella clunk. Owing to its heightened anterior profile, an ultracongruent polyethylene insert prevents the excessive posterior translation of tibia in the case of a deficient or scarified posterior cruciate ligament (PCL). This study aimed to determine whether an ultracongruent insert provides satisfactory clinical and functional outcomes and midterm survival benefits.
Based on the reviewed medical records of 200 patients, 240 primary TKA cases involving the use of Sigma Curved Plus (DePuy International, Ltd., Leeds, UK) ultracongruent insert were retrospectively enrolled in this study. Follow-up data were used to evaluate the clinical and radiological outcomes and to conduct a Kaplan-Meier survival analysis.
The mean follow-up duration for 224 knees was 5.8 years (range 5-6.5 years). A revision was made due to infection in two patients and due to periprosthetic fractures in two other patients. The mean knee flexion improved from 101.97° ± 9.43° (range 85°-125°) to 125.75° ± 9.58° (range 100°-140°) at the final follow-up. The mean Knee Society score improved from 43.1 ± 9.76 to 88.3 ± 3.2, and the function score improved from 44.95 ± 7.26 to 90.16 ± 3.71. None of the patients showed radiographic loosening of either insert component, but 22 (5%) patients showed radiolucent lines (<2 mm). The Kaplan-Meier analysis showed that the five-year survival of the insert with an endpoint of revision for any reason was 98.1% (confidence interval, CI, 95.7-99.6%).
The Sigma Curved Plus insert showed a low failure rate with good clinical, functional, and midterm survival outcomes in comparison to standard outcomes reported in earlier studies. Further follow-up studies are warranted to determine whether the insert's performance is maintained in the long term.
后稳定型（PS）全膝关节置换术（TKA）存在诸如髁间切迹骨切除的必要性以及凸轮和后髁磨损及髌骨卡顿等问题。由于其较高的前方轮廓，超匹配聚乙烯衬垫在交叉韧带（PCL）缺失或受损的情况下可防止胫骨过度后移。本研究旨在确定超匹配衬垫是否能提供令人满意的临床和功能结果以及中期生存益处。
基于对200例患者的病历回顾，本研究回顾性纳入了240例使用Sigma Curved Plus（英国利兹市DePuy International有限公司）超匹配衬垫的初次TKA病例。随访数据用于评估临床和放射学结果，并进行Kaplan-Meier生存分析。
224个膝关节的平均随访时间为5.8年（范围5 - 6.5年）。两名患者因感染进行了翻修，另外两名患者因假体周围骨折进行了翻修。末次随访时，膝关节平均屈曲度从101.97°±9.43°（范围85° - 125°）提高到125.75°±9.58°（范围100° - 140°）。膝关节协会平均评分从43.1±9.76提高到88.3±3.2，功能评分从44.95±7.26提高到90.16±3.71。所有患者均未出现任何衬垫组件的影像学松动，但22例（5%）患者出现了透亮线（<2 mm）。Kaplan-Meier分析显示，以任何原因进行翻修为终点的衬垫五年生存率为98.1%（置信区间，CI，95.7 - 99.6%）。
与早期研究报告的标准结果相比，Sigma Curved Plus衬垫显示出较低的失败率以及良好的临床、功能和中期生存结果。有必要进行进一步的随访研究以确定该衬垫的性能是否能长期维持。
