Dubin Jeremy A, Muskat Ahava, Westrich Geoffrey H
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
HSS J. 2020 Dec;16(Suppl 2):344-348. doi: 10.1007/s11420-019-09742-7. Epub 2020 Jan 18.
In total knee arthroplasty (TKA), advances in posterior-stabilized (PS) knee implant designs address patellofemoral mechanics and cam-post engagement in an effort to reduce patellofemoral pain and improve knee kinematics. Such modifications may include improved femoral rollback, improved femoral dislocation resistance, minimized wear, and improved longevity.
QUESTIONS/PURPOSES: In this study, we compared a newer PS knee design that incorporates a left and right specific femoral component and smoother trochlear groove to improve patellofemoral mechanics with an older PS design in order to assess patellofemoral pain, manipulation rates, and revision rates.
Using an institutional database, we retrospectively identified TKAs performed by the same surgeon using the Logic PS knee system and the older Optetrak PS knee system (Exactech Inc., Gainesville, FL, USA), with a minimum 2-year follow-up. Clinical outcomes for each cohort were measured using the Knee Society Clinical Rating System, University of California Los Angeles Activity Scale, pain visual analog scale (VAS), Veterans Rand 12-Item Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index. In addition, rates of anterior knee pain, manipulation, and revision were compared between the two knee systems, and a Kaplan-Meier survivorship curve defining failure as need for revision was calculated to allow comparison between the cohorts.
From 2000 to 2018, there were 1482 TKAs performed using the Logic PS (not counting 12 patients who had died) and 445 in the Optetrak PS group (not counting 20 patients who had died). In the Logic PS and Optetrak PS groups, respectively, the average age at operation was 66.7 years and 68.6 years and the average body mass index was 30.8 and 31.2. Pain VAS scores were significantly lower in the Logic PS group than in the Optetrak group (1.72 vs. 2.75 out of 10, respectively). There was also a significant difference in the percentages of patients reporting anterior knee pain in the Logic group, as compared with the Optetrak group (5.6% vs. 11.8%, respectively). In addition, manipulation rates differed significantly between the Logic and Optetrak groups (0.34% vs. 10.70%, respectively). The revision rates were 1.15% for the Logic group and 2.0% for the Optetrak group. However, there was a significant difference in rates of revision performed because of osteolysis, favoring the Logic group (0.07% vs. 0.6%). The Kaplan-Meier survivorship curve shows a significant difference in time until revision between the Logic and Optetrak groups.
Design modifications to improve patellofemoral mechanics demonstrated significant improvements in overall pain and patellofemoral pain and reduced manipulation rates post-operatively.
在全膝关节置换术（TKA）中，后稳定型（PS）膝关节植入物设计的进展旨在解决髌股关节力学问题和凸轮-柱结合问题，以减轻髌股关节疼痛并改善膝关节运动学。此类改进可能包括改善股骨后滚、增强股骨抗脱位能力、减少磨损以及提高使用寿命。
问题/目的：在本研究中，我们将一种采用左右特定股骨部件和更平滑滑车沟以改善髌股关节力学的新型PS膝关节设计与一种旧的PS设计进行比较，以评估髌股关节疼痛、手法治疗率和翻修率。
利用机构数据库，我们回顾性地确定了由同一位外科医生使用Logic PS膝关节系统和旧的Optetrak PS膝关节系统（美国佛罗里达州盖恩斯维尔市Exactech公司）进行的TKA手术，随访时间至少为2年。使用膝关节协会临床评分系统、加利福尼亚大学洛杉矶分校活动量表、疼痛视觉模拟量表（VAS）、退伍军人兰德12项健康调查以及西安大略和麦克马斯特大学骨关节炎指数对每个队列的临床结果进行测量。此外，比较了两种膝关节系统之间的前膝痛、手法治疗和翻修率，并计算了将翻修定义为失败的Kaplan-Meier生存曲线，以便在队列之间进行比较。
2000年至2018年期间，使用Logic PS进行了1482例TKA手术（不包括12例死亡患者），Optetrak PS组为445例（不包括20例死亡患者）。Logic PS组和Optetrak PS组的平均手术年龄分别为66.7岁和68.6岁，平均体重指数分别为30.8和31.2。Logic PS组的疼痛VAS评分显著低于Optetrak组（分别为1.72分和2.75分，满分10分）。与Optetrak组相比，Logic组报告前膝痛的患者百分比也存在显著差异（分别为5.6%和11.8%）。此外，Logic组和Optetrak组之间的手法治疗率差异显著（分别为0.34%和10.70%）。Logic组的翻修率为1.15%，Optetrak组为2.0%。然而，由于骨溶解导致的翻修率存在显著差异，Logic组更具优势（0.07%对0.6%）。Kaplan-Meier生存曲线显示Logic组和Optetrak组在翻修前的时间存在显著差异。
旨在改善髌股关节力学的设计改进在总体疼痛和髌股关节疼痛方面有显著改善，并降低了术后手法治疗率。
