Tan Alvin Ck
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore.
J Orthop. 2021 Jan 4;23:97-99. doi: 10.1016/j.jor.2020.12.016. eCollection 2021 Jan-Feb.
Despite the availability of modern implants and techniques, Revision Total Knee Arthroplasty (R-TKA) still poses a challenge to surgeons, particularly the management of bone loss/defects and the secure fixation of implants. Polymethylmethacrylate (PMMA) bone cement plays an important role for fixation as fully uncemented fixation in RTKA is rarely used. Cement can be employed as part of a full cementing construct or as a hybrid construct. While in fully cemented implants, the diaphyseal stem as well as any couplers or connectors in the metaphysis are cemented, in hybrid cementing, only the component parts at the joint surface and metaphysis are cemented, while the diaphyseal stem is fixed in a press-fit manner. In this article the literature on the in vitro as well on the in vivo results of both fixation options is reviewed. Although the fixation mechanism of both constructs are different, radiographic and clinical survivorship appear similar for both techniques. Although there appears to be a trend towards a hybrid fixation method, the choice of which technique to employ in revision total knee arthroplasty will depend on the surgeons' familiarity with each technique as well as the factors peculiar to each patients anatomy.
尽管有现代植入物和技术可用，但全膝关节置换翻修术（R-TKA）对外科医生来说仍然是一项挑战，尤其是骨丢失/缺损的处理以及植入物的牢固固定。聚甲基丙烯酸甲酯（PMMA）骨水泥在固定方面起着重要作用，因为在R-TKA中很少使用完全非骨水泥固定。骨水泥可作为全骨水泥结构的一部分或混合结构使用。在全骨水泥植入物中，骨干柄以及干骺端的任何联结器或连接件都用骨水泥固定，而在混合骨水泥固定中，只有关节表面和干骺端的组成部分用骨水泥固定，而骨干柄则以压配方式固定。本文回顾了关于这两种固定方式的体外和体内结果的文献。尽管两种结构的固定机制不同，但两种技术的影像学和临床生存率似乎相似。尽管似乎有一种倾向于混合固定方法的趋势，但在全膝关节置换翻修术中采用哪种技术将取决于外科医生对每种技术的熟悉程度以及每个患者解剖结构的特殊因素。
