Surgery Department, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Boul l'Assomption, Montreal, QC, H1T 2M4, Canada.
Clinique Orthopédique Duval, Laval, QC, Canada.
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):705-712. doi: 10.1007/s00167-020-06427-1. Epub 2021 Jan 16.
While kinematic alignment (KA) total knee arthroplasty (TKA) with cemented implants has been shown to provide equivalent or better results than mechanical alignment, its combination with cementless fixation has not yet been documented. The purpose of this study is to report (1) revision rate and causes, (2) clinical results based on patient report outcome measures (PROMs), and (3) radiological signs of implant dysfunction in patients with an uncemented TKA implanted with restricted KA (rKA), after a minimum follow-up of 2 years.
This study included the first 100 consecutive uncemented cruciate retaining TKAs implanted between November 2015 and February 2018 by a single surgeon following rKA principles. At last follow-up, all adverse events and PROMs assessed by WOMAC, KOOS, and FJS scores were documented. Radiographic evaluation was performed to identify signs of implant loosening.
After a mean follow-up of 49 months (32, 60), no implant revision was performed for aseptic loosening. Three revisions were performed: one for malalignment, one for a deep infection, and one for instability. The mean WOMAC score was 20.1 (0-79, 21.3), the mean KOOS score was 71.5 (19.0-96.6, 19.8), and the mean FJS score was 65.9 (0-100, 29.6). No radiological evidence of implant aseptic loosening or osteolysis was identified.
This study shows that in 99% of our cases, rKA combined with the tested cementless TKA implant allowed for adequate secondary fixation and good functional outcomes in the short term. Favourable mid- to long-term implant survivorship is anticipated.
III.
虽然已证实采用骨水泥固定假体的运动学对线全膝关节置换术（TKA）的效果与机械对线相当或更好，但将其与非骨水泥固定相结合的效果尚未得到证实。本研究的目的是报告（1）翻修率和原因，（2）基于患者报告的结果测量（PROM）的临床结果，以及（3）在至少 2 年的随访后，采用限制运动学对线（rKA）的非骨水泥固定 TKA 患者的影像学显示的假体功能障碍迹象。
本研究纳入了 2015 年 11 月至 2018 年 2 月期间由同一位外科医生采用 rKA 原则进行的首批 100 例连续的非骨水泥交叉韧带保留型 TKA。末次随访时，记录所有不良事件和 WOMAC、KOOS 和 FJS 评分评估的 PROMs。进行影像学评估以确定假体松动的迹象。
平均随访 49 个月（32，60）后，无因无菌性松动而进行假体翻修。进行了 3 次翻修：1 次为对线不良，1 次为深部感染，1 次为不稳定。WOMAC 平均评分为 20.1（0-79，21.3），KOOS 平均评分为 71.5（19.0-96.6，19.8），FJS 平均评分为 65.9（0-100，29.6）。未发现假体无菌性松动或骨溶解的影像学证据。
本研究表明，在我们的 99%病例中，rKA 与所测试的非骨水泥 TKA 假体结合使用可实现适当的二次固定和短期良好的功能结果。预计中期至长期假体存活率良好。
III。
