骨水泥固定活动衬垫型全膝关节假体可预防股骨假体周围骨矿物质密度丢失：平均随访 11 年的连续随访结果。
A cemented mobile-bearing total knee prosthesis prevents peri-prosthetic bone mineral density loss around the femoral component: a consecutive follow-up at a mean of 11 years.
机构信息
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku, Osaka, 545-8585, Japan.
Department of Orthopaedic Surgery, Shiraniwa Hospital, 6-10-1 Shiraniwadai Ikoma, Nara, 630-0136, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):734-739. doi: 10.1007/s00167-021-06448-4. Epub 2021 Jan 25.
PURPOSE
Research has shown that a cemented mobile-bearing component has a favorable effect on the bone mineral density (BMD) of the distal femur at 2 years after total knee arthroplasty (TKA). This study was performed to determine whether the advantage on BMD of a cemented mobile-bearing TKA over a conventional cemented fixed-bearing TKA changes with time. This report is an update of a matched cohort study initiated in 2004 and for which the 2-year results have been published.
METHODS
Twenty-eight knees that were treated with a fixed-bearing posterior stabilized (PS) prosthesis and 28 matched knees from a database of 76 knees that were treated with a mobile-bearing PS prosthesis in the same period were investigated. All knees underwent dual-energy X-ray absorptiometry (DEXA) scans around the femoral component preoperatively, 2 weeks postoperatively, 5 years postoperatively, and annually thereafter. Eighteen knees with a cemented mobile-bearing PS prosthesis and 20 knees with a cemented fixed-bearing PS prosthesis were investigated for more than 6 years. The mean follow-up period was 11 years.
RESULTS
The range of motion, Knee Society Score, BMD of the lumbar spine, and follow-up period were not significantly different preoperatively and postoperatively in the two groups. In the fixed-bearing group, the BMD of the anterior part of the femoral condyle decreased postoperatively. In the mobile-bearing group, the BMD of the posterior part of the femoral condyle increased postoperatively. The postoperative change in the BMD at 5 years and the latest follow-up period was statistically significant in the two groups.
CONCLUSIONS
This DEXA study revealed that a cemented mobile-bearing component had a favorable effect on the BMD of the distal femur after TKA even at a mean of 11 years postoperatively.
LEVEL OF EVIDENCE
Therapeutic study, level II, prospective comparative study.
目的
研究表明，全膝关节置换术（TKA）后 2 年，骨水泥固定的活动衬垫组件对股骨远端骨密度（BMD）有积极影响。本研究旨在确定骨水泥固定的活动衬垫 TKA 相对于传统骨水泥固定的固定衬垫 TKA 在 BMD 方面的优势是否随时间而改变。这是对 2004 年启动的匹配队列研究的更新，该研究的 2 年结果已经发表。
方法
28 例膝关节采用固定衬垫后稳定型（PS）假体治疗，同期数据库中有 76 例膝关节采用活动衬垫 PS 假体治疗，各选择 28 例匹配的膝关节进行研究。所有膝关节在术前、术后 2 周、术后 5 年和此后每年均行股骨组件周围双能 X 线吸收法（DEXA）扫描。18 例骨水泥固定活动衬垫 PS 假体和 20 例骨水泥固定固定衬垫 PS 假体的膝关节进行了超过 6 年的研究。平均随访时间为 11 年。
结果
两组术前和术后的关节活动度、膝关节协会评分、腰椎 BMD 和随访时间均无显著差异。在固定衬垫组，术后股骨髁前部的 BMD 下降。在活动衬垫组，术后股骨髁后部的 BMD 增加。两组术后 5 年和末次随访时的 BMD 变化均有统计学意义。
结论
这项 DEXA 研究表明，即使在平均 11 年的随访后，骨水泥固定的活动衬垫组件对 TKA 后股骨远端的 BMD 仍有积极影响。
证据水平
治疗性研究，II 级，前瞻性比较研究。
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