Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA.
Duke University School of Medicine, Durham, NC.
J Arthroplasty. 2021 Jul;36(7S):S303-S307. doi: 10.1016/j.arth.2020.12.017. Epub 2020 Dec 15.
There is scant literature evaluating varus-valgus constrained (VVC) prostheses in contemporary revision total knee arthroplasty (TKA). Therefore, we aimed to evaluate the durability of VVC revision TKA with selective use of cones.
A retrospective review of 194 revision TKAs with VVC was performed from August 2005 through February 2018 at a single institution. The final cohort consisted of 168 TKAs with a mean follow-up of 6 years. Stems were used in all but 1 TKA, tibial cones in 48%, and femoral cones in 19%. Anderson Orthopaedic Research Institute classification in femurs was 1 in 57, 2A in 33, 2B in 62, 3 in 16, and in tibias, 1 in 42, 2A in 29, 2B in 81, and 3 in 16.
Survival analysis showed that 93% were free of revision for aseptic component loosening, 76% were free of revision for any reason, and 74% were free of reoperation at 6 years. Anderson Orthopaedic Research Institute 3 femur or tibia, age <65 years, and progressive radiographic changes were associated with an increased risk of revision for aseptic loosening (P < .05). Progressive radiographic changes were seen in 19% of femoral and 16% of tibial constructs. The most common reason for re-revision was periprosthetic joint infection (65%).
VVC revision TKA with selective use of cones provided a reasonable outcome as 93% were free of revision for aseptic loosening at 6 years. However, given the rate of patients with progressive radiographic changes and survivorship free of reoperation of 74% at 6 years, long-term follow-up will help assess the durability of these constructs.
目前很少有文献评估在当代翻修全膝关节置换术中使用内翻-外翻限制（VVC）假体。因此，我们旨在评估选择性使用锥形假体的 VVC 翻修 TKA 的耐用性。
对 2005 年 8 月至 2018 年 2 月在一家机构进行的 194 例 VVC 翻修 TKA 进行回顾性研究。最终队列由 168 例 TKA 组成，平均随访时间为 6 年。除 1 例 TKA 使用股骨柄外，其余均使用胫骨柄，48%使用胫骨锥形假体，19%使用股骨锥形假体。股骨的安德森骨科研究协会（Anderson Orthopaedic Research Institute，AORI）分类为 57 例 1 型，33 例 2A 型，62 例 2B 型，16 例 3 型；胫骨的 AORI 分类为 42 例 1 型，29 例 2A 型，81 例 2B 型，16 例 3 型。
生存分析显示，93%的患者无无菌性假体松动翻修，76%的患者无任何原因翻修，74%的患者无再手术，6 年时的翻修率为 6 年。AORI 3 型股骨或胫骨、年龄<65 岁和进行性影像学改变与无菌性松动翻修风险增加相关（P<.05）。在 19%的股骨和 16%的胫骨结构中发现了进行性影像学改变。再翻修的最常见原因是假体周围关节感染（65%）。
使用锥形假体选择性进行 VVC 翻修 TKA 可获得较好的结果，93%的患者在 6 年内无无菌性松动翻修。然而，鉴于进行性影像学改变的患者比例和 6 年时无再手术的生存率为 74%，长期随访将有助于评估这些结构的耐用性。
