Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA.
Bone Joint J. 2021 Jun;103-B(6 Supple A):165-170. doi: 10.1302/0301-620X.103B6.BJJ-2020-2439.R2.
Stemmed tibial components are frequently used in revision total knee arthroplasty (TKA). The purpose of this study was to evaluate patient satisfaction, overall pain, and diaphyseal tibial pain in patients who underwent revision TKA with cemented or uncemented stemmed tibial components.
This is a retrospective cohort study involving 110 patients with revision TKA with cemented versus uncemented stemmed tibial components. Patients who underwent revision TKA with stemmed tibial components over a 15-year period at a single institution with at least two-year follow-up were assessed. Pain was evaluated through postal surveys. There were 63 patients with cemented tibial stems and 47 with uncemented stems. Radiographs and Knee Society Scores were used to evaluate for objective findings associated with pain or patient dissatisfaction. Postal surveys were analyzed using Fisher's exact test and the independent-samples -test. Logistic regression was used to adjust for age, sex, and preoperative bone loss.
No statistically significant differences in stem length, operative side, or indications for revision were found between the two cohorts. Tibial pain at the end of the stem was present in 25.3% (16/63) of cemented stems and 25.5% (12/47) of uncemented stems (p = 1.000); 74.6% (47/63) of cemented patients and 78.7% (37/47) of uncemented patients were satisfied following revision TKA (p = 0.657).
There were no differences in patient satisfaction, overall pain, and diaphyseal tibial pain in cemented and uncemented stemmed tibial components in revision TKA. Patient factors, rather than implant selection and surgical technique, likely play a large role in the presence of postoperative pain. Stemmed tibial components have been shown to be a possible source of pain in revision TKA. There is no difference in patient satisfaction or postoperative pain with cemented or uncemented stemmed tibial components in revision TKA. Cite this article: 2021;103-B(6 Supple A):165-170.
带柄胫骨假体常用于翻修全膝关节置换术（TKA）。本研究旨在评估接受骨水泥固定或非骨水泥固定带柄胫骨假体翻修 TKA 的患者的患者满意度、整体疼痛和骨干胫骨疼痛。
这是一项回顾性队列研究，纳入了 110 例接受骨水泥固定或非骨水泥固定带柄胫骨假体翻修 TKA 的患者。在一家单中心接受带柄胫骨假体翻修 TKA 治疗且至少随访 2 年的患者被纳入本研究。疼痛通过邮寄问卷调查进行评估。其中 63 例患者接受骨水泥固定胫骨柄，47 例患者接受非骨水泥固定胫骨柄。使用 X 线片和膝关节协会评分评估与疼痛或患者不满意相关的客观发现。使用 Fisher 确切检验和独立样本 t 检验对邮寄问卷调查进行分析。使用逻辑回归调整年龄、性别和术前骨丢失的影响。
两组患者在柄长度、手术侧和翻修指征方面无统计学差异。在骨水泥固定组和非骨水泥固定组中，分别有 25.3%（16/63）和 25.5%（12/47）的患者存在柄末端胫骨疼痛（p=1.000）；在骨水泥固定组和非骨水泥固定组中，分别有 74.6%（47/63）和 78.7%（37/47）的患者对翻修 TKA 感到满意（p=0.657）。
在骨水泥固定和非骨水泥固定带柄胫骨假体翻修 TKA 中，患者满意度、整体疼痛和骨干胫骨疼痛无差异。患者因素而非植入物选择和手术技术可能在术后疼痛的发生中起重要作用。带柄胫骨假体已被证实是翻修 TKA 中疼痛的一个可能来源。在翻修 TKA 中，骨水泥固定和非骨水泥固定带柄胫骨假体在患者满意度或术后疼痛方面无差异。
