Bouras Theodoros, Fennema Peter, Morgan-Jones Rhidian, Agarwal Sanjeev
Department of Trauma & Orthopaedics, Cardiff & Vale University Health Board, University Hospital Llandough, Cardiff, GBR.
Epidemiology and Public Health, AMR Advanced Medical Research, Männedorf, CHE.
Cureus. 2021 Sep 17;13(9):e18054. doi: 10.7759/cureus.18054. eCollection 2021 Sep.
Introduction A significant percentage of patients require re-revision surgery regardless of the demonstrated durable short- and mid-term clinical results using metaphyseal sleeves in revision total knee arthroplasty (TKA). The aim of this study was to identify the association between sleeve alignment and contact zones, with loosening in patients with revision TKA. Materials & Methods Of a series of 103 patients who underwent revision TKA, at a mean follow-up of eight years, six patients were re-revised for tibial loosening. These patients were compared with 19 unrevised control subjects in a 1:3 ratio. We calculated and compared the cumulative number of contact zones between the porous-coated part of the sleeve and bone on immediate postoperative X-rays between re-revised and unrevised patients. The main hypothesis was that neutral positioning and absolute circumferential contact between trabecular metaphyseal bone and porous-coated part of the sleeve would lead to a better outcome. Results The use of a conservative (nonparametric) approach indeed revealed better circumferential contact between trabecular metaphyseal bone and porous-coated part of the sleeve among the survivors, i.e., survivors: median (interquartile range [IQR]): 3 (2-4); failures: 3 (1-3), = 0.003 (Mann-Whitney [MW] test). The difference was borderline significant for coronal alignment, i.e., survivors: median (IQR): -1 (-4 to 2); failures: 0 (-1 to 3), = 0.0569 (MW test). Conclusion A circumferential bony contact of the metaphyseal sleeve would lead to better survival of the revision implant, whereas the degree of varus fixation did not seem to influence the longevity of the implant.
无论在翻修全膝关节置换术（TKA）中使用干骺端套筒所展示的短期和中期临床结果多么持久，仍有相当比例的患者需要再次翻修手术。本研究的目的是确定翻修TKA患者中套筒对线与接触区域之间的关联以及松动情况。材料与方法：在一系列103例行翻修TKA的患者中，平均随访8年，有6例患者因胫骨松动而再次翻修。这些患者与19例未翻修的对照受试者按1:3的比例进行比较。我们计算并比较了再次翻修患者和未翻修患者术后即刻X线片上套筒多孔涂层部分与骨之间接触区域的累积数量。主要假设是干骺端骨小梁与套筒多孔涂层部分之间的中立定位和绝对周向接触将导致更好的结果。结果：采用保守（非参数）方法确实显示，幸存者中干骺端骨小梁与套筒多孔涂层部分之间的周向接触更好，即幸存者：中位数（四分位间距[IQR]）：3（2 - 4）；失败者：3（1 - 3），P = 0.003（曼-惠特尼[MW]检验）。对于冠状位对线，差异接近显著，即幸存者：中位数（IQR）：-1（-4至2）；失败者：0（-1至3），P = 0.0569（MW检验）。结论：干骺端套筒的周向骨接触将导致翻修植入物更好的存活率，而内翻固定程度似乎不影响植入物的使用寿命。
