Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany.
Department of Orthopedics, Kepler University Hospital, Krankenhausstraße 9, 4020 Linz, Austria.
Knee. 2022 Jan;34:34-41. doi: 10.1016/j.knee.2021.10.001. Epub 2021 Dec 5.
The indications and outcomes of semi- or fully-constrained knee implants in primary total knee arthroplasty (TKA) are still controversially discussed. The present study aims to evaluate the mid-term results and complications of a modular/non-modular rotating-hinge implant in complex primary TKA.
Eighty-two patients (86 knees) following primary TKA were retrospectively evaluated with a mean follow-up of 63 months. The functional outcome was assessed using the American Knee Society Score (AKSS) and the Oxford Knee Score (OKS). A Visual Analog Scale (VAS) was used to determine pain levels. Implant survival and reoperation rateswere estimated using competing risk analysis. Cox regression analysis wasperformed to evaluate the influence of modularity on implant survival.
The survival rate with the endpoint implant revision was 90% (95 %CI:83-98%) and the survival rate with the endpoint all reoperations was 84% (95 %CI:75-94%) at 7 years. The AKSS improved significantly from 24 (SD 14.9, range:0-69) preoperatively to 83 (SD 14.3, range:57-100) postoperatively (p < 0.001); functional AKSS improved significantly from 27 (SD 24.3, range:0-100) to 46 (SD: 32.9, range 0-100) (p = 0.003), and OKS from 19 (SD: 8.3, range:5-43) to 29 (SD: 10.7, range:6-48), respectively (p < 0.0001). VAS decreased significantly from 8 (SD: 2.6, range:0-10) preoperatively to 3 (SD: 2.9, range:0-9) postoperatively (p < 0.0001). There was no significant influence of modularity on revision rates comparing modular to non-modular implants (p = 0.072).
The present rotating-hinge implant provides substantial improvement in function and reduction of pain with good implant survival in the mid-term. Modularity was not associated with higher rates of revision.
在初次全膝关节置换术（TKA）中，半约束或全约束膝关节假体的适应证和结果仍存在争议。本研究旨在评估一种模块化/非模块化旋转铰链植入物在复杂初次 TKA 中的中期结果和并发症。
对 82 例（86 膝）初次 TKA 患者进行回顾性评估，平均随访 63 个月。采用美国膝关节协会评分（AKSS）和牛津膝关节评分（OKS）评估功能结果。采用视觉模拟评分（VAS）评估疼痛程度。采用竞争风险分析估计植入物存活率和再手术率。采用Cox 回归分析评估模块化对植入物存活率的影响。
以翻修为终点的植入物存活率为 90%（95%CI：83-98%），以所有再手术为终点的存活率为 84%（95%CI：75-94%），7 年时。AKSS 从术前的 24 分（SD 14.9，范围：0-69）显著改善至术后的 83 分（SD 14.3，范围：57-100）（p<0.001）；功能 AKSS 从术前的 27 分（SD 24.3，范围：0-100）显著改善至术后的 46 分（SD：32.9，范围 0-100）（p=0.003），OKS 从术前的 19 分（SD：8.3，范围：5-43）改善至术后的 29 分（SD：10.7，范围：6-48）（p<0.0001）。VAS 从术前的 8 分（SD：2.6，范围：0-10）显著降低至术后的 3 分（SD：2.9，范围：0-9）（p<0.0001）。与非模块化植入物相比，模块化植入物的翻修率无显著差异（p=0.072）。
本研究中的旋转铰链植入物在中期提供了功能的显著改善和疼痛的减轻，同时具有良好的植入物存活率。模块化与更高的翻修率无关。
