Eggenberger Eileen E, Hurst Jason M, Morris Michael J, Berend Keith R, Lombardi Adolph V, Crawford David A
Park Nocollet Orthopedics, Shakopee, MN.
Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH.
J Arthroplasty. 2022 Jun;37(6S):S245-S249. doi: 10.1016/j.arth.2021.12.010. Epub 2022 Feb 18.
The purpose of this study is to report midterm outcomes and survivorship of a bicruciate retaining knee arthroplasty compared with a bicruciate sacrificing anterior stabilized knee arthroplasty.
A retrospective comparative cohort analysis was performed of all patients who underwent primary total knee arthroplasty with the bicruciate retaining (XP) knee arthroplasty compared with an anterior stabilized (AS) cruciate sacrificing bearing. The XP system was used in 195 knees and was compared with 1471 knees in which the AS bearing was used. Patients were included in analysis if they had minimum 2-year follow-up or had a revision at any point. Preoperative and postoperative range of motion, Knee Society Scores, complications, and reoperations were evaluated. Unpaired t-test and chi-square analysis were performed. Kaplan-Meier survival analysis was performed for all-cause and aseptic survival.
At an average of 5.2-year follow-up, 22 (11.3%) XP knees had been revised, compared with 23 (1.6%) AS knees (P < .001). Nineteen (9.7%) XP knees were revised for aseptic tibial loosening; one (0.1%) of the AS knees was revised for the same (P < .001). Nineteen of the XR revision surgeries (86.4%) were for aseptic tibial loosening. Compared with AS knees, the XP knees had significantly lower improvement in range of motion (3.2 deg vs 2.2 deg, P < .001), Knee Society (KS) pain scores (39 vs 35.7, P = .014), KS clinical scores (52.4 vs 46, P < .001), and KS functional scores (20.9 vs 15.5, P = .01).
The bicruciate retaining Vanguard XP Total Knee System demonstrated an unacceptably high rate of aseptic tibial loosening without conferring the benefit of improved postoperative function relative to other available bearings.
本研究的目的是报告保留双交叉韧带膝关节置换术与牺牲双交叉韧带的前稳定型膝关节置换术的中期结果和生存率。
对所有接受初次全膝关节置换术的患者进行回顾性比较队列分析，其中一组采用保留双交叉韧带（XP）膝关节置换术，另一组采用牺牲前交叉韧带的前稳定型（AS）假体。195例膝关节使用了XP系统，并与1471例使用AS假体的膝关节进行比较。如果患者至少有2年的随访或在任何时间进行了翻修，则纳入分析。评估术前和术后的活动范围、膝关节协会评分、并发症和再次手术情况。进行了非配对t检验和卡方分析。对全因生存率和无菌生存率进行了Kaplan-Meier生存分析。
平均随访5.2年时，22例（11.3%）XP膝关节进行了翻修，而AS膝关节为23例（1.6%）（P <.001）。19例（9.7%）XP膝关节因无菌性胫骨松动进行了翻修；AS膝关节中有1例（0.1%）因同样原因进行了翻修（P <.001）。XR翻修手术中有19例（86.4%）是因无菌性胫骨松动。与AS膝关节相比，XP膝关节在活动范围（3.2°对2.2°，P <.001）、膝关节协会（KS）疼痛评分（39对35.7，P =.014）、KS临床评分（52.4对46，P <.001）和KS功能评分（20.9对15.5，P =.01）方面的改善明显更低。
保留双交叉韧带的Vanguard XP全膝关节系统显示出不可接受的高无菌性胫骨松动率，且相对于其他可用假体，并未带来术后功能改善的益处。
