Shah Vikram Indrajit, Upadhyay Sachin, Shah Kalpesh, Sheth Ashish, Kshatriya Amish, Patil Jayesh
Department of Knee and Hip Arthroplasty, Shalby Hospitals, Ahmedabad, Gujarat, India.
Department of Orthopaedics, NSCB Medical College, Jabalpur, MP, India.
Arthroplasty. 2020 Apr 14;2(1):11. doi: 10.1186/s42836-020-00030-y.
The present study aimed to evaluate the functional outcome of single-stage total knee arthroplasty using long-stem tibial component with proximal fibular resection (PFR) for patients with knee osteoarthritis with varus deformity associated with tibial stress fracture.
A cohort of 62 patients with a mean age 71.63 ± 7.40 years who met the criteria were randomized to a study group and a control group. Patients in the study group underwent single-stage total knee arthroplasty using long-stem tibial component with PFR. The control group received conventional treatment. All patients were followed at 1, 3, 6 and 12 month(s) after surgery. Standard anteroposterior and lateral weight bearing knee X-rays were analyzed. Western Ontario and Mc-master Universities Osteoarthritis Index score (WOMAC) and the visual analog scale (VAS) score were used to assess the functional outcome. The level of significance was set at p < 0.05 levels.
One patient in the study group was lost to follow-up, leaving 61 patients for final assessment. The WOMAC total score and mean VAS score were significantly better in study group than in control group at final follow-up (p < 0.05). All fractures were successfully united in a mean time of 12.26 ± 1.20 weeks in study group. A total of 16 patients in control group had delayed union, five had established nonunion and required further interventions. No complications relating to surgery was detected.
Total knee arthroplasty with PFR for knee arthritis with varus deformity associated with tibial stress fractures restores limb alignment, improves biomechanics, enhances fracture healing and provides excellent functional outcome.
本研究旨在评估采用长柄胫骨假体并结合近端腓骨切除术（PFR）的单阶段全膝关节置换术对伴有内翻畸形和胫骨应力性骨折的膝关节骨关节炎患者的功能结局。
将62例符合标准的平均年龄为71.63±7.40岁的患者随机分为研究组和对照组。研究组患者接受采用长柄胫骨假体并结合PFR的单阶段全膝关节置换术。对照组接受传统治疗。所有患者在术后1、3、6和12个月进行随访。分析标准的负重位膝关节正侧位X线片。采用西安大略和麦克马斯特大学骨关节炎指数评分（WOMAC）和视觉模拟量表（VAS）评分来评估功能结局。显著性水平设定为p<0.05。
研究组有1例患者失访，最终61例患者接受评估。在末次随访时，研究组的WOMAC总分和平均VAS评分显著优于对照组（p<0.05）。研究组所有骨折均在平均12.26±1.20周内成功愈合。对照组共有16例患者出现延迟愈合，5例出现骨不连并需要进一步干预。未检测到与手术相关的并发症。
对于伴有内翻畸形和胫骨应力性骨折的膝关节骨关节炎患者，采用PFR的全膝关节置换术可恢复肢体对线，改善生物力学，促进骨折愈合，并提供良好的功能结局。
