Rossi Stefano Marco Paolo, Perticarini Loris, Ghiara Matteo, Jannelli Eugenio, Cortesi Leonardo, Benazzo Francesco
Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy.
Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Brescia, Italy.
Knee. 2022 Mar;35:175-182. doi: 10.1016/j.knee.2022.03.007. Epub 2022 Mar 26.
Large metaphyseal bone losses are commonly encountered in revision total knee arthroplasty (rTKA). Anderson Orthopaedic Research Institute (AORI) type 2 and 3 defects generally require some metaphyseal fixation or augmentation. This study evaluates the midterm results of Porous Tantalum Trabecular Metal™ (TM) cones in revision TKA addressing severe bone loss.
Patients who underwent revision TKA using metaphyseal cones and a varus-valgus constrained (VVC) implant from January 2010 to January 2018 at our institution were identified from a prospective research database. Pre-operative patient characteristics and operative data were reviewed. Postoperative outcomes were compared with pre-operative values. Primary study aims were to evaluate outcomes, including complications and re-operations, radiographic assessment of cones osteointegration, and survivorship.
A total of 101 knees (101 patients) underwent revision TKA with 139 metaphyseal cones (80 tibial, 59 femoral). AORI defect classification was assessed intraoperatively. All patients were available for a minimum of 2 years of clinical and radiographic follow up. Mean follow up was 7.5 years (range 3-11 years). All patients showed significant improvement of clinical outcomes. Fifteen knees required re-operation and nine required revision of the implants, most commonly for recurrent infection (six of nine revisions) with cones removal. Kaplan-Meier survival analysis show a survival rate of 93.9% at 2 years and a survival rate of 90.2% at 5 and 11 years.
This large series illustrates the utility of porous metaphyseal cones in revision TKA with promising clinical and radiographic results and a high survival rate at mid-term follow up.
在全膝关节置换翻修术（rTKA）中，常见较大的干骺端骨缺损。安德森骨科研究所（AORI）2型和3型骨缺损通常需要一些干骺端固定或增强。本研究评估多孔钽小梁金属™（TM）锥体在rTKA治疗严重骨缺损中的中期结果。
从前瞻性研究数据库中识别出2010年1月至2018年1月在我院接受使用干骺端锥体和内外翻受限（VVC）植入物的rTKA患者。回顾术前患者特征和手术数据。将术后结果与术前值进行比较。主要研究目的是评估结果，包括并发症和再次手术、锥体骨整合的影像学评估以及生存率。
共有101例膝关节（101例患者）接受了rTKA，使用了139个干骺端锥体（80个胫骨，59个股骨）。术中评估AORI骨缺损分类。所有患者至少有2年的临床和影像学随访资料。平均随访时间为7.5年（范围3 - 11年）。所有患者的临床结果均有显著改善。15例膝关节需要再次手术，9例需要翻修植入物，最常见的原因是反复感染（9例翻修中有6例）并取出锥体。Kaplan - Meier生存分析显示，2年生存率为93.9%，5年和11年生存率为90.2%。
这个大样本系列研究表明，多孔干骺端锥体在rTKA中具有实用价值，中期随访显示出良好的临床和影像学结果以及较高的生存率。
