Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02453, Korea.
Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
Int Orthop. 2022 Jul;46(7):1521-1527. doi: 10.1007/s00264-022-05412-2. Epub 2022 Apr 26.
The study aims to analyze long-term clinical and radiographic results, and survival of re-revision total knee arthroplasty (TKA) using fully cemented stems performed on femurs with diaphyseal deformation.
Thirty-seven re-revision TKAs using fully cemented stems performed in femoral diaphyseal deformations, characterized as diaphyseal canal enlargement and cortex deformation due to aseptic loosening of previously implanted stems, between 2003 and 2015 were retrospectively reviewed. The mean follow-up period was 10.0 years. Clinically, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Radiographically, mechanical axis (MA) and component positions were measured. Complications and survival rates were also analyzed.
Clinically, the WOMAC significantly improved at final follow-up (61.2 vs 47.2, p < 0.001), but not the ROM (95.5 vs 102.5, p = 0.206). Radiographically, the MA and component positions were appropriate, with no changes in component positions from immediately post-operative to final follow-up, but with MA change from varus 2.9° to 3.7° (p = 0.020). Two cases (5.4%) with history of previous infections developed periprosthetic joint infection (PJI). Debridement with polyethylene insert exchange following antibiotic suppression were performed in those cases because of concern for difficult implant-cement removal. The five and ten year survival rates were 100% and 93.2%, respectively.
Fully cemented stems are viable in providing long-term satisfactory survival after re-revision TKA in patients with femoral diaphyseal deformation. However, it should be used carefully for those with previous infections.
本研究旨在分析因先前植入的假体无菌性松动导致骨干变形的股骨发生骨干变形后行全骨水泥固定柄再次翻修全膝关节置换术（TKA）的长期临床和影像学结果及生存率。
回顾性分析 2003 年至 2015 年期间 37 例因骨干变形（骨干管腔扩大和皮质变形）行全骨水泥固定柄再次翻修 TKA 的患者资料，这些患者都曾因无菌性松动而植入假体。平均随访时间为 10.0 年。临床评估采用西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）和关节活动度（ROM）。影像学评估包括机械轴（MA）和假体位置。还分析了并发症和生存率。
临床方面，WOMAC 在末次随访时显著改善（61.2 分比 47.2 分，p<0.001），但 ROM 无明显改善（95.5 度比 102.5 度，p=0.206）。影像学方面，MA 和假体位置适当，从术后即刻到末次随访时假体位置无变化，但 MA 从内翻 2.9°变为 3.7°（p=0.020）。2 例（5.4%）有既往感染史的患者发生了假体周围关节感染（PJI）。由于担心难以取出假体-骨水泥，这 2 例患者采用了抗生素抑制下的清创术联合聚乙烯衬垫置换。5 年和 10 年的生存率分别为 100%和 93.2%。
在股骨骨干变形的患者中，全骨水泥固定柄在再次翻修 TKA 后能提供长期满意的生存率，但对于有既往感染史的患者应谨慎使用。
