Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam, The Netherlands.
J Arthroplasty. 2022 Oct;37(10):2041-2048. doi: 10.1016/j.arth.2022.04.039. Epub 2022 May 5.
The aim of this study is to report long-term survival and patient-reported outcome measures (PROMs) of the uncemented low contact stress total knee system and explore the potential association between prior knee surgery and outcomes.
A total of 1,289 procedures in 1,068 patients performed between 2000 and 2010 (mean follow-up 11.1 years) were retrospectively identified. All patients received an uncemented, mobile bearing, anterior stabilized (cruciate sacrificing) knee implant with a porous coating on the bone-prosthesis surface. Implant survival was calculated using competing risk analyses at 5, 10, and 15 years. PROMs include the Oxford Knee Score, Knee Society Score (domain function), EuroQol 5D-3L, and Numeric Rating Scale for pain during rest and activity, and for overall satisfaction. The association between previous surgery (no surgery versus meniscectomy versus arthroscopy versus corrective osteotomies) and implant survival was assessed with multivariable Cox proportional hazards analysis; the association with PROMs was assessed with multivariable linear regression analyses.
Survival after 5, 10, and 15 years was 97.0% (95% CI 96.0-98.0), 96.3% (95% CI 95.3-97.3), and 96.0% (95% CI 94.8-97.2), respectively. The most common reason for revision was aseptic loosening of the tibial tray (23/49 revisions, 47%). All PROMs were comparable with the reference values of the Dutch Arthroplasty Register. History of knee surgery prior to TKA was not associated with survival or PROMs.
The low contact stress uncemented mobile bearing knee implant provides excellent survival and patient satisfaction in our cohort. Previous surgery does not seem to compromise results in our population.
本研究旨在报告非骨水泥低接触压应力全膝关节系统的长期生存率和患者报告的结局测量（PROMs），并探讨既往膝关节手术与结局之间的潜在关联。
回顾性确定了 2000 年至 2010 年间进行的 1068 例患者的 1289 例手术（平均随访 11.1 年）。所有患者均接受了非骨水泥、活动衬垫、前稳定（牺牲交叉韧带）膝关节植入物，其骨-假体表面具有多孔涂层。使用竞争风险分析计算 5、10 和 15 年时的植入物生存率。PROMs 包括牛津膝关节评分、膝关节协会评分（功能域）、EuroQol 5D-3L 和静息和活动时疼痛的数字评定量表，以及总体满意度。使用多变量 Cox 比例风险分析评估既往手术（无手术、半月板切除术、关节镜检查、矫正性截骨术）与植入物生存率之间的关联；使用多变量线性回归分析评估与 PROMs 的关联。
5、10 和 15 年后的生存率分别为 97.0%（95%CI 96.0-98.0）、96.3%（95%CI 95.3-97.3）和 96.0%（95%CI 94.8-97.2）。翻修的最常见原因是胫骨托无菌性松动（23/49 例，47%）。所有 PROMs 与荷兰关节置换登记处的参考值相当。TKA 前的膝关节手术史与生存率或 PROMs 无关。
低接触压应力非骨水泥活动衬垫膝关节植入物在我们的队列中提供了优异的生存率和患者满意度。既往手术似乎不会影响我们人群的结果。
