Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky.
Department of Orthopedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
J Knee Surg. 2023 Jul;36(9):995-1000. doi: 10.1055/s-0042-1748900. Epub 2022 Jun 9.
Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) can pose a challenging problem with implant survivorship due to greater stress at the cement-bone interface. With the advent of additive manufacturing (three-dimensional printing), highly porous implants are now readily available. The purpose of this study was to review the results of primary TKA in the morbidly obese (body mass index [BMI] ≥ 40) patient using a highly porous cementless tibial baseplate. This is a retrospective study of 167 TKAs in patients with morbid obesity undergoing primary cementless TKA with a minimum 5-year follow-up. A total of 6 patients died and 14 were lost to follow-up, leaving 147 TKAs in 136 patients with a mean follow-up of 66 months (range 60-79 months). The average age was 59 years (range 36-84 years) and average BMI was 45 kg/m (range 39.5-63.9). Clinical results, patient-reported outcome measures, radiographs, and complications were reviewed. There were 9 failures requiring revision, including 3 for aseptic tibial loosening (2.0%), 2 for deep infection (1.4%), 2 for patellar resurfacing (1.4%), 1 for patella instability (0.7%), and 1 for extensor mechanism rupture (0.7%). Knee Society Score (KSS) improved from 48 to 90 at 2- and 5-year follow-up. KSS function score improved from 49 to 68 and 79 at 2- and 5-year follow-up, respectively. Survivorship with aseptic loosening as the endpoint was 98.0% at 5 years. Cementless TKA using a highly porous tibial baseplate in morbidly obese patients demonstrated excellent clinical results with 98% survivorship at 5 years and appears to offer durable long-term biologic fixation as an alternative to mechanical cement fixation in this challenging group of patients.
患有病态肥胖症（BMI≥40）的患者在接受骨水泥初次全膝关节置换术（TKA）时，由于骨水泥-骨界面承受更大的压力，可能会对假体的存活率造成挑战。随着增材制造（三维打印）的出现，现在可方便地获得高多孔假体。本研究的目的是回顾使用高多孔非骨水泥胫骨基底治疗病态肥胖（BMI≥40）初次 TKA 的结果。这是一项对 167 例病态肥胖症患者行初次非骨水泥 TKA 的回顾性研究，这些患者均获得了至少 5 年的随访。共有 6 例患者死亡，14 例患者失访，最终有 136 例患者的 147 例 TKA 进入研究，平均随访 66 个月（60-79 个月）。平均年龄为 59 岁（36-84 岁），平均 BMI 为 45kg/m（39.5-63.9）。评估了临床结果、患者报告的结局测量、影像学和并发症。有 9 例需要翻修，包括 3 例胫骨无菌性松动（2.0%）、2 例深部感染（1.4%）、2 例髌骨表面置换（1.4%）、1 例髌骨不稳定（0.7%）和 1 例伸膝装置断裂（0.7%）。膝关节学会评分（KSS）在术后 2 年和 5 年分别从 48 分提高到 90 分。KSS 功能评分分别从 49 分提高到 68 分和 79 分。以无菌性松动为终点的 5 年生存率为 98.0%。在病态肥胖患者中使用高多孔胫骨基底的非骨水泥 TKA 具有优异的临床结果，5 年生存率为 98.0%，并且似乎为该类患者提供了持久的长期生物学固定，作为机械骨水泥固定的替代方法。
