Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand.
ANZ J Surg. 2022 Sep;92(9):2254-2260. doi: 10.1111/ans.17864. Epub 2022 Jun 27.
There is uncertainty around optimal tibial stem length in revision total knee arthroplasty (rTKA) utilizing a tibial trabecular metal (TM) cone. The purpose of this study was to compare: (1) functional outcomes, (2) radiographic outcomes and (3) implant survivorship in rTKA utilizing TM cones combined with either short stems (SS) or long stems (LS) at minimum 2 years follow-up.
In this retrospective, multi-centre study, patients undergoing rTKA utilizing a TM cone between 2008 and 2019 were included. Patients were divided into: SS group (no diaphyseal engagement), and LS group (diaphyseal engagement). All relevant clinical charts and post-operative radiographs were examined. Oxford Knee Score (OKS) and EuroQol-5D (EQ-5D-5L) data were collected at most recent follow-up.
In total, 44 patients were included: 18 in the SS group and 26 in the LS group. The mean time of follow-up was 4.0 years. Failure free survival was 94.4% for the SS group and 92.3% for the LS group. All failures were for prosthetic joint infections managed with debridement, antibiotics, and implant retention. At most recent follow-up, 3 patients demonstrated radiographic signs of lucency (1 SS 2 LS, P = 1) and the mean OKS were 37 ± 4 and 36 ± 6 (P = 0.73) in the SS and LS groups, respectively.
Tibial SS combined with TM cones performed as well as LS in rTKA at minimum 2 years follow-up. A tibial SS in combination with a TM cone is a reliable technique to achieve stable and durable fixation in rTKA.
在使用胫骨小梁金属（TM）锥形物的翻修全膝关节置换术（rTKA）中，胫骨柄的最佳长度存在不确定性。本研究的目的是比较：（1）功能结果，（2）影像学结果和（3）在最低 2 年随访时使用 TM 锥形物结合短柄（SS）或长柄（LS）的 rTKA 的植入物存活率。
在这项回顾性多中心研究中，纳入了 2008 年至 2019 年间接受 TM 锥形物翻修全膝关节置换术的患者。患者分为：SS 组（无骨干接合）和 LS 组（骨干接合）。检查了所有相关的临床图表和术后 X 线片。在最近的随访中收集了牛津膝关节评分（OKS）和欧洲五维健康量表（EQ-5D-5L）数据。
共纳入 44 例患者：SS 组 18 例，LS 组 26 例。平均随访时间为 4.0 年。SS 组的无失败生存率为 94.4％，LS 组为 92.3％。所有失败均为假体关节感染，采用清创术、抗生素和保留植入物治疗。在最近的随访中，有 3 例患者出现透亮线迹象（1 例 SS，2 例 LS，P=1），SS 组和 LS 组的平均 OKS 分别为 37±4 和 36±6（P=0.73）。
胫骨 SS 结合 TM 锥形物在最低 2 年随访时与 LS 一样适用于 rTKA。胫骨 SS 结合 TM 锥形物是一种可靠的技术，可在 rTKA 中实现稳定和持久的固定。
