D'Ambrosi Riccardo, Menon Prem Haridas, Salunke Abhijeet, Mariani Ilaria, Palminteri Giovanni, Basile Giuseppe, Ursino Nicola, Mangiavini Laura, Hantes Michael
IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi di Milano, 20133 Milan, Italy.
J Clin Med. 2022 Jun 30;11(13):3795. doi: 10.3390/jcm11133795.
Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T0) and at two consecutive follow-ups at least 1 (T1) and 2 (T2) years after surgery. Implant survival was calculated using the Kaplan−Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T1 than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time.
本研究的主要目的是比较80岁及以上接受全膝关节置换术（TKA）并使用保留交叉韧带（CR）或后稳定型（PS）植入物的患者的生存率和功能结果。方法：我们前瞻性分析了两个连续队列中80岁及以上患者共96例植入物的临床记录。第一个队列包括59例连续的骨水泥型PS病例，而第二个队列包括37例连续的骨水泥型CR病例。进行PS或CR关节置换术的决定基于术前磁共振成像和术中发现。临床评估包括评估每位患者的疼痛视觉模拟量表（VAS）、活动范围（屈曲和伸展）、膝关节协会评分（KSS）和牛津膝关节评分（OKS）。每位患者在手术前一天（T0）以及术后至少1年（T1）和2年（T2）的两次连续随访中接受临床评估。使用Kaplan-Meier方法计算植入物生存率。结果：与术前值相比，两组在每次随访时均显示出统计学上的显著改善（p < 0.05）。CR组在T1时的屈曲度高于PS组（116.14±5.57°对113.16±7.66°；p = 0.048）。两组在生存率方面未发现差异（卡方检验p值 = 0.789）。CR组有3例失败，而PS组有4例。结论：这项前瞻性临床研究表明，CR和PS TKA在八旬老人的膝关节功能、术后膝关节疼痛和其他并发症方面具有相似的临床结果。CR和PS TKA的假体生存率均令人满意，在选定的八旬老人患者中，由于手术时间缩短，应始终考虑CR TKA。
