Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstr. 9, 4020, Linz, Austria.
Knee Surg Sports Traumatol Arthrosc. 2023 Mar;31(3):969-978. doi: 10.1007/s00167-022-07113-0. Epub 2022 Aug 15.
Cemented fixation remains the gold standard in total knee arthroplasty. With an increasing number of younger patients undergoing total knee arthroplasty and a growing patient population demanding higher physical activity, a rising interest in discussion of cementless fixation is notable. The current scientific literature does not give a clear recommendation for or against uncemented total knee arthroplasty. The purpose of this study was the investigation of the 5-year clinical and radiographic outcomes of a cementless deep-dish rotating platform implant.
A total of 91 primary cementless total knee arthroplasties were included in this single-centre prospective observational study. The primary outcome was revision rate due to aseptic component loosening. Further outcome measures were assessment of the of the radiographic outcome as well as the clinical outcome based on Range of Motion and scores such as American Knee Society Score, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score and European Quality of Life 5 Dimension 3 Level at a follow-up of 5 years.
Mean age of the study population was 67.3 ± 6.6 years with 49.5% of the participants being female. Aseptic component loosening occurred in none of the patients. Implant survival with revision for any reason as endpoint was 97.8% (95% CI 100-96%) and 95.6% (95% CI 100-94%) with reoperation of any cause as endpoint. Radiolucent lines were detected in a total of eight cases (8.8%) and disappeared within the first year after surgery in five cases. Total Range of Motion improved significantly from 106° ± 15° preoperatively to 118° ± 10° at final FU (p < 0.001). All investigated scores improved significantly after total knee arthroplasty.
The results of this study reveal excellent mid-term performance of a cementless deep dish rotating platform total knee implant, with no component loosening, very low overall revision rate, only temporarily present radiolucent lines in a minority of patients and excellent clinical results. Therefore, cementless total knee arthroplasty is an appropriate treatment option for patients with severe osteoarthritis of the knee.
Level II (prospective cohort study).
在全膝关节置换术中，骨水泥固定仍然是金标准。随着越来越多的年轻患者接受全膝关节置换术，以及越来越多的患者群体要求更高的身体活动水平，人们对非骨水泥固定的讨论兴趣显著增加。目前的科学文献并没有明确推荐或反对非骨水泥全膝关节置换术。本研究的目的是探讨一种非骨水泥深碟旋转平台植入物的 5 年临床和影像学结果。
本单中心前瞻性观察研究共纳入 91 例初次非骨水泥全膝关节置换术。主要结局是因无菌性组件松动而进行的翻修率。进一步的结果测量包括评估放射学结果以及基于活动范围和美国膝关节协会评分、牛津膝关节评分、膝关节损伤和骨关节炎结果评分、欧洲生活质量 5 维 3 级评分的临床结果，随访 5 年。
研究人群的平均年龄为 67.3±6.6 岁，其中 49.5%为女性。所有患者均未发生无菌性组件松动。以任何原因进行翻修为终点的植入物存活率为 97.8%（95%CI 100-96%），以任何原因再次手术为终点的存活率为 95.6%（95%CI 100-94%）。总共在 8 例（8.8%）中检测到透亮线，其中 5 例在手术后 1 年内消失。总活动范围从术前的 106°±15°显著改善至最终随访时的 118°±10°（p<0.001）。全膝关节置换术后所有调查评分均显著改善。
本研究结果显示，一种非骨水泥深碟旋转平台全膝关节植入物具有优异的中期表现，无组件松动，总体翻修率非常低，少数患者暂时存在透亮线，临床结果优异。因此，非骨水泥全膝关节置换术是治疗严重膝关节骨关节炎患者的一种合适的治疗选择。
II 级（前瞻性队列研究）。
