Baldini Andrea, Lamberti Alfredo, Balato Giovanni, Cavallo Giuseppe, Summa Pierpaolo
Istituto Fiorentino di Cura e Assistenza (IFCA), Via del Pergolino 4/6, 50139, Florence, Italy.
Department of Public Health, School of Medicine, Federico II University, Via S. Pansini, 80131, Naples, Italy.
Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1477-1482. doi: 10.1007/s00167-022-07280-0. Epub 2023 Jan 3.
Extensor mechanism lesion after total knee arthroplasty (TKA) is a catastrophic complication. Reconstruction with extensor mechanism allograft (EMA) has been described as a sound salvage procedure. Its effectiveness at long term and in septic cases is still under scrutiny. The long-term results of EMA reconstruction for chronic extensor mechanism failures following aseptic and septic revision TKA have been analysed.
From the institutional database, 35 patients with a revision TKA (RevTKA) undergoing EMA reconstruction from 2005 to 2015 have been retrospectively identified. A history of periprosthetic joint infection (PJI) was found in 13 (37%) patients. The mean follow-up was 81.2 months (± 34.7, range 3-120). EMA failures were considered for lag more than 20°, Knee Society Score (KSS) less than 60 points, and/or in the case of revision of the allograft.
The mean KSS improved from 35.9 (± 16.9, range 0-54) to 86.6 (± 10.4, range 54-99) points in the aseptic group (p < 0.001) and from 27.5 (± 11.6, range 10-44) to 79.4 (± 16.3, range 48-94) points in the septic group (p < 0.001). The extensor lag changed from 48.4° (± 14.5, range 30-90) to 4.6° (± 10.8, range 0-50) in the aseptic group (p < 0.001) and from 56.5° (± 20.8, range 30-90) to 6.1° (± 6.8, range 0-20) in the septic group (p < 0.001). The mean postoperative flexion was 105.2° (± 13.2, range 75-130) in the aseptic group and 102.7° (± 12.5, range 80-120) in the septic group (p = 0.32). Three failures (14% of the cases) occurred in the aseptic group and five in the septic group (38% of the cases). The overall survivorship at 10 years was 83.3% (22 cases, CI 94.2-121.7) vs 58% (13 cases, CI 67.2-111.7) in the aseptic and septic group, respectively (p = 0.01).
EMA reconstruction after extensor mechanism disruptions in TKA is a reliable salvage procedure. The septic nature of the revision decreased the functionality of the knee joint after EMA, but it did not represent a risk factor for re-ruptures or recurrence of infection.
Level III.
全膝关节置换术（TKA）后伸肌机制损伤是一种灾难性并发症。同种异体伸肌机制重建术（EMA）已被描述为一种有效的挽救手术。其长期有效性以及在感染病例中的有效性仍在研究中。本文分析了EMA重建术用于无菌性和感染性翻修TKA后慢性伸肌机制失败的长期结果。
从机构数据库中，回顾性确定了2005年至2015年期间35例行EMA重建术的翻修TKA患者。其中13例（37%）患者有假体周围关节感染（PJI）病史。平均随访时间为81.2个月（±34.7，范围3 - 120个月）。当伸肌滞后超过20°、膝关节协会评分（KSS）低于60分和/或进行同种异体移植翻修时，视为EMA失败。
无菌组的平均KSS从35.9分（±16.9，范围0 - 54）提高到86.6分（±10.4，范围54 - 99）（p < 0.001），感染组从27.5分（±11.6，范围10 - 44）提高到79.4分（±16.3，范围48 - 94）（p < 0.001）。无菌组的伸肌滞后从48.4°（±14.5，范围30 - 90）变为4.6°（±10.8，范围0 - 50）（p < 0.001），感染组从56.5°（±20.8，范围30 - 90）变为6.1°（±6.8，范围0 - 20）（p < 0.001）。无菌组术后平均屈曲度为105.2°（±13.2，范围75 - 130），感染组为102.7°（±12.5，范围80 - 120）（p = 0.32）。无菌组发生3例失败（占病例的14%），感染组发生5例（占病例的38%）。无菌组和感染组10年的总体生存率分别为83.3%（22例，CI 94.2 - 121.7）和58%（13例，CI 67.2 - 111.7）（p = 0.01）。
TKA伸肌机制破坏后进行EMA重建是一种可靠的挽救手术。翻修的感染性质降低了EMA术后膝关节的功能，但它不是再次断裂或感染复发的危险因素。
三级。
