Service de Chirurgie Orthopédique, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
J Knee Surg. 2024 Feb;37(3):205-213. doi: 10.1055/a-2037-6261. Epub 2023 Feb 17.
Bicruciate-retaining total knee arthroplasty (BCR TKA) results in kinematics closer to the native knee and in greater patient satisfaction but information concerning its outcome and complications is lacking.The goal of this study is to report the clinical and radiological outcomes of BCR prosthesis implanted using a spacer-based gap balancing technique and to assess if some preoperative factors are associated with a worse prognosis.A cohort of 207 knees in 194 patients who underwent BCR TKA, with a minimum 1-year follow-up, was retrospectively analyzed.Patients were followed at 6 weeks, 6 months, 1 year, and then every following year postoperatively, and filled questionnaires (Knee Society and Knee injury and Osteoarthritis Outcome Score) at every visit. Clinical and radiological assessments included range of motion, knee alignment, pain, and complications as defined by the Knee Society's Standardized list and definition of Complication of Total Knee Arthroplasty.Forty-three knees (20.8%) suffered major complications. Twenty-one knees (10.1%) underwent revision at an average of 32.1 months after the index procedure. Revision-free survival at 100 months was 85.7%. Revision was performed for aseptic tibial loosening in eight knees (3.9%) and stiffness in five knees (2.4%). There were 29 reoperations other than revision (14.0%), the most frequent procedure being manipulation under anesthesia in 14 knees (6.8%). Minor complications included tendonitis (20.8%), persistent synovitis (6.8%), and superficial wound infections (6.3%).All outcomes scores were greatly improved at the 1-year follow-up compared with preoperatively ( < 0.001). However, maximum flexion at the last follow-up was significantly reduced compared with preoperatively (mean maximum flexion ± standard deviation: 119.9 ± 15.6 vs. 129.9 ± 14.4, < 0.001). Aseptic tibial loosening was associated with a hypercorrection in varus of preoperative valgus knees ( = 0.012).BCR TKA can give functional results similar to other types of prostheses but involves a substantial risk of complications. Important factors that can explain failed BCR TKA and guide its use were identified, more particularly knee alignment and its role in aseptic tibial loosening.
保留后交叉韧带的全膝关节置换术（BCR TKA）可使膝关节运动学更接近正常膝关节，并提高患者满意度，但有关其结果和并发症的信息尚缺乏。本研究的目的是报告使用基于间隔物的间隙平衡技术植入 BCR 假体的临床和影像学结果，并评估某些术前因素是否与预后较差相关。回顾性分析了 194 例 207 膝接受 BCR TKA 的患者，所有患者均随访至少 1 年。患者在术后 6 周、6 个月、1 年及以后每年随访时接受检查，并在每次就诊时填写膝关节协会（Knee Society）和膝关节损伤和骨关节炎结果评分（Knee injury and Osteoarthritis Outcome Score）。临床和影像学评估包括运动范围、膝关节对线、疼痛和并发症，并发症的定义和分类均采用膝关节协会的标准化列表和全膝关节置换术并发症的定义。43 例（20.8%）发生严重并发症。21 例（10.1%）在指数手术后平均 32.1 个月时进行了翻修。100 个月时的无翻修生存率为 85.7%。翻修原因包括 8 例（3.9%）无菌性胫骨松动和 5 例（2.4%）膝关节僵硬。除翻修外，还有 29 例再手术（14.0%），最常见的手术是 14 例膝关节镜下手法松解（6.8%）。轻微并发症包括肌腱炎（20.8%）、持续性滑膜炎（6.8%）和浅表性伤口感染（6.3%）。与术前相比，所有术后评分在 1 年随访时均有显著改善（ < 0.001）。然而，末次随访时的最大屈曲度与术前相比显著降低（最大屈曲度的平均 ± 标准差：119.9 ± 15.6 比 129.9 ± 14.4， < 0.001）。无菌性胫骨松动与术前外翻膝的内翻过度校正有关（ = 0.012）。BCR TKA 可提供与其他类型假体相似的功能结果，但并发症风险较高。确定了一些可以解释 BCR TKA 失败并指导其使用的重要因素，特别是膝关节对线及其在无菌性胫骨松动中的作用。
