Service d'orthopédie-traumatologie, CHU de Rennes, Rennes, France.
Service d'orthopédie-traumatologie, CHU de Rennes, Rennes, France.
Orthop Traumatol Surg Res. 2023 Sep;109(5):103583. doi: 10.1016/j.otsr.2023.103583. Epub 2023 Mar 4.
The optimal technique for component fixation in revision total knee arthroplasty (rTKA) remains controversial: full cementation (FC) versus hybrid fixation (HF), which involves press-fit stem with cement fixation in the metaphyseal and epiphyseal zones. Previous series have either demonstrated the superiority of one or the other of these techniques or their equivalence. However, few studies have compared these 2 methods for rTKA using the Legacy® Constrained Condylar Knee (LCCK) prosthesis (Zimmer, Warsaw, Indiana, USA).
Our hypothesis was that HF of LCCK components is associated with a higher rate of aseptic loosening (AL) than FC.
This was a single-center, multi-surgeon, retrospective study. Primary revisions between January 2010 and December 2014 were included for all indications. The only exclusion criterion was death without revision before the 5-year follow-up. The primary objective of this study was to compare the survivorship of 2 groups of LCCK components (femoral or tibial), depending on whether their stems had been cemented (HF versus FC), taking AL, revised or not, as the endpoint. The secondary objective was to look for other predictive factors of AL.
A total of 75 rTKAs (150 components) were included. The FC group (51 components) had more Anderson Orthopedic Research Institute (AORI) type 2B and type 3 bone defects (BDs) (p<0.001), more reconstructions using trabecular metal (TM) cones (19 FCs and 5 HFs; p<0.001), and bone allografts (p<0.001). At more than 5 years, none of the FC components were loose compared to 10 HF components (9.4%), with 4 of these stems revised. The only significant difference was survivorship without radiographic AL at 9 years (FC=100%; HF=78.6%; p=0.04). The only predictive factor of AL in the HF group was the filling of the diaphyseal canal (p<0.01). The detrimental effect of BD severity (p=0.78) and the protective effect of TM cones were not demonstrated (p=0.21).
Other series studying revisions using the same type of prosthesis also concluded the superiority of FC, not found for other revision prostheses. Despite this study's limitations (retrospective, multi-surgeon, limited sample size, and limited follow-up), all patient outcomes were known, and the difference in survivorship between the groups was very significant.
HF has not been proven effective for the LCCK prosthesis. Better diaphyseal filling, wider metaphyseal bone tunnels enabling better cement injections, and stem designs more appropriate for press-fit fixation could improve these results. TM cones are an interesting avenue for further research.
III; retrospective comparative study.
在翻修全膝关节置换术（rTKA）中，组件固定的最佳技术仍存在争议：全骨水泥固定（FC）与混合固定（HF），后者涉及压配式股骨柄，在骨干和干骺端采用骨水泥固定。之前的研究要么证明了这两种技术中的一种或另一种具有优越性，要么证明了它们具有等效性。然而，很少有研究使用 Legacy® Constrained Condylar Knee（LCCK）假体（Zimmer，印第安纳州华沙）比较这两种方法在 rTKA 中的应用。
我们的假设是，与 FC 相比，HF 的 LCCK 组件与更高的无菌性松动（AL）率相关。
这是一项单中心、多外科医生、回顾性研究。所有适应证的初次翻修均包括在研究中。唯一的排除标准是在 5 年随访前死亡而未行翻修。本研究的主要目的是比较 2 组 LCCK 组件（股骨或胫骨）的存活率，取决于其柄是否被骨水泥固定（HF 与 FC），以 AL 是否需要翻修为终点。次要目的是寻找其他 AL 的预测因素。
共纳入 75 例 rTKA（150 个组件）。FC 组（51 个组件）有更多的安德森骨科研究所（AORI）2B 型和 3 型骨缺损（BD）（p<0.001），更多采用小梁金属（TM）锥体（19 个 FC 和 5 个 HF；p<0.001）和同种异体骨（p<0.001）进行重建。超过 5 年，与 10 个 HF 组件（9.4%）相比，没有一个 FC 组件松动，其中 4 个需要翻修。唯一显著的差异是在 9 年时无影像学 AL 的生存率（FC=100%；HF=78.6%；p=0.04）。HF 组中 AL 的唯一预测因素是骨干管腔的填充（p<0.01）。BD 严重程度的不利影响（p=0.78）和 TM 锥体的保护作用未得到证实（p=0.21）。
其他使用相同类型假体研究翻修的系列也得出了 FC 的优越性的结论，而这在其他翻修假体中没有发现。尽管本研究存在局限性（回顾性、多外科医生、样本量有限、随访时间有限），但所有患者的结局都是已知的，而且两组之间的生存率差异非常显著。
HF 对 LCCK 假体的效果尚未得到证实。更好的骨干填充、更大的骨干骨隧道以允许更好的骨水泥注射、以及更适合压配固定的柄设计，可能会改善这些结果。TM 锥体是进一步研究的一个有趣方向。
III；回顾性比较研究。
