From the Faculty of Medicine, McGill University, Montréal, Que. (Moisan); the Department of Orthopedic Surgery, McGill University, Montréal, Que. (Barimani, Al Kindi); and the Department of Orthopedic Surgery, Saint Mary's Hospital, Montréal, Que. (Mutch, Albers).
From the Faculty of Medicine, McGill University, Montréal, Que. (Moisan); the Department of Orthopedic Surgery, McGill University, Montréal, Que. (Barimani, Al Kindi); and the Department of Orthopedic Surgery, Saint Mary's Hospital, Montréal, Que. (Mutch, Albers)
Can J Surg. 2023 Mar 7;66(2):E103-E108. doi: 10.1503/cjs.000622. Print 2023 Mar-Apr.
The constrained posterior-stabilized (CPS) implant for use in total knee arthroplasty (TKA) has a constraint level midway between that of a posterior-stabilized implant and a valgus-varus-constrained implant; there is currently no consensus on the surgical indications for use of this degree of constraint. We present our experience using this implant at our centre.
We reviewed the charts of patients who received a CPS polyethylene insert during TKA in our centre between January 2016 and April 2020. We collected patient demographic characteristics, surgical indications, pre- and postoperative radiographs, and complications.
A total of 85 patients (74 females and 11 males with a mean age of 73 yr [standard deviation 9.4 yr, range 36-88 yr]) (85 knees) received a CPS insert over the study period. Of the 85 cases, 80 (94%) were primary TKA and 5 (6%) were revision TKA. The most common indications for primary CPS use were severe valgus deformity with medial soft-tissue laxity (29 patients [34%]), medial soft-tissue laxity without substantial deformity (27 [32%]) and severe varus deformity with lateral soft-tissue laxity (13 [15%]). The indications for the 5 patients who underwent revision TKA were medial laxity (4 patients) and an iatrogenic lateral condyle fracture (1 patient). Four patients had postoperative complications. The 30-day return to hospital rate was 2.3% (owing to infection and hematoma). A single patient required revision surgery for periprosthetic joint infection.
We found excellent short-term survivorship of the CPS polyethylene insert when used for a spectrum of coronal plane ligamentous imbalances with or without pre-operative coronal plane deformities. Long-term follow-up of these cases will be important to identify adverse outcomes such as loosening or polyethylene-related problems.
在全膝关节置换术（TKA）中使用的受限后稳定型（CPS）植入物的约束程度位于后稳定型植入物和外翻-内翻约束型植入物之间；目前对于使用这种程度的约束的手术指征尚无共识。我们介绍了我们在中心使用这种植入物的经验。
我们回顾了 2016 年 1 月至 2020 年 4 月期间在我们中心接受 CPS 聚乙烯插入物的 TKA 患者的图表。我们收集了患者的人口统计学特征、手术指征、术前和术后 X 线片以及并发症。
在研究期间，共有 85 名患者（74 名女性和 11 名男性，平均年龄 73 岁[标准差 9.4 岁，范围 36-88 岁]）（85 膝）接受了 CPS 插入物。85 例中，80 例（94%）为初次 TKA，5 例（6%）为翻修 TKA。初次 CPS 使用的最常见指征是严重的外翻畸形伴内侧软组织松弛（29 例[34%]）、内侧软组织松弛无明显畸形（27 例[32%]）和严重的内翻畸形伴外侧软组织松弛（13 例[15%]）。5 例接受翻修 TKA 的患者的指征是内侧松弛（4 例）和医源性外侧髁骨折（1 例）。4 例患者术后出现并发症。30 天内返回医院的比例为 2.3%（由于感染和血肿）。1 例患者因假体周围关节感染需要翻修手术。
我们发现 CPS 聚乙烯插入物在治疗冠状面韧带失衡（伴或不伴术前冠状面畸形）方面具有出色的短期生存率。对这些病例进行长期随访对于识别松动或与聚乙烯相关的问题等不良结果非常重要。
