ULP Orthopedics, UofL Health, Louisville, Kentucky.
University of Louisville School of Medicine, Louisville, Kentucky.
J Knee Surg. 2024 Mar;37(4):267-274. doi: 10.1055/s-0043-56997. Epub 2023 Apr 11.
Initial design cementless metal-backed patellar implants failed due to multiple reasons including implant design, use of first-generation polyethylene, and surgical technique. This study evaluates clinical outcomes and survivorship of total knee arthroplasty (TKA) using a current generation highly porous metal-backed patellar component. One-hundred twenty-five consecutive primary cementless TKAs with a compression molded highly porous metal-backed patella were reviewed. One-hundred three TKAs (82.4%) with 5-year clinical and radiographic follow-up were available for review. These were matched with 103 consecutive TKAs using a cemented patella of the same implant design. The cementless cohort had a mean age of 65.5 years, body mass index (BMI) of 33.0, and follow-up of 64.4 months. Indications for cementless TKA were based on multiple factors including age, BMI, and bone quality. There were no revisions for loosening or mechanical failure of the cementless patella compared with two cemented patellae revised for aseptic loosening. Eight patients required revisions in the cementless cohort: three for prosthetic joint infection (PJI), two for instability, one periprosthetic femur fracture, one for patella instability, and one for extensor mechanism rupture. Five patients required revisions in the cemented cohort: two for aseptic patellar loosening, one for aseptic femoral loosening, one for PJI, and one for instability. All-cause survivorship at 5 years was 92.2 and 95.1% for the cementless metal-backed implant and cemented implant cohorts, respectively. Use of a compression molded highly porous metal-backed patella component demonstrated excellent clinical and radiographic results at 5-year follow-up. Longer follow-up is required to evaluate the ability of highly porous cementless patella implants to provide durable long-term fixation.
初始设计的无水泥金属背衬髌骨假体因多种原因而失败，包括假体设计、第一代聚乙烯的使用和手术技术。本研究评估了使用当前一代高多孔金属背衬髌骨假体的全膝关节置换术（TKA）的临床结果和存活率。回顾了 125 例连续的原发性无水泥 TKA，其中使用了压缩成型的高多孔金属背衬髌骨。103 例（82.4%）有 5 年临床和影像学随访结果可供回顾。这些病例与 103 例使用相同植入物设计的水泥固定髌骨的连续 TKA 进行了匹配。无水泥组的平均年龄为 65.5 岁，体重指数（BMI）为 33.0，随访时间为 64.4 个月。无水泥 TKA 的适应证基于多种因素，包括年龄、BMI 和骨质量。与 2 例因无菌性松动而翻修的水泥固定髌骨相比，无水泥髌骨无松动或机械故障的翻修。在无水泥组中，有 8 例患者需要进行翻修：3 例因假体关节感染（PJI），2 例因不稳定，1 例因股骨周围骨折，1 例因髌骨不稳定，1 例因伸肌机制破裂。在水泥组中，有 5 例患者需要进行翻修：2 例因无菌性髌骨松动，1 例因无菌性股骨松动，1 例因 PJI，1 例因不稳定。无水泥金属背衬植入物和水泥植入物组的全因存活率分别为 5 年时的 92.2%和 95.1%。使用压缩成型的高多孔金属背衬髌骨组件在 5 年随访时显示出优异的临床和影像学结果。需要更长时间的随访来评估高多孔无水泥髌骨植入物提供持久的长期固定的能力。
