1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.
Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
Musculoskelet Surg. 2024 Jun;108(2):195-200. doi: 10.1007/s12306-023-00790-1. Epub 2023 May 26.
Total knee replacement (TKR) failure represents a hard challenge for knee surgeons. TKR failure can be managed in revision with different constraint, related with soft and bone knee damages. The choice of the right constraint for every failure cause represents a not summarized entity. The purpose of this study is identifying distribution of different constraints in revision TKR (rTKR) for failure cause and the overall survival.
A registry study based on the Emilia Romagna Register of the Orthopaedic Prosthetic Implants (called RIPO) was performed with a selection of 1432 implants, in the period between 2000 and 2019. Selection implants including primary surgery constraint, failure cause and constraint revision for every patient, and divided for constraint degrees used during procedures (Cruciate Retaining-CR, Posterior Stabilized-PS, Condylar Constrained Knee-CCK, Hinged).
The most common cause of primary TKR failure was aseptic loosening (51,45%), followed by septic loosening (29,12%). Each type of failure was managed with different constraint, the most used was CCK in the most of failure causes, such as to manage aseptic and septic loosening in CR and PS failure. Overall survival of TKA revisions has been calculated at 5 and 10 years for each constraint, with a range of 75.1-90.0% at 5 years and 75.1-87.5% at 10 years.
Constraint degree in rTKR is typically higher than primary, CCK is the most used constraint in revision surgery with an overall survival of 87.5% at 10 years.
全膝关节置换术（TKR）失败对膝关节外科医生来说是一个严峻的挑战。TKR 失败可通过不同的约束条件进行翻修，这与膝关节的软组织结构和骨骼损伤有关。为每种失败原因选择合适的约束条件是一个尚未解决的问题。本研究的目的是确定不同约束条件在翻修全膝关节置换术（rTKR）中因失败原因和总体生存率的分布。
本研究基于艾米利亚-罗马涅地区骨科假体植入物登记处（称为 RIPO）进行了一项注册研究，对 2000 年至 2019 年间的 1432 例假体进行了选择。入选的假体包括初次手术的约束条件、失败原因和每位患者的约束条件修正，并按手术过程中使用的约束程度进行分类（交叉韧带保留型-CR、后稳定型-PS、髁限制型膝关节-CCK、铰链型）。
TKR 初次手术失败的最常见原因是无菌性松动（51.45%），其次是感染性松动（29.12%）。每种类型的失败都采用了不同的约束条件进行处理，最常用的是 CCK，用于处理 CR 和 PS 失败中的无菌性和感染性松动。每种约束条件的 TKA 翻修的总体生存率已在 5 年和 10 年时进行了计算，范围分别为 5 年时的 75.1%-90.0%和 10 年时的 75.1%-87.5%。
rTKR 中的约束程度通常高于初次手术，CCK 是翻修手术中最常用的约束条件，10 年总体生存率为 87.5%。
