Alpan Bugra, Civan Melih, Eralp Levent, Özger Harzem
Acibadem Mehmet Ali Aydinlar University, School of Medicine, Dept. of Orthopaedics and Traumatology, Kayısdagi Cad. 34752 Atasehir, Istanbul, Turkey.
Basaksehir Pine and Sakura City Hospital, Dept. of Orthopaedics and Traumatology, Basaksehir Olimpiyat Bulvarı 34480 Basaksehir, Istanbul, Turkey.
Int J Surg Case Rep. 2023 Jul;108:108389. doi: 10.1016/j.ijscr.2023.108389. Epub 2023 Jun 14.
Total knee arthroplasty (TKA) in the neuropathic unstable knee (NUK) setting is classically a challenging orthopedic problem due to intraoperative technical difficulties and a higher frequency of periprosthetic complications. More recently, satisfactory results have been reported using improved constraints, stems and revision-type TKA components. The study aims to present long-term results of a small case series with NUK osteoarthritis reconstructed by a condylar, semi-constrained prosthesis with a polygonal, hydroxyapatite-coated (HA-coated) press-fit stem.
From 2009 through 2010, three knees in three patients with advanced NUK arthropathy underwent TKAs in our institution using the PENTA® prosthesis. The average age at surgery was 44 years (32-58). The patients were followed up for a mean period of 124 months (120-128). The etiology of NUK was determined to be poliomyelitis sequela in 2 cases and spinal cord injury in one case. Functional outcomes were assessed with Knee Society (KS) Knee and Function Scores, and radiological outcomes were evaluated with ISOLS radiographic implant scores. Patients were monitored for complications clinically and radiologically.
KS knee scores improved from a mean of 12,3 (0-37) preoperatively to 71,3 (65-77) and KS function scores improved from a mean of 1,7 (0-5) preoperatively to 68,3 (55-80) at the latest follow-up. Radiological outcomes were excellent according to ISOLS scores, and no complications were observed.
Although this is a small case series, the significant improvement in functional scores, excellent radiological outcome, and implant survival at the end of a long follow-up period warrants TKA with a semi-constrained hinged implant in the setting of NUK. PENTA® prosthesis offers a good choice of implant with its hydroxyapatite-coated, press-fit, pentagonal stem and precisely designed rotating hinge.
在神经性不稳定膝关节（NUK）情况下进行全膝关节置换术（TKA），传统上是一个具有挑战性的骨科问题，因为存在术中技术困难以及假体周围并发症的发生率较高。最近，使用改进的限制装置、柄部和翻修型TKA组件已报告了令人满意的结果。本研究旨在展示一个小病例系列的长期结果，该系列为患有NUK骨关节炎的患者采用髁型、半限制型假体以及带有多边形、羟基磷灰石涂层（HA涂层）压配柄进行重建。
2009年至2010年期间，我们机构中3例患有晚期NUK关节病的患者的3个膝关节使用PENTA®假体进行了TKA手术。手术时的平均年龄为44岁（32 - 58岁）。患者平均随访124个月（120 - 128个月）。2例NUK的病因确定为小儿麻痹后遗症，1例为脊髓损伤。使用膝关节协会（KS）膝关节和功能评分评估功能结果，使用ISOLS影像学植入物评分评估放射学结果。对患者进行临床和放射学并发症监测。
在最近一次随访时，KS膝关节评分从术前平均12.3（0 - 37）提高到71.3（65 - 77），KS功能评分从术前平均1.7（0 - 5）提高到68.3（55 - 80）。根据ISOLS评分，放射学结果极佳，未观察到并发症。
尽管这是一个小病例系列，但在长期随访结束时功能评分的显著改善、出色的放射学结果以及植入物生存率，证明在NUK情况下使用半限制型铰链植入物进行TKA是合理的。PENTA®假体凭借其羟基磷灰石涂层、压配式五角形柄部和精确设计的旋转铰链，提供了一个良好的植入物选择。
