Department of Orthopedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Hwasun, Korea.
Clin Orthop Surg. 2023 Aug;15(4):589-596. doi: 10.4055/cios22012. Epub 2022 Nov 24.
Revision total knee arthroplasty (RTKA) is a technically demanding procedure for failed primary TKA. Posterior-stabilized (PS) and constrained condylar knee (CCK) articulations are commonly used for RTKA, but comparison of these articulations in RTKA is scarce. The aim of this study was to compare survival rates and clinical outcomes of RTKAs using PS articulation and CCK articulation.
This study conducted a retrospective analysis of 86 RTKAs (PS, n = 41; CCK, n = 45) with a mean follow-up of 9.15 ± 2.79 years. Clinical outcomes were evaluated using the Hospital for Special Surgery score, Knee Society Score, and The Western Ontario and McMaster Universities Osteoarthritis Index at final follow-up. The survival rate of each group was analyzed by Kaplan-Meier survival analysis and Cox-hazard progression model.
Clinical outcomes were improved in both groups without significant difference. Twelve patients had orthopedic complications (4 in PS group and 8 in CCK group). Eight of them underwent re-RTKA (3 in PS group and 5 in CCK group). The articulation design did not influence the failure. The estimated 10-year survival rate was 92.7% in the PS group and 88.2% in the CCK group with no significant difference ( = 0.60). Also in septic failure, there was no significant difference in survival rate (92.7% in PS group and 92.5% in CCK group, = 0.87). The hazard ratio in the PS group was not significantly different ( = 0.607).
In RTKA, both PS and CCK showed similar survival rates and clinical outcomes at a mean follow-up of 9.2 years. Implant articulation did not affect the outcomes when properly indicated.
翻修全膝关节置换术（RTKA）是治疗初次 TKA 失败的一项技术要求较高的手术。后稳定型（PS）和约束性髁膝关节（CCK）关节在 RTKA 中通常被使用，但这些关节在 RTKA 中的比较研究很少。本研究旨在比较 PS 关节和 CCK 关节在 RTKA 中的生存率和临床结果。
本研究对 86 例 RTKA（PS 组 41 例，CCK 组 45 例）进行回顾性分析，平均随访时间为 9.15 ± 2.79 年。临床结果采用髋关节功能评分（HSS）、膝关节协会评分（KSS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）进行评估。采用 Kaplan-Meier 生存分析和 Cox 风险进展模型对每组的生存率进行分析。
两组患者的临床结果均得到改善，无显著差异。两组各有 12 例患者发生骨科并发症（PS 组 4 例，CCK 组 8 例）。其中 8 例患者接受了再次 RTKA（PS 组 3 例，CCK 组 5 例）。关节设计未影响失败。PS 组 10 年估计生存率为 92.7%，CCK 组为 88.2%，差异无统计学意义（ = 0.60）。在感染性失败中，两组的生存率也无显著差异（PS 组 92.7%，CCK 组 92.5%， = 0.87）。PS 组的风险比无显著差异（ = 0.607）。
在 RTKA 中，PS 和 CCK 在平均 9.2 年的随访中显示出相似的生存率和临床结果。在适当的指征下，植入物关节不会影响结果。
