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新型运动保留型假体初次全膝关节置换的短期临床疗效:与既往保留交叉韧带假体的比较。

Short-term clinical outcomes of primary total knee arthroplasty with a new-type kinematic retaining implant: A comparison with preexisting cruciate retaining prosthesis.

机构信息

Department of Orthopaedic Surgery, Marunouchi Hospital, Matsumoto, Nagano, Japan.

Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.

出版信息

Medicine (Baltimore). 2023 Aug 25;102(34):e34769. doi: 10.1097/MD.0000000000034769.

DOI:10.1097/MD.0000000000034769
PMID:37653763
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10470764/
Abstract

Despite the success of total knee arthroplasty (TKA), current implant designs could not consistently restore the physiological knee kinematics, especially in cruciate-retaining (CR) implants. This study aimed to investigate the short-term clinical outcomes, particularly patient satisfaction, of primary TKA employing a new-type kinematic retaining (KR) implant. We analyzed 149 cases applied the KR implant at our institutions during June 2017 to May 2019. The effectiveness of this implant design was compared with another CR one (171 cases). Both groups underwent primary TKA in the same period and all patients completed 2 years of follow-up. Perioperative changes in range of motion (ROM), Knee Score, function score, and patient satisfaction by Forgotten Joint Score-12 (FJS-12) method were evaluated. Postoperative ROM, Knee Score, and function score were significantly improved at 1 year after surgeries and maintained for another year in both KR and CR groups. The improvement rate of ROM in KR group (108.1%) was substantially higher than that in CR (104.5%), even 4% increase could have affected patients' satisfaction in a real-world setting. Regarding the patient satisfaction, such 4 items as climbing stairs, walking on a bumpy road, doing housework or gardening, and taking a walk or hiking were significantly enhanced in KR cases compared to CR. There were no loosening or revision cases and the short-term survivorships of both implants were 100%. In addition, there has been no case of obvious complications in both groups during and after surgeries. The results of the present study suggest that this novel KR prosthesis can reproduce physiological knee kinematics, recover its functions, and contribute to pain relief after TKA. TKA procedure using the KR implant should be a good surgical option to improve postoperative outcomes.

摘要

尽管全膝关节置换术(TKA)取得了成功,但目前的植入物设计并不能始终恢复生理膝关节运动学,尤其是在保留交叉韧带(CR)的植入物中。本研究旨在探讨采用新型运动学保留(KR)植入物的初次 TKA 的短期临床结果,特别是患者满意度。我们分析了 2017 年 6 月至 2019 年 5 月在我们机构应用 KR 植入物的 149 例病例。将该植入物设计的效果与另一种 CR 植入物(171 例)进行了比较。两组均在同一时期接受了初次 TKA,所有患者均完成了 2 年的随访。评估了术后运动范围(ROM)、膝关节评分、功能评分和通过遗忘关节评分-12(FJS-12)方法的患者满意度的变化。两组术后 ROM、膝关节评分和功能评分在手术后 1 年均显著改善,并在接下来的 1 年中保持稳定。KR 组的 ROM 改善率(108.1%)明显高于 CR 组(104.5%),即使在实际情况下增加 4%也可能会影响患者的满意度。在患者满意度方面,KR 组在爬楼梯、在不平坦的道路上行走、做家务或园艺、散步或徒步旅行等 4 项方面明显优于 CR 组。两组均无松动或翻修病例,两种植入物的短期生存率均为 100%。此外,两组在手术中和手术后均无明显并发症。本研究结果表明,这种新型 KR 假体可以复制生理膝关节运动学,恢复其功能,并有助于 TKA 后的疼痛缓解。使用 KR 植入物的 TKA 手术应该是改善术后结果的一种良好手术选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/ca6ee8747e0a/medi-102-e34769-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/0a2f337d11f5/medi-102-e34769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/0150daf4bb8e/medi-102-e34769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/ca6ee8747e0a/medi-102-e34769-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/0a2f337d11f5/medi-102-e34769-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/0150daf4bb8e/medi-102-e34769-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b57/10470764/ca6ee8747e0a/medi-102-e34769-g003.jpg

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本文引用的文献

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Projected increase in total knee arthroplasty in the United States - an alternative projection model.预计美国全膝关节置换术的增长——一种替代的预测模型。
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The "forgotten joint" as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure.将“被遗忘的关节”作为关节置换术的终极目标:一种新的患者报告结局测量的验证。
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