Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain.
Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Rey Juan Carlos, C. Gladiolo, s/n, 28933, Móstoles, Madrid, Spain.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):577-583. doi: 10.1007/s00590-023-03659-y. Epub 2023 Sep 1.
To compare clinical and radiological outcomes, implant survivorship at a minimum of 1-year follow-up using metaphyseal trabecular cones with or without impaction grafting in a complex revision TKA.
A retrospective comparative matched analysis was performed and 15 patients who underwent revision surgery using the combination of porous trabecular metaphyseal cone and diaphyseal impaction grafting (MC-IBG) were matched with a group of 13 patients who also underwent revision surgery using metaphyseal cone (MC) without impaction grafting. All included patients presented severe bone defect (AORI 2,3) and a rotating-hinge prosthesis were implanted.
Both groups were comparable regarding the baseline demographic and clinical data. Patients had previously undergone a mean of 4 (range, 2-12) and 3 (range, 2-5) previous procedures in the MC-IBG and MC groups, respectively. The indications for revision were aseptic loosening in 11 (73.3%) and 11 (84.6%) patients; prosthetic joint infection in 4 (26.7%) and 2 (15.4%) in the MC-IBG and MC groups, respectively. There was no significant difference in the mean postoperative Knee Society Score between the study groups (p = 0.806). Overall, 4 patients had further revision. Two patients were revised in the MC-IBG group, one patient for aseptic loosening and the second one after 2 episodes of instability. Two patients in the MC group presented prosthetic joint infection and underwent a two-stage reimplantation. No significant difference was observed between the study groups at comparison (p = 0.92).
Trabecular metal cones with diaphyseal impaction grafting provide an alternative technique in a complex revision TKA surgery with early clinical and radiographic success.
比较使用带或不带打压植骨的干骺端骨小梁锥形骨与单纯使用干骺端骨小梁锥形骨在复杂翻修全膝关节置换术（TKA）中 1 年以上随访时的临床和影像学结果、植体存活率。
进行回顾性对比匹配分析，将 15 例接受多孔小梁干骺端锥形骨和骨干打压植骨（MC-IBG）联合翻修手术的患者与 13 例单纯使用干骺端锥形骨（MC）而未行打压植骨的患者进行匹配。所有纳入的患者均存在严重的骨缺损（AORI 2,3），并植入旋转铰链假体。
两组患者的基线人口统计学和临床数据具有可比性。MC-IBG 组和 MC 组患者分别有 4 次（范围 2-12 次）和 3 次（范围 2-5 次）既往手术史。翻修的原因分别为 11 例（73.3%）和 11 例（84.6%）无菌性松动；4 例（26.7%）和 2 例（15.4%）为假体关节感染。两组患者术后膝关节协会评分的平均差异无统计学意义（p=0.806）。总体而言，有 4 例患者需要进一步翻修。MC-IBG 组中有 2 例患者需要翻修，其中 1 例为无菌性松动，第 2 例为 2 次不稳定后；MC 组中有 2 例患者出现假体关节感染，行两阶段再植入术。两组患者比较无显著差异（p=0.92）。
带骨干打压植骨的小梁金属锥形骨在复杂翻修 TKA 手术中提供了一种替代技术，具有早期临床和影像学成功。
