Howell Stephen M, Akhtar Muzammil, Nedopil Alexander J, Hull Maury L
Department of Biomedical Engineering, University of California at Davis, Davis, California.
College of Medicine, California Northstate University, Elk Grove, California.
J Arthroplasty. 2024 Mar;39(3):695-700. doi: 10.1016/j.arth.2023.08.080. Epub 2023 Sep 1.
The preceding study reported a 10-year follow-up of 222 kinematically aligned total knee arthroplasties (TKA) performed in 217 patients in 2007. As 35% of tibial components and 8% of limbs were in >3° varus, the present study assessed whether this adversely affected reoperation, implant survival, and function at 16 years.
We retrospectively reviewed a single surgeon's private practice database to determine the patients who underwent reoperation as well as Forgotten Joint Score and Oxford Knee Score.
There were 7 patients who had a major reoperation (revision of a loose tibial component [n = 2], and revision of well-fixed component due to stiffness [n = 1], patella instability [n = 1], pain [n = 1], and infection [n = 2]). There were 5 who had a minor reoperation that retained the components, and 91 patients (94 TKAs) died. Implant survivorship was 93% using reoperation for any reason as the endpoint. The median (interquartile range) Forgotten Joint and Oxford Knee scores were 88 (57 to 100) and 45 (39 to 48) points, respectively.
The kinematically aligned TKA had a 7% reoperation rate at 16 years follow-up, comparable to or lower than reports of mechanically aligned TKA, which supports the concept of the unrestricted version of kinematic alignment in which the patient's prearthritic alignment is fully restored regardless of deformity.
先前的研究报告了对2007年217例患者实施的222例运动学对齐全膝关节置换术（TKA）进行的10年随访。由于35%的胫骨组件和8%的肢体存在大于3°的内翻，本研究评估了这是否会对16年时的再次手术、植入物生存率和功能产生不利影响。
我们回顾性地查阅了一位外科医生的私人执业数据库，以确定接受再次手术的患者以及遗忘关节评分和牛津膝关节评分。
有7例患者进行了大手术（翻修松动的胫骨组件[n = 2]，以及因僵硬[n = 1]、髌骨不稳定[n = 1]、疼痛[n = 1]和感染[n = 2]而翻修固定良好的组件）。有5例进行了保留组件的小手术，91例患者（94个TKA）死亡。以任何原因进行再次手术作为终点，植入物生存率为93%。遗忘关节评分和牛津膝关节评分的中位数（四分位间距）分别为88（57至100）分和45（39至48）分。
在16年的随访中，运动学对齐的TKA再次手术率为7%，与机械对齐TKA的报告相当或更低，这支持了运动学对齐无限制版本的概念，即无论畸形如何，患者术前关节炎前的对线均可完全恢复。
