Toom Daniel Aaron den, Rieke Markus, Elbadawi Allaeldin, Kösters Clemens
Maria-Josef Hospital Greven, Greven, Germany.
J Exp Orthop. 2023 Sep 14;10(1):92. doi: 10.1186/s40634-023-00648-2.
Focal chondral lesions of the femur are currently treated with biological repair or arthroplasty. However, some patients are not suitable for either one due to lesion size, age, or prior biological treatment attempts. While singular patient-specific focal mini metal implants already showed good results, the outcomes of bicompartmental implantation of these implants have not been discussed in the literature yet. This study aims to evaluate clinical outcomes of patients who underwent bicompartmental implantation of two patient-specific implants.
This prospective, non-randomized, non-comparative pilot study evaluates results up to two years after bicompartmental implantation of two implants (Episealer Implant, Episurf, Stockholm, Sweden). A damage report is compiled using a special MRI program and patient specific implants are manufactured, including 3D-printed surgical instruments to provide exact placement of the implant. The patients were assessed repeatedly using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) for pain during the follow-up.
The scores were evaluated three, 12, and 24 months after surgery and showed good results. The median in both scores improved from 37.7 for the KOOS5 preoperatively to 69.1 after 24 months and from 69 for the VAS for pain preoperatively to 9 after 24 months.
Overall, for the small study group presented, the early results are promising. With noticeable improvement in KOOS and VAS for pain after two years, patient specific implants appear to become relevant in future standardized treatment of femoral chondral lesions. Especially with bicompartmental implantation, full arthroplasty can be delayed even further.
IV.
目前股骨局灶性软骨损伤采用生物修复或关节置换术治疗。然而，由于损伤大小、年龄或先前的生物治疗尝试，一些患者不适合这两种治疗方法。虽然单一的患者特异性局灶性微型金属植入物已显示出良好效果，但这些植入物双间室植入的结果尚未在文献中讨论。本研究旨在评估接受两枚患者特异性植入物双间室植入的患者的临床结果。
这项前瞻性、非随机、非对照的试点研究评估了两枚植入物（Episealer植入物，Episurf，瑞典斯德哥尔摩）双间室植入后长达两年的结果。使用特殊的MRI程序编制损伤报告，并制造患者特异性植入物，包括3D打印手术器械，以确保植入物的精确放置。在随访期间，使用膝关节损伤和骨关节炎结果评分（KOOS）和视觉模拟评分（VAS）对患者进行反复评估。
在术后3个月、12个月和24个月对评分进行评估，结果良好。两个评分的中位数从术前KOOS5的37.7提高到24个月后的69.1，术前疼痛VAS评分从69提高到24个月后的9。
总体而言，对于所呈现的小研究组，早期结果很有前景。两年后KOOS和疼痛VAS评分有显著改善，患者特异性植入物在未来股骨软骨损伤的标准化治疗中似乎变得至关重要。特别是双间室植入时，全关节置换术甚至可以进一步推迟。
IV级。
